Contextualisation of clinical practice guidelines: An innovative approach for the primary healthcare of chronic musculoskeletal pain in South Africa

Article type
Authors
Ernstzen DV1, Louw QA1, Hillier SL2
1Division Physiotherapy, Department of Health and Rehabilitation Sciences
2Division Physiotherapy, Department of Health and Rehabilitation Sciences, South Africa AND Sansom Institute for Health Research, University of South Australia, Adelaide
Abstract
Background: Chronic musculoskeletal pain (CMSP) is a global healthcare concern. High-quality, evidence-based clinical practice guidelines (CPGs) can facilitate quality healthcare for CMSP. CPGs developed in developed nations may not be appropriate in resource-constrained settings, due to differences in socio-cultural and policy contexts. Contextualisation is an option to develop guidance for resource-constrained settings.

Objectives: To develop an evidence-based CPG for the primary healthcare of adults with CMSP in the Western Cape Province of South Africa, using a novel process of CPG contextualisation.

Methods: A four-part contextualisation model was developed. The four parts consisted of a contextual analysis, evidence synthesis, contextual integration and evaluation. Qualitative methodology was used to investigate context factors that influence the healthcare of patients with CMSP. A systematic review was conducted to identify current, high-quality CPGs on the topic, and a core set of recommendations were synthesised from the CPGs. A multidisciplinary panel of experts authenticated recommendations and contextualised them for the intended context, using consensus methodology. The CPG was externally reviewed, using a survey.

Results: A core set of 43 clinical recommendations were developed through the evidence synthesis and contextual-integration processes. The 20 patients and 21 clinicians who participated in the contextual analysis agreed on the context factors that influence care as: personal characteristics of the patient and clinician; social and environmental circumstances; healthcare interventions received; and, healthcare system factors. A diverse group of 18 potential end-users rated the recommendations as largely acceptable for the intended context.

Conclusions: CPG contextualisation was found to be a time and resource-efficient way to summarise evidence-based recommendations from high-quality, existing CPGs. The approach facilitated the integration of multiple stakeholder perspectives in CPG development. The end-result was a contextualised evidence-based, multimodal CPG for the primary healthcare of adults with CMSP in South Africa.