Article type
Abstract
Background
De novo creation of Clinical Practice Guidelines (CPGs) is a laborious, resource-intensive process. When not possible due to a lack of resources, the optimal development process could be based on the adoption or adaptation of existing guidelines. The GRADE-ADOLOPMENT approach is one of the currently recommended methods for this. We applied this framework to develop CPGs for chronic non-cancer pain (CNCP) in the National Health System (NHS) of Spain.
Objectives
We aimed to describe our experience and impressions after applying a framework for CPGs production based on the GRADE-ADOLOPMENT approach to offer high-quality assessment and management strategies for people with CNCP over 16s in Spain.
Methods
The source guidelines were selected by research methodology experts after a literature review on existing CPGs for CNCP. We applied the GRADE-ADOLOPMENT approach over CPGs published by the National Institute for Care Excellence (NICE) in 2021, “Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain”. Recommendations from the source guidelines were either adopted as is, excluded, or adapted to our local context.
Results
NICE Guideline included a total of 14 clinical questions, out of which 10 were selected using a prioritization method. Questions about the effectiveness of acupuncture, electrotherapy or manual therapy were excluded. One question about the applicability of pain neuroscience education programs was added. Literature search strategies required syntax adaptation and considering other sources of evidence. . Evidence to decision (EtD) tables were developed de novo. The combination of the source and the updated evidence was challenging due to differences in the synthesis methods and the growth of new evidence. .
Conclusion
The GRADE-ADOLOPMENT approach represents a systematic, time-efficient and useful methodology to develop reliable CPGs suited to the context of particular health systems to improve patient management. However, it is necessary to take into account that this process may not be as straightforward as would be expected and may imply investing a considerable time fitting in the source and new evidence and judgements, as well as developing and tailoring decision tools that may differ between CPGs developers.
De novo creation of Clinical Practice Guidelines (CPGs) is a laborious, resource-intensive process. When not possible due to a lack of resources, the optimal development process could be based on the adoption or adaptation of existing guidelines. The GRADE-ADOLOPMENT approach is one of the currently recommended methods for this. We applied this framework to develop CPGs for chronic non-cancer pain (CNCP) in the National Health System (NHS) of Spain.
Objectives
We aimed to describe our experience and impressions after applying a framework for CPGs production based on the GRADE-ADOLOPMENT approach to offer high-quality assessment and management strategies for people with CNCP over 16s in Spain.
Methods
The source guidelines were selected by research methodology experts after a literature review on existing CPGs for CNCP. We applied the GRADE-ADOLOPMENT approach over CPGs published by the National Institute for Care Excellence (NICE) in 2021, “Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain”. Recommendations from the source guidelines were either adopted as is, excluded, or adapted to our local context.
Results
NICE Guideline included a total of 14 clinical questions, out of which 10 were selected using a prioritization method. Questions about the effectiveness of acupuncture, electrotherapy or manual therapy were excluded. One question about the applicability of pain neuroscience education programs was added. Literature search strategies required syntax adaptation and considering other sources of evidence. . Evidence to decision (EtD) tables were developed de novo. The combination of the source and the updated evidence was challenging due to differences in the synthesis methods and the growth of new evidence. .
Conclusion
The GRADE-ADOLOPMENT approach represents a systematic, time-efficient and useful methodology to develop reliable CPGs suited to the context of particular health systems to improve patient management. However, it is necessary to take into account that this process may not be as straightforward as would be expected and may imply investing a considerable time fitting in the source and new evidence and judgements, as well as developing and tailoring decision tools that may differ between CPGs developers.