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Synthesis of the evidence and contextualisation process. Consuelo B. Gonzalez-Suarez, MD, PhD University of Santo Tomas Philippine Academy of Rehabilitation Medicine. Objectives. To be able to m atch the evidence from the guidelines to the part of the patient journey
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Synthesis of the evidence and contextualisation process Consuelo B. Gonzalez-Suarez, MD, PhD University of Santo Tomas Philippine Academy of Rehabilitation Medicine
Objectives • To be able to match the evidence from the guidelines to the part of the patient journey • To be able extract data (recommendations and references ) from guidelines • To be able to synthesize the recommendations using PARM Writing guide and Level of Evidence • To be understand the importance of Context Points • To be able to write Context Points
Recognition of nomenclature and methodology issues • Inconsistent nomenclature, with guidelines, recommendations, care pathways and protocols • Adapting or Contextualising?????
What constitutes contextualization? • Key elements • Typical Filipino patient journey • Typical Filipino workforce and service delivery available
What constitutes contextualization? • Key Elements • Whether recommendations were available for each step of the journey and to workforce • What implementing recommendations meant in terms of healthcare workforce, resources, training and willingness to change practice
What constitutes contextualisation? • PARM writing guide was established • Available evidence relative to the patient journey • Summarise different approaches to presenting the available evidence • Construct ‘PARM endorsements’ of the existing recommendations • Construct PARM Context Points
Considered use of available tools • Did not “recreate the wheel” • Assess the generalisability and applicability • For any confusion or contradictory recommendation, group went back to the original references for clarification
Parameters used for grading the Level of Evidence • Consistency of evidence levels • Volume of references • Age of references • Uniformity of thought
Example Therefore, PARM SUGGESTS therapeutic exercises in the management of patients with acute low back pain.
Context Points • Generalizability and applicability are addressed • Provide a framework in which the PARM endorsed recommendation can be applied, considering local service delivery issues • Structure and Process are considered order to define the important elements of service delivery underpinning evidence-based care (practice context)
Context Points • A standard framework was developed with minimum best-practice and advanced standard care were considered • Included essential equipment, standards and resources, training and workforce