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Evidence-Based Practice in Physical and Manual Therapy: Development and Content of Dutch National Practice Guidelines for Patients with Non-Specific Low Back Pain

Rob A. B. Oostendorp, PhD, PT, MT
Gwendolyne G. M. Scholten-Peeters, MSc, PT, MT
Raymond A. H. M. Swinkels, MSc, PT, MT
Geertruida E. Bekkering, PhD, PT
Marcel W. F. G. J. Heijmans, MSc, PT, MT
Peter A. Huijbregts, DPT, FAAOMPT, FCAMT
Erik J. M. Hendriks, PhD, PT

Abstract: Clinical practice in physical and manual therapy is experiencing a paradigm shift from an experience- and authority-based model to a more evidence-based model. National Practice Guidelines (NPG) are examples of this shift towards research-based knowledge. This article discusses the five steps in the development of NPGs. These steps are illustrated by a discussion of development and content of two NPGs produced recently in the Netherlands for the treatment of patients with non-specific low back pain.

Key Words: Evidence-based Practice, Physical Therapy, Manual Therapy, Non-specific Low Back Pain

Definition of National Practice Guideline (NPG)
A clinical practice guideline can be described as a set of systematic statements that indicate to the clinician what evidence base exists for the assessment and treatment of specific patient disorders. According to Hendriks et al, a clinical practice guideline is based on the different phases of the physiotherapy care process, the available clinical evidence, and expert consensus. Such a guideline has been field-tested prior to dissemination and may address the performance of diagnostic and/or therapeutic interventions for persons with definitive or suspected health-threatening conditions1. A clinical practice guideline may also address issues pertaining to the good management and administration of the profession and its members. A National Practice Guideline (NPG) adds to this definition in that it is a guideline developed under the auspices of a professional organization1.

Guidelines are intended to be flexible. They should be followed in most cases, but they also leave room for individual practitioner choice1. An NPG may serve the following functions1:

  • To provide an up-to-date state-of-the-art document to help in making diagnostic and therapeutic decisions
  • To reduce (intra- and inter-therapist) variations in clinical management
  • To reduce costs for health insurance companies, government, and public health agencies
  • To improve patient outcomes
  • To provide a tool to formulate criteria to evaluate care

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