Developing clinical practice guidelines for physiotherapists working with people with inherited bleeding disorders

Abstract

Introduction Several bleeding disorders are characterized by haemorrhage into joints and muscles. These conditions are best managed by interdisciplinary teams that include physiotherapists. In 1997, physiotherapists from haemophilia treatment centres in Canada formed the Canadian Physiotherapists in Hemophilia Care (CPHC). The guiding principles of the CPHC reflect a commitment to evidence‐based practice, education and collaboration. Aim To describe the process used by CPHC to develop evidence‐based clinical practice guidelines to inform best practice, guide decision‐making and help educate physiotherapists, students, and other team members about the physiotherapy management of people with bleeding disorders. Methods We followed the procedures outlined in the American Physical Therapy Association's Clinical Practice Guideline Process Manual (2018). Namely, we selected a working group, determined the scope of the guidelines, performed a literature search, selected and appraised the evidence, drafted the guidelines as practice statements, assigned a strength of recommendation to each practice statement and disseminated the guidelines. Results Thirty‐nine practice statements were developed in nine practice areas. Strength of evidence was strong for two statements, moderate for one and weak for three. The remainder were graded as theoretical or best practice. Conclusion To our knowledge, these are the first evidence‐based clinical practice guidelines that cover all aspects of physiotherapy management of people with bleeding disorders. Some areas, such as exercise and manual therapy, have been well investigated. However, the overall low levels of evidence and low strengths of recommendations highlight the need for more rigorous research with this population.

European principles of care for physiotherapy provision for persons with inherited bleeding disorders: Perspectives of physiotherapists and patients

“…Physiotherapists also play a key role in peri‐surgical planning and care for those undergoing orthopaedic surgery and are an important member in teams delivering interventions for complex pain management. With regards to practice guidelines, a Canadian working group of physiotherapists recently published clinical practice guidelines that can be used to educate and provide guidance to physiotherapists new to a HTC and to those in primary care outside a HTC 4 …”

“…With regards to practice guidelines, a Canadian working group of physiotherapists recently published clinical practice guidelines that can be used to educate and provide guidance to physiotherapists new to a HTC and to those in primary care outside a HTC. 4…”

“…Clinical practice guidelines for physiotherapists working with PWBD have recently been developed by a Canadian working group following standardised methodology including literature review, and appraising and grading of evidence, that can be used to increase the uniformity and quality of physiotherapy care provided to PWBD. 4 Despite inclusion within international guidelines, a survey of thirtyseven European countries by the EHC (2015) 5 and a scope of physiotherapy practice survey of eighty physiotherapists from twenty-four European countries by the EAHAD (2019)…”

“…Physiotherapists help people maximise their quality of life, looking at physical, psychological, emotional and social wellbeing encompassing the health spheres of promotion, prevention, treatment/intervention, and rehabilitation. Clinical practice guidelines for physiotherapists working with PWBD have recently been developed by a Canadian working group following standardised methodology including literature review, and appraising and grading of evidence, that can be used to increase the uniformity and quality of physiotherapy care provided to PWBD 4 …”

The evolution of physiotherapy in the multidisciplinary management of persons with haemophilia (PWH): A scoping review

“…These and other professionals in the team work together with the goal to obtain more and more information on the clinical picture from their different points of view, and thus to guarantee to patients the best possible care and quality of life. This new role of the physiotherapist has been extensively developed in the recently published Canadian guidelines, 84 which emphasize how the figure of this specialist is involved in all the aspects of the PWH management, from the evaluation and treatment of acute and chronic events toward health promotion, education, and multidisciplinary collaboration.…”