Systematic review of clinical practice guidelines for adults with fractures: identification of best evidence for rehabilitation to develop the WHO\u2019s Package of Interventions for Rehabilitation

Francesca Gimigliano,Sanaz Pournajaf,Maria Sgarbanti,Giuseppe Toro,Claudio Curci,Antimo Moretti,Michele Patrini,Sara Liguori,Alexandra Rauch,Stefano Negrini,Livia Peschi,Giovanni Iolascon

doi:10.1186/s10195-020-00560-w

Abstract

BackgroundThe identification of existing rehabilitation interventions and related evidence represents a crucial step along the development of the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR). The methods for such identification have been developed by the WHO Rehabilitation Programme and Cochrane Rehabilitation under the guidance of the WHO’s Guideline Review Committee secretariat. The aim of this paper is to report on the results of the systematic search for clinical practice guidelines (CPGs) relevant to the rehabilitation of adults with fractures and to present the current state of evidence available from the identified CPGs.MethodsThis paper is part of the Best Evidence for Rehabilitation (be4rehab) series, developed according to the methodology presented in the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR) introductory paper. It is a systematic review of existing CPGs on fractures in adult population published from 2009 to 2019.ResultsWe identified 23 relevant CPGs after title and abstract screening. According to inclusion/exclusion criteria, we selected 13 CPGs. After checking for quality, publication time, multiprofessionality, and comprehensiveness, we finally included five CPGs dealing with rehabilitative management of fractures in adult population, two CPGs addressing treatment of distal radius fracture and three the treatment of femoral/hip fracture.ConclusionThe selected CPGs on management of distal radius and femoral/hip fracture include few recommendations regarding rehabilitation, with overall low to very low quality of evidence and weak/conditional strength of recommendation. Moreover, several gaps in specific rehabilitative topics occur. Further high-quality trials are required to upgrade the quality of the available evidence.Level of evidenceLevel 1.

Highlights

The World Health Organization (WHO) has the strategic priority of achieving Universal Health Coverage (UHC), which means that “all people receive quality health services that meet their needs without being exposed to financial hardship in Gimigliano et al J Orthop Traumatol (2020) 21:20 paying for the services” [1]
The WHO Rehabilitation Programme and Cochrane Rehabilitation developed the corresponding methodology under the guidance of the WHO’s Guideline Review Committee secretariat and are collaborating in conducting this step
The objective of this paper is to report on the results of the systematic search for clinical practice guidelines (CPGs) relevant to rehabilitation of adults with fractures, limiting the search to the following sites: humerus, radius, femur/hip, and tibia

Summary

Introduction

The WHO has the strategic priority of achieving Universal Health Coverage (UHC), which means that “all people receive quality health services that meet their needs without being exposed to financial hardship in Gimigliano et al J Orthop Traumatol (2020) 21:20 paying for the services” [1]. The WHO Rehabilitation Programme and Cochrane Rehabilitation developed the corresponding methodology under the guidance of the WHO’s Guideline Review Committee secretariat and are collaborating in conducting this step. Be4rehab includes a series of systematic reviews on clinical practice guidelines (CPGs) for the different health conditions. The identification of existing rehabilitation interventions and related evidence represents a crucial step along the development of the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR). The methods for such identification have been developed by the WHO Rehabilitation Programme and Cochrane Rehabilitation under the guidance of the WHO’s Guideline Review Committee secretariat. The aim of this paper is to report on the results of the systematic search for clinical practice guidelines (CPGs) relevant to the rehabilitation of adults with fractures and to present the current state of evidence available from the identified CPGs

Objectives

Methods

Results

Discussion

Conclusion