TY - JOUR
T1 - Methodology for evidence synthesis and development of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain
AU - Manchikanti, Laxmaiah
AU - Atluri, Sairam
AU - Boswell, Mark V.
AU - Calodney, Aaron K.
AU - Diwan, Sudhir
AU - Gupta, Sanjeeva
AU - Kaye, Alan D.
AU - Knezevic, Nebojsa Nick
AU - Candido, Kenneth D.
AU - Abd-Elsayed, Alaa
AU - Pappolla, Miguel A.
AU - Racz, Gabor B.
AU - Sachdeva, Harsh
AU - Sanapati, Mahendra R.
AU - Shah, Shalini
AU - Singh, Vanila
AU - Soin, Amol
AU - Hirsch, Joshua A.
N1 - Publisher Copyright:
© 2021, American Society of Interventional Pain Physicians. All rights reserved.
PY - 2021/1/24
Y1 - 2021/1/24
N2 - Background: The re-engineered definition of clinical guidelines in 2011 from the IOM (Institute of Medicine) states, “clinical practice guidelines are statements that include recommendations intended to optimize patient care that is informed by a systematic review of evidence and an assessment of the benefit and harms of alternative care options.” The revised definition distinguishes between the term “clinical practice guideline” and other forms of clinical guidance derived from widely disparate development processes, such as consensus statements, expert advice, and appropriate use criteria. Objective: To assess the literature and develop methodology for evidence synthesis and development of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Methods: A systematic review of the literature including methodology of guideline development encompassing GRADE approach for guidance on evidence synthesis with recommendations. Results: Some of the many factors described in 2011 continue as of 2020 and impede the development of clinical practice guidelines. These impediments include biases due to a variety of conflicts and confluence of interest, inappropriate and poor methodological quality, poor writing and ambiguous presentation, projecting a view that these are not applicable to individual patients or too restrictive with the elimination of clinician autonomy, and overzealous and inappropriate recommendations, either positive, negative, or non-committal. Thus, ideally, a knowledgeable, multidisciplinary panel of experts with true lack of bias and confluence of interest must develop guidelines based on a systematic review of the existing evidence. This manuscript describes evidence synthesis from observational studies, various types of randomized controlled trials (RCTs), and, finally, methodological and reporting quality of systematic reviews. The manuscript also describes various methods utilized in the assessment of the quality of observational studies, diagnostic accuracy studies, RCTs, and systematic reviews. Limitations: Paucity of publications with appropriate evidence synthesis methodology in reference to interventional techniques. Conclusion: This review described comprehensive evidence synthesis derived from systematic reviews, including methodologic quality and bias measurement. The manuscript described various methods utilized in the assessment of the quality of the systematic reviews, RCTs, diagnostic accuracy studies, and observational studies.
AB - Background: The re-engineered definition of clinical guidelines in 2011 from the IOM (Institute of Medicine) states, “clinical practice guidelines are statements that include recommendations intended to optimize patient care that is informed by a systematic review of evidence and an assessment of the benefit and harms of alternative care options.” The revised definition distinguishes between the term “clinical practice guideline” and other forms of clinical guidance derived from widely disparate development processes, such as consensus statements, expert advice, and appropriate use criteria. Objective: To assess the literature and develop methodology for evidence synthesis and development of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Methods: A systematic review of the literature including methodology of guideline development encompassing GRADE approach for guidance on evidence synthesis with recommendations. Results: Some of the many factors described in 2011 continue as of 2020 and impede the development of clinical practice guidelines. These impediments include biases due to a variety of conflicts and confluence of interest, inappropriate and poor methodological quality, poor writing and ambiguous presentation, projecting a view that these are not applicable to individual patients or too restrictive with the elimination of clinician autonomy, and overzealous and inappropriate recommendations, either positive, negative, or non-committal. Thus, ideally, a knowledgeable, multidisciplinary panel of experts with true lack of bias and confluence of interest must develop guidelines based on a systematic review of the existing evidence. This manuscript describes evidence synthesis from observational studies, various types of randomized controlled trials (RCTs), and, finally, methodological and reporting quality of systematic reviews. The manuscript also describes various methods utilized in the assessment of the quality of observational studies, diagnostic accuracy studies, RCTs, and systematic reviews. Limitations: Paucity of publications with appropriate evidence synthesis methodology in reference to interventional techniques. Conclusion: This review described comprehensive evidence synthesis derived from systematic reviews, including methodologic quality and bias measurement. The manuscript described various methods utilized in the assessment of the quality of the systematic reviews, RCTs, diagnostic accuracy studies, and observational studies.
KW - Clinical practice guidelines
KW - Comparative effectiveness research (CER)
KW - Conflict of interest
KW - Confluence of interest
KW - Evidence synthesis
KW - Evidence-based medicine (EBM)
KW - Interventional pain management
KW - Meta-analysis
KW - Methodological quality assessment
KW - Systematic reviews
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M3 - Article
C2 - 33492917
AN - SCOPUS:85099952568
SN - 1533-3159
VL - 24
SP - S1-S26
JO - Pain physician
JF - Pain physician
ER -