Research article

An interdisciplinary guideline development process: the Clinic on Low-back pain in Interdisciplinary Practice (CLIP) low-back pain guidelines

Michel Rossignol¹ , Stéphane Poitras¹ , Clermont Dionne² , Michel Tousignant³ , Manon Truchon⁴ , Bertrand Arsenault⁵ , Pierre Allard⁶ , Manon Coté⁷ and Alain Neveu⁸

¹  Montreal Department of Public Health, McGill University, Montreal, Canada

²  Department of Rehabilitation, Laval University, Quebec City, Canada

³  Department of Rehabilitation, Sherbrooke University, Sherbrooke, Canada

⁴  Department of Industrial Relations, Laval University, Quebec City, Canada

⁵  School of Rehabilitation, University of Montreal, Montreal, Canada

⁶  Sir Mortimer B Davis Jewish General Hospital, Montreal, Canada

⁷  Jewish Rehabilitation Hospital, Montreal, Canada

⁸  Constance Lethbridge Rehabilitation Centre, Montreal, Canada

author email corresponding author email

Implementation Science 2007, 2:36doi:10.1186/1748-5908-2-36

Published:	24 November 2007

Abstract

Background

Evaluation of low-back pain guidelines using Appraisal of Guidelines Research and Evaluation (AGREE) criteria has shown weaknesses, particularly in stakeholder involvement and applicability of recommendations. The objectives of this project were to: 1) develop a primary care interdisciplinary clinical practice guideline aimed at preventing prolonged disability from low-back pain, using a community of practice approach, and 2) assess the participants' impressions with the process, and evaluate the relationship between participant characteristics and their participation.

Methods

Ten stakeholder representatives recruited 136 clinicians to participate in this community of practice. Clinicians were drawn from the following professions: physiotherapists (46%), occupational therapists (37%), and family physicians (17%). Using previously published guidelines, systematic reviews, and meta-analyses, a first draft of the guidelines was presented to the community of practice. Four communication tools were provided for discussion and exchanges with experts: a web-based discussion forum, an anonymous comment form, meetings, and a symposium. Participants were prompted for comments on interpretation, clarity, and applicability of the recommendations. Clinical management recommendations were revised following these exchanges. At the end of the project, a questionnaire was sent to the participants to assess satisfaction towards the guidelines and the development process.

Results

Twelve clinical management recommendations on management of low-back pain and persistent disability were initially developed. These were discussed through 188 comments posted on the discussion forum and 103 commentary forms submitted. All recommendations were modified following input of the participants. A clinical algorithm summarizing the guidelines was also developed. A response rate of 75% was obtained for the satisfaction questionnaire. The majority of respondents appreciated the development process and agreed with the guideline content. Most participants thought recommendations improved between versions, and that participant comments contributed to this improvement. All stakeholders officially endorsed the guidelines.

Conclusion

The community of practice approach was a successful method to develop guidelines on low-back pain, with participants providing information to improve guideline recommendations. The information technology infrastructure that was developed remains for continuous interdisciplinary exchanges and updating of the guidelines.