Philippine Academy of Rehabilitation Medicine (PARM) project
To address the lack/limited local evidence base, a model of contextualization of global evidence process to inform local practice decisions in the form of clinical practice guidelines was presented and the processes undertaken. Local clinical practice guidelines on stroke and low back pain were developed using this model of contextualization. This innovative process is reported in the paper by Suarez et al 2012 and described in the following:
Contextualization of Western Guidelines for Stroke and Low Back Pain Rehabilitation (http://www.dovepress.com/contextualizing-western-guidelines-for-stroke-and-low-back-pain-to-a-d-peer-reviewed-article-JHL)
The medical associations in the Philippines have been asked to write clinical practice guidelines on the most common conditions which have the highest cause of morbidity and mortality. Evidence-based practice is a new concept in the Philippines and there is a limited local capacity or knowledge regarding guideline development. In 2011 Philippine Academy of Rehabilitation Medicine (PARM) led the academy members in formulation clinical practice guidelines. PARM is the national Filipino society of physiatrists. They are involved in the management of physical disorders that limit participation of individuals in activities of daily living and vocational and avocational activities. A partnership between the International Centre for Allied Health Evidence and PARM has been forged to provide mentorship in this endeavour. It was decided that a denovo clinical practice guideline was not to be written because it would entail enormous funding which the association did not have. Instead, contextualization of guidelines from Western countries for management of the two most common conditions referred to rehabilitation which are low back pain and stroke was undertaken. These guidelines have been undergone public consultation and are presently in the PARM website (http://www.eparm.org/) under the clinical practice guidelines tab. Because of the efficiency and simplicity of the methodology of contextualizing the guidelines for Filipino setting, PARM has mandated regional associations to write guidelines on other medical conditions such as neck and shoulder pain. Clinical practice guideline workshops to other PARM members were conducted. There were about 30 members who attended these workshops. It is envisioned that by the end of 2013, two guidelines will be written and will undergo public consultation. To date, the low back pain and stroke rehabilitation clinical practice guidelines have been submitted to the Philippine Health Insurance to serve as guide in the reimbursement of rehabilitation services. This is a milestone for rehabilitation practice in the Philippine because up to now, only medications, medical services , surgical procedures and hospital stay are being reimburse to patients.
Clinical audit of current practice in stroke rehabilitation
At present, a nationwide, multi-centre audit study is being conducted in order to establish current rehabilitation practices for stroke patients in the Philippines . This would have the potential to capture ‘gaps’ in current practice and could be used as part of the education provided to Filipino healthcare practitioners, as part of the guidelines implementation program. Sixty percent (60%) of the hospitals with rehabilitation facilities are targeted to be audited.
Implementation of Clinical Practice Guidelines in Stroke Rehabilitation (http://www.dovepress.com/implementation-of-recommendations-from-the-philippine-academy-of-rehab-peer-reviewed-article-CA)
Concurrent with the audit of current practice, a pilot study of the implementation of 6 recommendations with best evidence from the stroke rehabilitation CPG is currently being conducted. Three rehabilitation medicine training hospitals and one government hospital in Metro Manila are included in this study. Protocols and flow charts have been created that would be utilized in the proper implementation of the recommendations. These include protocols for:
1. In patient referral
2. Dysphagia assessment
3. Pressure sore assessment and treatment
4. Exercise protocol for gait training
5. Discharge summary.
This would have an impact in Filipino practice because these hospitals train health professionals to become rehabilitation specialists. It is hoped that there will be a paradigm shift in the practice where decisions will be made based on best available evidence.
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