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Clinical practice guidelines--how do they apply to cardiovascular and pulmonary physical therapy?

Recently, I was asked, along with our President, to represent the Cardiovascular and Pulmonary Section on a work group convened by APTA to discuss the development of Clinical Practice Guidelines (CPGs) by all specialties. In this very thought-provoking discussion, I was challenged to think about how our specialty would interact with evidence in the management of patients. While there are many guidelines for physician management of cardiovascular and pulmonary conditions such as chronic heart failure, chronic obstructive pulmonary disease, and peripheral arterial disease, these guidelines only guide part of our practice.

I learned about the process of developing CPGs, in which evidence is reviewed and graded to lead to a recommendation from an expert panel. However, guidelines produced by and for physicians discount case studies and qualitative methodological studies and focus primarily on diagnosis. Physical therapy management of patients with these cardiovascular and pulmonary conditions is importantly informed by case studies and other forms of study, and diagnosis is not the sole end of our interaction with our patients. These issues highlight how our practice is different from that of physicians.

So, what do CPGs mean for us? The emphasis needs to be on the clinical aspect of that term. Clinical practice is often messy and different from a research setting. (For an illustration, see the Letter to the Editor in this issue.) However, a practitioner needs to be guided by the best evidence possible. This is the challenge of developing CPGs. Thus, all types of research must be available for review when developing the guidelines. This is where journals like this one play an important role. By sharing work of all types--case studies, educational interventions, and randomized controlled trials--the full picture of practice can be seen. This issue illustrates the diversity that we strive to showcase.

There are roles for all of us in the development of CPGs. Scholars need to give us evidence in many types of settings, educators need to systematically examine what and how we teach the next generation of PTs, and clinicians need to keep both groups informed of the realities of clinical practice. The process is long and takes many dedicated people to accomplish the task. So, in the near future, you may be asked to contribute to the development of CPGs for cardiovascular and pulmonary physical therapy practice. I hope you accept the challenge and help our specialty area improve.

Anne K. Swisher, PT, PhD, CCS

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Title Annotation:Editorial
Author:Swisher, Anne K.
Publication:Cardiopulmonary Physical Therapy Journal
Date:Sep 1, 2011
Previous Article:The Linda Crane Memorial Lecture: leading leaders: a vision for our centennial years.
Next Article:Letter to the editor.

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