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Table 5 Considered judgment to formulate recommendations

From: Comparison of international guideline programs to evaluate and update the Dutch program for clinical guideline development in physical therapy

Organization Criteria for considered judgment Process
CBO Clinical relevance
Safety
Patient perspective
Professional perspective
Available resources
Cost-effectiveness Organization of care
Legal consequences
Ethical considerations
Commercial interest
Considered judgment is described after description of the evidence. Formulation of the recommendation is based on the evidence and the considered judgment.
A checklist is available for the development group with detailed criteria within ten domains as listed in this table.
CSP Strength of evidence
Clinical relevance and applicability of evidence
Acceptability to patients
Benefits and risks
Costs
Development group should discuss considerations. When possible quantitative analysis should be made to estimate relative risks and benefits. Guideline document should describe some of the discussion and clearly describe the link between evidence review and recommendations.
NHMRC Applicability of the evidence
Probable outcome of intervention
Balance of benefits against risks
Alternative interventions
Economic appraisal
A balance sheet is described to balance benefits and harms.
NZGG Volume of evidence
Consistency of the evidence
Applicability of the evidence
Clinical impact of the intervention
A considered judgment form is used to link clinical questions, evidence and recommendation. The development group needs to make a decision at the beginning of the process about how to resolve differences.
SIGN Quantity, quality and consistency of evidence
Generalizability of study findings
Directness of application to target population
Clinical impact
Implementability
Development group summarizes view of considered judgment using a form to record their main points. The level of evidence is assigned to the judgment and a graded recommendation is formulated.
USPSTF Quality of studies, linkage to key question using 3 criteria (internal validity, external validity, consistency), linkage to entire preventive service
Magnitude and weighing of benefits and harms
Extrapolation and generalization
Other issues as cost effectiveness, resource prioritization, logistical factors, ethical and legal concerns, patient and societal expectations should be considered, but recommendations reflect primarily the state of the evidence.
Guideline topic team assesses criteria using systematic methods and rating systems. Recommendations reflect primarily the state of evidence. Making recommendations is done with the understanding that clinicians and policymakers must still consider additional factors in making their own decisions. Setting priorities in clinical practice (e.g. based on resource requirements) are beyond the scope of the review.