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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.