Cleaning Up the Clinical Clutter

There are many chores that I do not enjoy doing, but somehow, washing dishes does not make it on that list. Maybe it’s watching something transform from dirty to clean, or maybe it's just getting into a rhythm. Washing dishes is as simple as rinse, scrub, wash, and repeat. Looking at the variety of physical therapy treatment approaches that exist for an even more diverse range of patient presentations, it can start to feel like you are looking at a long ‘to-do’ list on a Saturday morning. Where do you start? Is there a formula to use? Can it be as easy as clearing out the dishes in the sink? Thankfully, the research community is strong in our field, and they are called to further our practice through evidence-based reviews of our most effective techniques. No rinse, scrub, wash, and repeat formula works for all of our patients, but we do have clinical practice guidelines (CPGs) that give us an effective skeleton to build an individualized plan of care around. Armed with the knowledge to interpret these guidelines, we can be confident in approaching our ‘to-do’ list knowing proven methods back us.

How to Find and Access CPGs

In our rapidly evolving world, technology in the clinic is becoming more of a time saver for clinicians to access CPGs. While we cannot predict what CPG you will need and when, we can offer some advice on how to access them to bring your time cost down when every second counts in the clinic.  

1. APTA: https://www.apta.org/patient-care/evidence-based-practice-resources/cpgs

   Did you know the APTA has a dedicated page that contains a library of clinical practice guidelines? This page has an available search bar that will allow you to quickly narrow down your results to locate your topic of interest. One caveat to this resource is that there is a membership cost to access many of these, but there are discounted rates for students, and the yearly membership cost can be negotiated with your future or current employer as an added benefit.

2.  PubMed: https://pubmed.ncbi.nlm.nih.gov/

   We could easily call this one ‘Old Faithful’ as we have used it repeatedly throughout our educational process. As one of the largest online resources for medical research, PubMed is also a great place to locate CPGs. After making a search, you will find that in the filter column (on the left side of the screen), there is an ‘Article Type’ selection that has ‘Practice Guideline’ as an option. Selecting this to refine your search will populate CPGs into your search.

3. ChatGPT (or your AI search engine of choice)

   Say what you will about AI, but there is a place for it in the clinic. This is one of the fastest resources you will have to hunt down CPGs in your clinical practice. Typing in a simple command such as ‘Find me a physical therapy CPG about _________’ will yield quick links to potential resources. However, use this resource with a grain of salt and always double check references found with AI.

How to Interpret CPGs

So, now that you’ve found a CPG…what’s next? Interpreting a clinical practice guideline might not be as straightforward as reading a recipe, but it doesn’t have to feel like decoding ancient scrolls either. A good place to begin is the executive summary or abstract. This is like reading the back of a book before deciding to dive in. It gives you a high-level idea of what the guideline covers, the population it targets, and the key takeaways.

Next, take a look at the strength of recommendations. Most CPGs will use a grading system (often A, B, C, or similar) to show how strong the evidence is for a given intervention. Think of it like a weather forecast: an ‘A’ grade means you are likely to see good results when using the intervention. A lower grade might mean the intervention could help, but more research is needed. Be aware of the "actionable items" as well. These often come in the form of tables, bullet points, or algorithms that can be applied directly to patient care. If you’re feeling overwhelmed by the length of the document, zero in on these sections they are true clinical pearls.

Lastly, keep context in mind. A CPG is a guide, not a script. It helps inform your clinical reasoning but doesn’t replace it. The best clinicians are the ones who take what the research says and apply it with nuance and compassion, considering each patient’s unique situation.

Benefits and Drawbacks

CPGs, like any tool in our clinical toolbox, come with both perks and pitfalls. On the bright side, they offer us confidence. When we’re unsure of what direction to take with a patient, a well-supported guideline can be the compass we need to point us in the right direction. They also help standardize care, so whether a patient is seen in a small-town outpatient clinic or a large urban hospital, they’re getting treatment informed by the best available evidence. CPGs are also time-savers, preventing us from reinventing the wheel with every case as we stand on the shoulders of the researchers and clinicians who came before us.

This all sounds great, but they’re not without drawbacks. For one, CPGs will become outdated. Research takes a long time to be published and can take over 15 years to reach the mainstream of practice. CPGs are generally thought to be counted as current if they have been published in the last 5 to 7 years. Taking time to check the publication date and staying immersed in current research for updates is key. Additionally, there is not always an inclusive aspect to these guidelines. A lack of accounting for individual patient preferences or comorbidities can do more harm than good if we do not readily apply our clinical reasoning alongside CPG recommendations. 

Skimming Speedily

Let’s face it, these documents are long. Sometimes it can seem as if you’d be holding a textbook's worth of information if it were a paper copy. Learning to skim effectively and interpret quickly is a skill that protects your most valuable asset in the clinic: your time. Efficiently navigating CPGs will boost your productivity by helping you forge a road to success. Below we have included some of our best advice for making CPGs into a quick read.

• Start with the table of contents to jump directly to the sections most relevant to your patient case. One of the best things to do initially is look at the population the CPG is focused on. This will allow you to understand whether the information in generalizable to the patient you’re working with.

• Scan for headings and subheadings to quickly locate key sections like "Recommendations" or "Summary of Evidence."

• Prioritize charts, tables, and algorithms, they often summarize large amounts of information in a clear, visual format.

• Use CTRL + F (or Command + F on Mac) to search for specific terms (e.g., “manual therapy,” “strengthening,” “post-op”).

• Highlight or annotate digitally to mark important points and improve retention, even if you never review them again.

• Skip the deep methodology unless needed focus on practical, clinical guidance unless you're diving into research critique.

Parting Words

In the dynamic world of physical therapy, clinical practice guidelines serve as invaluable tools to support decision-making and ensure that care remains grounded in the best available evidence. While these documents can be extensive and at times overwhelming, developing the ability to efficiently locate, interpret, and apply them is a skill that strengthens with experience. By integrating CPGs into clinical reasoning, practitioners can approach each patient with greater confidence, consistency, and clarity, while still maintaining the individualized care that lies at the heart of our profession. Ultimately, these guidelines are not meant to replace clinical judgment, but to enhance it. With a strong foundation in evidence-based practice, we are better equipped to meet the diverse needs of our patients and advance the quality of care within our field.

Disclaimer:

We are a current Doctor of Physical Therapy (DPT) students sharing information based on our formal education and independent studies. The content presented in this newsletter is intended for informational and educational purposes only and should not be considered professional medical advice. While we strive to provide accurate and up-to-date information, our knowledge is based on our current academic and clinical rotations and ongoing learning, not extensive clinical practice.