Clinical practice guidelines (usually called “guidelines” for short) are recommendations for diagnoses, treatments, and prognoses based on a careful review of the current available medical evidence on a disease or treatment topic. Here, we outline some commonly-asked questions about guidelines to help you navigate them.
Why are guidelines written?
Guidelines help neurologists and other health care professionals understand the most important conclusions from all available studies on a topic and how they can use that information to improve patient care.
Who writes guidelines?
Many different medical organizations around the world create guidelines to support the care of people with specific conditions. The American Academy of Neurology (AAN) develops guidelines related to people with neurologic conditions. AAN guidelines are written by a panel of authors with expert knowledge in neurology, research, and the specific topic of the guideline. Author panels may also include people who have the neurologic condition being addressed in the guideline.
What evidence is used for guidelines?
AAN guideline authors start with deciding what questions the guideline should answer. These questions are called PICO questions. Each question includes:
- the Population (the people in the studies who receive the intervention)
- the Intervention used (treatment or diagnostic tool)
- the Control group (the people in the studies who do not receive the intervention)
- and the Outcome
An example question is, “For people with Bell’s palsy (Population), do oral steroids given within the first three days of onset (Intervention) compared to people given no steroids (Control) improve long-term facial function outcomes (Outcome)?” The authors then search for studies that will answer these questions.
The studies from the search are then reviewed by the authors. They use a standardized system to weed out the studies that do not meet the criteria to be included. The remaining studies are then reviewed to determine the strength or quality of the evidence each study provides.
For example, conclusions from a study that included hundreds of participants and reported objective results will usually provide stronger evidence than an observational study with only 20 participants.
The authors then analyze the evidence collected from these studies and write their recommendations.
How are the recommendations developed?
The recommendation statements are based on the evidence from the reviewed studies and other factors, such as the authors’ general medical knowledge and experience. All authors then vote on how much they agree with each recommendation. The results determine the strength of each recommendation.
The recommendations are assigned one of the following levels according to their strength:
- A—is the strongest recommendation level and is indicated by the verb “must”
- B—is next strongest level and is indicated by the verb “should”
- C—is the least strong level and is indicated by the verb “may”
This example recommendation shows how a level is reported:
“Clinicians should integrate patient preferences concerning formulation, mode of administration, and cost when prescribing a dopamine agonist (Level B).”
Why are guidelines important to me as a person with a neurologic condition or a caregiver?
AAN guidelines are based on the best evidence about neurologic conditions and treatments. If you or a loved one has a neurologic condition, AAN guidelines—and guideline summaries written with minimal medical jargon for the public—can help keep you informed about which treatments and diagnostic approaches are currently recommended based on evidence and agreement of the experts.
When reading guidelines, it is important to remember that every person is different. A recommendation that works well for many people may not always work well for you. However, guidelines can be a great resource to help you learn more about the treatments for a condition. You can use this knowledge in discussions with your doctor for more productive visits.
