Contextualizing Western guidelines for stroke and low back pain to a developing country (Philippines): an innovative approach to putting evidence into practice efficiently

Background: High-quality evidence-based clinical guidelines are widely available for many diseases. Clinical guidelines support evidence-based care decisions and improved health outcomes. Most clinical practice guidelines have been developed in the Western world and reflect a developed country's health systems and services, disease epidemiology, and workforce. Such guidelines are therefore not immediately relevant or generalizable to developing countries. Guidelines are expensive to produce, and it is more resource efficient for developing countries to contextualize available Western guidelines, rather than develop their own. This paper describes a leadership initiative by the Philippines Association of Rehabilitation Medicine to contextualize high-quality relevant Western guidelines for local management of stroke and low back pain. Methods: Twenty-one steps were developed, covering initial training and establishing the framework within which recommendations were contextualized; then guideline searching, critiquing, and including; and then contextualization, review, and implementation. A writing guide assisted the group to endorse recommendations in a standard manner, relevant to a "typical" patient journey, and to contextualize recommendations for local settings. Results: Recommendations were extracted from eight low back pain and five stroke clinical guidelines. Philippines Association of Rehabilitation Medicine endorsements were made, reflecting summarized recommendations and underpinning strength of the evidence body. Philippines Association of Rehabilitation Medicine context points contextualized the recommendations in terms of local health service delivery. Conclusion: A systematic reproducible process was applied to contextualize high-quality, relevant Western guidelines for immediate application to one developing country. This approach focused resources on contextualization, implementation, and uptake rather than de novo development. This leadership initiative offers a resource efficient way to implement evidence-based practice in developing countries when there is neither time nor resources for de novo guideline development. Keywords: PARM, clinical guidelines, Philippines, endorsements, context points, evidence-based practice