Contextualisation of clinical practice guidelines: An innovative approach for the primary healthcare of chronic musculoskeletal pain in South Africa




Long oral session 3: Guideline adaptation and updating


Wednesday 13 September 2017 - 14:00 to 15:30


All authors in correct order:

Ernstzen DV1, Louw QA1, Hillier SL2
1 Division Physiotherapy, Department of Health and Rehabilitation Sciences, South Africa
2 Division Physiotherapy, Department of Health and Rehabilitation Sciences, South Africa AND Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
Presenting author and contact person

Presenting author:

Dawn Ernstzen

Contact person:

Abstract text
Background: Chronic musculoskeletal pain (CMSP) is a global healthcare concern. High-quality, evidence-based clinical practice guidelines (CPGs) can facilitate quality healthcare for CMSP. CPGs developed in developed nations may not be appropriate in resource-constrained settings, due to differences in socio-cultural and policy contexts. Contextualisation is an option to develop guidance for resource-constrained settings.

Objectives: To develop an evidence-based CPG for the primary healthcare of adults with CMSP in the Western Cape Province of South Africa, using a novel process of CPG contextualisation.

Methods: A four-part contextualisation model was developed. The four parts consisted of a contextual analysis, evidence synthesis, contextual integration and evaluation. Qualitative methodology was used to investigate context factors that influence the healthcare of patients with CMSP. A systematic review was conducted to identify current, high-quality CPGs on the topic, and a core set of recommendations were synthesised from the CPGs. A multidisciplinary panel of experts authenticated recommendations and contextualised them for the intended context, using consensus methodology. The CPG was externally reviewed, using a survey.

Results: A core set of 43 clinical recommendations were developed through the evidence synthesis and contextual-integration processes. The 20 patients and 21 clinicians who participated in the contextual analysis agreed on the context factors that influence care as: personal characteristics of the patient and clinician; social and environmental circumstances; healthcare interventions received; and, healthcare system factors. A diverse group of 18 potential end-users rated the recommendations as largely acceptable for the intended context.

Conclusions: CPG contextualisation was found to be a time and resource-efficient way to summarise evidence-based recommendations from high-quality, existing CPGs. The approach facilitated the integration of multiple stakeholder perspectives in CPG development. The end-result was a contextualised evidence-based, multimodal CPG for the primary healthcare of adults with CMSP in South Africa.