Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 1

CLINICAL PRACTICE GUIDELINE

The Consortium for Spinal Cord
Medicine

T

he Consortium is a collaboration of professional
and consumer organizations funded and
administered by PVA. The Steering Committee,
administratively supported by PVA's Research and
Education Department, is comprised of one
representative from each Consortium-Member
Organization. The Consortium's mission is to
direct the development and dissemination of
evidence-based CPGs and companion consumer
guides. This mission is solely directed to
improving the health care and quality of life for
persons with SCI/D.

Guideline Development
Process
The process used to develop the guidelines
is based on the model derived from the Agency
for Health Research and Quality (AHRQ). The
model is-


Interdisciplinary, to reflect the multiple
information needs of the spinal cord
medicine practice community.



Responsive, with a well-managed timeline
for completion of each guideline.



Reality-based, making use of the scientific
literature where it exists and using practical
and clinical expertise where there are gaps
in the scientific literature.

This innovative and cost-efficient approach
recognizes the specialized needs of the United
States' spinal cord injury medical community,
encourages the participation of both payer
representatives and consumers, and emphasizes
utilization of graded evidence drawn from the
international scientific literature.
The Consortium's CPG development process
involves specific review steps to ensure scientific
and liability integrity for Steering Committee
Members, Panelists, and field reviewers. This
process involves extensive field review as well as
a legal review against copyright, trademark, and
restraint of trade issues.

Methodology

An independent scientific consulting firm is
contracted by PVA to provide methodological
support for evidence grading. This Methodology
Team has three (3) main functions:
(1) conducting a review of the literature;
(2) grading of scientific evidence and conducting
meta-analyses; and
(3) drafting the methodological section for the
guideline document.
After a review of the literature is conducted,
each recommendation receives two objective
ratings:
1) "Scientific evidence"-this reflects the level of
evidence rating for each article cited in the
rationale and

2) "Grade of recommendation"-this is calculated
based on the scientific evidence. Additionally,
each recommendation receives a subjective
rating, "Strength of panel opinion."
Note: The grading of recommendations may change
based on best practices consistent with specific scientific
principles appropriate to each subject matter.

Literature Review and Drafting
of Recommendations
After a CPG topic is explicated and
reviewed, Panel Members provide search terms
and parameters relating to their sub-topic to the
Methodology Team to PVA's Research and
Education Department. PVA will transmit the
search terms and parameters to the Methodology
Team who will then be responsible for providing
PVA's Research and Education Department
journal article citations based on the specific
search terms and parameters. PVA's Research
and Education Department will then transmit
these citations to Panel Members. Panel members
must also note knowledge gaps and unique
features of the sub-topic literature. While Panel
Members are reviewing journal articles cited by
the Methodology Team, they are to individually
write sub-topic recommendations and supporting
rationales according to each area of the Panel
Members' expertise. A few select opinion-based
recommendations may be suggested to provide
sub-topic continuity; however, for the most part,

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Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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