Respiratory Management Following Spinal Cord Injury - 7

CLINICAL PRACTICE GUIDELINE

These items were not aggregated into an overall quality score, but were considered individually. Studies meeting the above criteria were summarized in the AHRQ evidence report or in update reports, which included additional topics searched expressly for this guideline, prepared for the expert guideline panel. Additional studies that do not meet the above criteria are cited in some sections of the report when sufficient high-quality evidence on the target population was not available. These studies are not graded according to the quality criteria.

If the literature supporting a recommendation comes from two or more levels, the number and level of the studies are reported (e.g., in the case of a recommendation that is supported by two studies, one a level III, the other a level V the “Sci, entific evidence” is indicated as “III/V”). In situations in which no published literature exists, consensus of the panel members and outside expert reviewers was used to develop the recommendation and is indicated as “Expert consensus.”

Grading of Panel Consensus
The level of agreement with the recommendation among panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with 1 corresponding to neutrality and 5 representing maximum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong, as shown in Table 3. A panel member could abstain from the voting process for a variety of reasons, including, but not limited to, lack of expertise associated with the particular recommendation.

Grading the Guideline Recommendations
After panel members had drafted their sections of the guideline, each recommendation was graded according to the level of scientific evidence supporting it. The framework used by the methodology team is outlined in Table 2. It should be emphasized that these ratings, like the evidence table ratings, represent the strength of the supporting evidence, not the strength of the recommendation itself. The strength of the recommendation is indicated by the language describing the rationale.
TA B L E 2

Categories of the Strength of Evidence Associated with the Recommendations
Category Description

TA B L E 3

Levels of Panel Agreement with the Recommendations
Level Mean Agreement Score

A B C

The guideline recommendation is supported by one or more level I studies. The guideline recommendation is supported by one or more level II studies. The guideline recommendation is supported only by one or more level III, IV, or V studies.

Low Moderate Strong

1.0 to less than 2.33 2.33 to less than 3.67 3.67 to 5.0

Sources: Sackett, D.L., Rules of evidence and clinical recommendation on the use of antithrombotic agents, Chest 95 (2 Suppl) (1989), 2S-4S; and the U.S. Preventive Health Services Task Force, Guide to Clinical Preventive Services, 2nd ed. (Baltimore: Williams and Wilkins, 1996).

Category A requires that the recommendation be supported by scientific evidence from at least one properly designed and implemented randomized, controlled trial, providing statistical results that consistently support the guideline statement. Category B requires that the recommendation be supported by scientific evidence from at least one small randomized trial with uncertain results; this category also may include small randomized trials with certain results where statistical power is low. Category C recommendations are supported by either nonrandomized, controlled trials or by trials for which no controls are used.

Respiratory Management Following Spinal Cord Injury

Table of Contents for the Digital Edition of Respiratory Management Following Spinal Cord Injury