Content » Vol 45, Issue 4

Letter to the Editor

The search for guidelines in physical and rehabilitation medecine: ISPRM whistling from Southeast Asia

With continuing advances in medicine, the quality of healthcare services worldwide is improving. However, as the range of therapeutic alternatives increases, the therapeutic approaches of physicians are likely to become increasingly divergent. Thus, there is a need for more standardized treatment protocols worldwide.

The number of international clinical guidelines is increasing. There are published guidelines for particular health conditions in physical and rehabilitation medicine (PRM), e.g. low back pain, osteoarthritis and stroke, but none that apply solely to PRM, and thus they lack a physiatrist’s approach (1–3). As those diseases account for some of the most common clinical scenarios that PRM physicians face in their daily practice (4), the lack of relevant international PRM guidelines is a problem.

In February 2013 this subject was discussed at an expert meeting during the 6th Asian Rehabilitation Medicine Association congress in Manila, Philippines. It was noted that a few countries have their own guidelines; for example, the Brazilian Association of Physical and Rehabilitation Medicine has developed clinical practice guidelines for stroke, spinal cord injury, traumatic brain injury, cerebral palsy, chronic non-specific low back, and neck pain (5–8). The Philippine Academy of Rehabilitation Medicine has developed clinical practice guidelines on stroke rehabilitation and low back pain management, through the approach of contextualizing relevant Western guidelines, i.e. implementation and uptake, rather than de novo development (4). This approach can be adopted by developing countries to bring evidence efficiently into practice. Likewise, Turkish PRM physicians took a similar approach to produce “consensus” papers on knee osteoarthritis (9), rheumatoid arthritis (10), and ankylosing spondylitis (11, 12).

It is likely that there are other national guidelines for PRM physicians, of which we are unaware, since only a few have been published in international journals (9–12). Thus, the recently established ISPRM Clinical Sciences Committee has initiated an attempt to determine how these “local” guidelines can be gathered and used under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM) (or somehow be endorsed by the ISPRM). It is hoped that the literature will shortly be enriched by new international guidelines for PRM.


Marta Imamura, MD, PhD1, Consuelo Gonzalez-Suarez, MD, PhD2 Reynaldo Rey-Matias, MD, MSHMS3, Bonifacio Rafanan, MD3 and Levent Özçakar, MD4*

From the 1Institute of Physical and Rehabilitation Medicine, University of São Paulo School of Medicine, São Paulo, Brazil, 2Department of Rehabilitation Medicine, University of Santo Tomas, Faculty of Medicine and Surgery, Manila, Philippines, 3Department of Physical and Rehabilitation Medicine, Philippine General Hospital, Manila, Philippines and 4Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey


1. Zhang W, Doherty M, Peat G, Bierma-Zeinstra MA, Arden NK, Bresnihan B, et al. EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann Rheum Dis 2010; 69: 483–489.

2. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 147: 478–491.

3. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke 2012; 43: 1711–1737.

4. Gonzalez-Suarez CB, Grimmer-Somers K, Dizon JM, King E, Lorenzo S, Valdecanas C, et al. Contextualising Western guidelines for stroke and low back pain to a developing country (Philippines): an innovative approach to putting evidence into practice efficiently. J Healthcare Leadership 2012; 4: 141–156.

5. Naki IK, Rodrigues TA, Andrade TS, Esotico APCA, Heyn D, Imamura M, et al. [Acute encephalic vascular accident: rehablitation]. Acta Fisiatr 2012; 19: 60–65 (in Portuguese).

6. Delfino PD, Rampim DB, Alfieri FM, Tomikawa LCO, Fadel G, Stump PRNAG, et al. [Neck pain: rehabilitation]. Acta Fisiatr 2012; 9: 73–81 (in Portuguese).

7. Rached RDVA, Rosa CDP, Alfieri FM, Amaro SMC, Nogueira B, Dotta L, et al. [Chronic lumbar pain: rehabilitation]. Acta Fisiatr 2012; 19: 99–113 (in Portuguese).

8. Capucho PY, Carnier SADC, Souza P, Castro DC, Finocchio AP, Oliveira DM, et al. [Cerebral palsy - lower limbs: rehabilitation]. Acta Fisiatr 2012; 19: 114–122 (in Portuguese).

9. Tuncer T, Çay HF, Kaçar C, Altan L, Atik OŞ, Aydın AT et al. Evidence-based recommendations for the management of knee osteoarthritis: a consensus report of the Turkish League Against Rheumatism. Turk J Rheumatol 2012; 27: 1–17.

10. Ataman Ş, Borman P, Deniz E, Aydoĝ E, Ayhan F, Yildizlar D, et al. Management of rheumatoid arthritis: consensus recommendations from the Turkish League Against Rheumatism. Turk J Rheumatol 2011; 26: 273–294.

11. Bodur H, Sivas F, Yılmaz Ö, Özgöçmen S, Günaydın R, Kaya T, et al. Turkish League Against Rheumatism national recommendations for the management of ankylosing spondylitis. Turk J Rheumatol 2011; 26: 173–186.

12. Özgöçmen S, Akgul O, Altay Z, Altindag O, Baysal O, Calis M, et al. Expert opinion and key recommendations for the physical therapy and rehabilitation of patients with ankylosing spondylitis. Int J Rheum Dis 2012; 15: 229–238.


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