Getting Started Consuelo B. Gonzalez-Suarez, MD, PhD University of Santo Tomas Philippine Academy of Rehabilitation Medicine

Mission To promote and advance the field of rehabilitation medicine, elevate the standards of practice through training, education, research and service thereby improving the quality of life of the Filipino people. Vision The PARM is a nationally-recognized and globally-accepted society to dynamic, compassionate and highly competent rehabilitation medicine specialists (Physiatrists) at the forefront of comprehensive healthcare of the Filipino people.

Objectives Understand the important issues on the developing a clinical practice guideline Identify enablers that facilitated the development of CPG Create a patient’s journey

Identification of important issues Lack of local knowledge and available training regarding evidence-based practice Not all medical and paramedical schools are offering evidence based research Lack of time and resources to construct de novo guidelines Requirement of the government to develop CPGs for the National Health Insurance

Identification of important issues Small numbers of relevant Filipino research studies Lack of evidence-based practice culture Most guidelines are developed in Western countries where practice may be different from the Philippines Lack of a leader in the evidence-based practice movement

Enablers Overt support for guidelines implementation from the Philippines Department for Health Growing awareness of the use of evidence-based practice Interest from Filipino universities in using an evidence-based model for training healthcare providers Wider access to the Internet

Enablers General desire within the PARM group and amongst policy-makers to improve healthcare practices and patient outcomes in the Philippines Urgent need to address the ramifications of the high incidence in all parts of the country of disabling conditions amongst Filipinos

Preliminary research Health workforce Difference of healthcare practice in rural and urban areas 7100 islands which have mostly primary hospitals; Tertiary hospitals are only in cities of the different provinces Identifying important health conditions Stroke Low back pain

Establishing our teams Physicians and residents in training Knowledge in evidence-based practice is varied Guideline construction principles On-going mentorship and peer review through the guideline writing process

Establishing our teams

Patient Journey Patients follow a series of care pathways implemented by healthcare professionals When patient is admitted in the hospital When patient is treated in the out patient department Involved physical examination, diagnostic procedures, treatment strategies

Stroke Out Patient Journey Stroke Patient referred at out patient rehabilitation clinic Initial Rehabilitation Evaluation Treatment Physical therapy Occupational Therapy Speech therapy Pharmacologic management Provision for orthosis and walking aids Reassessment Modification of rehabilitation prescription Assistive device, mobility aids, splints and orthosis Fall Assessment Pain and spasticity Management Treatment of post-stroke complications Instructions for home care Referral to other specialists as needed Secondary prevention Reintegration to community Continuation of care Treatment of residual neurological deficits Improvement of cardiovascular and muscular endurance

Thank you very much!