Background:
Clinical practice guidelines have been defined as systematically developed statements to assist practitioner and patient decision-making about appropriate health care forspecific clinical circumstances. They play an important role in guiding evidence based clinicalpractice. The Australian National Health and Medical Research Council has developed and pilot testeda new framework for guideline development, the FORM approach, the role of which has yet to be further defined.
Methods:
We critically review the elements of the FRAME approach and compare it to other,more established methods for rating the quality of evidence and strength of recommendations.
Results:
FORM recognizes five factors that impact the strength of a recommendation which arethe evidence base, consistency, clinical impact, generalizability and applicability. Considerationof these elements leads to a four-tiered rating system represented by the letters A ("body ofevidence can be trusted to guide practice") to D ("body of evidence is weak andrecommendation must be applied with caution"). It builds on other existing guidelinemethodologies such as those developed by the Scottish Intercollegiate Guidelines Network(SIGN), the Strength of Recommendation Taxonomy (SORT) and the Grading ofRecommendations Assessment, Development and Evaluation (GRADE) groups. FORMdistinguishes itself from other systems by its strong emphasis on applicability, which isseparated out as its own category and relates the relevance of the body of evidence to theAustralian healthcare system.
Conclusions:
The FORM approach offers a methodologically rigorous alternative approach toguideline development that places particular emphasis on aspects of applicability. This featureis unique and may prompt future adoption by other guidelines systems