Philippine Clinical Practice Guidelines on Function-based Rehabilitation

This clinical practice guideline is a systematic synthesis of evidence to address clinical questions on function-based rehabilitation in the primary care setting. It provides thirteen (13) weak recommendations and one (1) strong recommendation on ten (10) prioritized questions, based on very low to moderate evidence.

Recommendations are based on the appraisal of the best available evidence on each of the identified clinical questions. This CPG is intended to be used by medical professionals (general practitioners, pediatricians, family medicine specialists, and rehabilitation medicine specialists), allied health workers (nurse, physical therapist, occupational therapist, and speech language therapist), and community workers (disability affairs officer, barangay health worker, and special education teachers).

The guideline development process followed the Philippine Department of Health Technical Manual on Clinical Practice Guideline Development and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach including GRADE Adolopment, a systematic process of adapting evidence summaries, and the GRADE Evidence to Decision (EtD) framework. It included: (1) identification of critical questions and critical outcomes, (2) retrieval of current evidence, (3) assessment and synthesis of the evidence base for the critical questions, (4) formulation of draft recommendations, (5) convening of a multi-sectoral stakeholder panel to discuss values and preferences and assess the strength of the recommendations, and (6) planning for dissemination, implementation, impact
evaluation and updating.

The recommendations in this CPG shall hold and will be updated after five years or when new evidence arises.

No.	Recommendations	Certainty of Evidence	Strength of Recommendation
Question 1. Should function-based screening in the community or home setting versus facility-based screening be done among persons at risk of disability in the primary care setting?
1	Among persons at risk of disability in the primary care setting, we suggest the performance of function-based screening in the community or home setting.	Very Low	Weak
Question 2. Should provision of functional use of assistive technology with caregiver re/training versus functional use of assistive technology alone be done among persons with apparent mild to moderate physical disability in the primary care setting?
2	Among persons with apparent mild to moderate physical disability, we suggest the provision of functional use of assistive technology with caregiver re/training rather than provision of assistive technology alone.	Low	Weak
Question 3. Should task-oriented approach in the community or home setting versus facility setting be done among persons with apparent mild to moderate physical disability in the primary care setting?
3	Among persons with apparent mild to moderate physical disability, we suggest the provision of task-oriented rehabilitation in the community or home setting.	Very Low	Weak
Question 4. Should group-based therapeutic exercises versus individual-based therapeutic exercises be done among persons with apparent mild to moderate physical disability in the primary care setting?
4.1	Among adults with apparent mild to moderate physical disability, we suggest the provision of group- based therapeutic exercises in the primary care setting.	Low	Weak
4.2	Among children with apparent mild physical disability, we suggest the provision of group-based therapeutic exercises in the primary care setting.	Low	Weak
4.3	Among children with apparent moderate physical disability, we suggest against the use group-based therapeutic exercises in the primary care setting.	Low	Weak
Question 5. Should community- or home-based therapeutic exercises with physical modalities versus facility-based therapeutic exercises alone be done among persons with apparent moderate physical disability in the primary care setting?
5	Among persons with apparent moderate physical disability, we suggest against the use of physical modalities in the community or home setting.	Very Low	Weak
Question 6. Should activities of daily living re/training with environmental modifications versus facility-based simulated activities of daily living training be done among persons with apparent mild to moderate physical disability in the primary care setting?
6	Among persons with apparent mild to moderate physical disability, we suggest the provision of activities of daily living re/training with environmental modifications in the community or home setting.	Moderate	Weak
Question 7. Should community-based or home-based mobility training with caregiver training versus facility-based mobility training alone be done among persons with apparent mild to moderate physical disability in the primary care setting?
7.1	Among adults with apparent mild to moderate physical disability, we suggest the provision of community-based or home-based mobility training with caregiver training in the primary care setting.	Very Low	Weak
7.2	Among children with apparent mild to moderate physical disability, we recommend the provision of community-based or home-based mobility training with caregiver training in the primary care setting.	Moderate	Strong
Question 8. Should caregiver-led versus therapist-led habilitation intervention be done among persons born with apparent physical disability in the primary care setting?
8	Among persons born with apparent physical disability, we suggest against the use of caregiver-led habilitation interventions in the primary care setting.	Very Low	Weak
Question 9. Should follow-up and monitoring versus no follow-up and monitoring be done among persons with apparent mild to moderate physical disability in the primary care setting?
9	Among persons with apparent mild to moderate physical disability, we suggest follow-up and monitoring in the primary care setting.	Low	Weak
Question 10. Should referral and specialist care management be done among persons with severe physical disability in the primary care setting?
10.1	Among adults with severe physical disability, we suggest the provision of referral and specialist care management in the primary care setting.	Low	Weak
10.2	Among children with severe physical disability, we suggest the provision of referral and specialist care management in the primary care setting.	Very Low	Weak