Background
Females with persistent pelvic pain (PPP) report great variability in the treatments recommended to them despite the availability of clinical practice guidelines (CPGs) that aim to ...standardise care. A clear consensus for the best practice care for PPP is required.
Objective
To identify and summarise treatment recommendations across CPGs for the management of PPP, and appraise their quality.
Search strategy
MEDLINE, CENTRAL, EMBASE, EmCare, SCOPUS, the Cochrane Database of Systematic Reviews, Web of Science Core Collection and relevant guideline databases were searched from their inception to June 2021.
Selection criteria
Included CPGs were those for the management of urogynaecological conditions in adult females published in English, of any publication date, and endorsed by a professional organisation or society.
Data collection and analysis
We screened 1379 records and included 20 CPGs. CPG quality was assessed using The Appraisal of Guidelines for Research and Evaluation II (AGREE‐II) tool. Descriptive synthesis compiled treatment recommendations across CPGs.
Main results
The CPGs for seven conditions provided 270 individual recommendations. On quality appraisal, guidelines on average scored ‘excellent’ for the domains ‘scope and purpose’ (80.6%, SD = 13.3) and ‘clarity and presentation’ (74.4%, SD = 12.0); for other domains, average scores were satisfactory or poor. Four guidelines (for Endometriosis: NICE, RANZCOG and ESHRE; for polycystic ovary syndrome: Teede et al. 2018, International Evidence Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome, Monash University, Melbourne, Australia) were deemed recommended for use. Recommendations were most frequent for pharmaceutical and surgical interventions. Recommendations were variable for psychological, physiotherapy and other conservative interventions.
Conclusions
The quality of CPGs for PPP is generally poor. Several CPGs endorse the consideration of biopsychosocial elements of PPP. Yet most recommend pharmaceutical, surgical and other biomedical interventions.
Tweetable
Persistent pelvic pain guidelines are often poor quality, and most recommendations are for biomedical interventions.
This report provides a broad overview of the Federal programs that are designed to help agricultural producers manage risks to income or profitability caused by natural and economic forces. This ...report refers to these programs as “risk management programs.” Focus is given to risk management programs that are available under the Agriculture Improvement Act of 2018 (i.e., 2018 Farm Bill). Thus, this publication serves as an update to previous work (Motamed et al., 2018), which focused on programs available under the Agricultural Act of 2014 (i.e., 2014 Farm Bill). Although each title of the Farm Bill contains programs that attenuate risk indirectly, most current targeted risk management programs are authorized under Title I: Commodity Programs or Title XI: Crop Insurance. Accordingly, this report primarily focuses on programs for crop and livestock producers that are available under these two titles. Available policies for managing production and price risk are discussed with recent trends in program enrollment and outlays provided.
