Pratique d’Activités Physiques Adaptées comme intervention non médicamenteuse (HAS 2011)
Mooven’s Adapted Physical Activity Paths are founded on Evidence Based Medicine. This approach to the practice of Physical and Sports Activities makes it possible to optimise decision-making by emphasising the use of evidence in the design and support of our research/actions. The proposed programmes are initially designed using the most rigorous methodologies (meta-analyses, systematic reviews and randomised controlled trials) to provide a high level of evidence for recommendations. Nevertheless, when the real situation and individual specific needs require us to adapt the “ideal in terms of effectiveness” programme, we are then able to offer “tailor-made” programmes with lower levels of evidence (such as those of case-control studies). Our approach focuses on the use of scientific evidence in the design of guidelines for patient groups and populations.
The steps in designing explicit support pathways, based on scientific evidence, are our real added value:
1/ Answering a question based on critical questioning, a conception of the pathway or programme and the levels of evidence under the prism of the 5Ps: Participatory, Personalised, Predictive, Preventive and Proven on the population, the intervention, the results, the time horizon, the framework)ouvrir la parenthese?;
2/ Systematic search for the best available evidence thanks to our R&D Innovation department;
3/ Critical evaluation of validating evidence (selection bias, information bias and a confounding factor…);
4/Quantitative and qualitative aspects of the diagnosis in terms of adapted physical activities and recommended programmes (The size of the effect and its accuracy, Clinical importance of the results, External or generalisable validity, application of the results in current practice after computer scanning in our databases, Evaluation of the performance of the effect…).
Categories of recommendation
In guidelines and other publications, the clinical service recommendation is ranked according to the risk/benefit balance and the level of evidence on which this information is based. The U.S. Working Group on Preventive Services uses:
Level A: Good scientific evidence suggests that the benefits of the clinical service far outweigh the potential risks. Clinicians should discuss the service with eligible patients.
Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweigh the potential risks. Clinicians should discuss the service with eligible patients.
Level C: At least convincing scientific evidence suggests that the clinical service has benefits, but that the balance between benefits and risks is too close to make general recommendations. Clinicians do not need to offer it unless there are individual considerations.
Level D: At least fair scientific evidence suggests that the risks of the clinical service outweigh the potential benefits. Clinicians should not systematically offer this service to asymptomatic patients.
Level I: Scientific evidence is lacking, of poor quality or contradictory, so the risk/benefit ratio cannot be assessed. Clinicians should help patients understand the uncertainty surrounding clinical service.
GRADE guidelines experts can make strong or weak recommendations based on additional criteria. Some of the important criteria are the balance between desirable and undesirable effects (regardless of costs), the quality of evidence, values, preferences and costs.