Improving the use of research evidence in guideline development: 13. Applicability, transferability and adaptation

Schünemann, Holger J; Fretheim, Atle; Oxman, Andrew D

• Implementability (i.e. how practical it would be for the NHS in Scotland to implement the recommendation.) SIGN guideline development groups are provided with a form in which to record the main points from their considered judgement [24] . Once they have considered these issues, the group is asked to summarise its view of the evidence and assign a level of evidence to it, before going on to derive a graded recommendation. During this process SIGN guideline developers are also able to downgrade a recommendation if they think the evidence is not generalisable, not directly applicable to the target population, or for other reasons is perceived as being weaker than a simple evaluation of the methodology would suggest. In other areas, the appropriate action may be inclusion in the guideline of a commentary on the main economic issues that should be considered in relation to the subject of the guideline (for example [25] ). Another option is the provision of basic information that will allow guideline users to work out the resource implications for their own service (for example [26] ).