Physical Health Guidelines
Icons used in these guidelines
Recommendations with are strongly recommended; the symbol indicates clinicians’ top recommendations; or indicates that reviewed publications pertain to the guideline background; blue indicates a subtype that increases the strength of the recommendation.
Types of knowledge
The guideline recommendations are based on four different types of knowledge: empirical knowledge; knowledge about the health care ecosystem; clinical expert knowledge; and experiential knowledge. The subtypes of knowledge are related to the strength of recommendation.
Strength of Recommendation
These guidelines outline standards of care for which there is a good basis in current knowledge. Other factors, however, were considered for deciding whether a proposed action is “strongly recommended” or “recommended”, including availability and use of resources.
The physical health guidelines are organized like a review of body systems, a familiar format for family physicians that promotes comprehensiveness in history-taking and physical examination, which is also useful for patients who may have difficulty communicating symptoms. The content of the guidelines identifies conditions for which adults with intellectual and developmental disabilities are at a higher risk than those in the general population. Given the evidence available for actions, the recommendations most often involve assessing risk or monitoring individuals for these conditions and providing appropriate advice.
This revision of the previous 2011 guidelines has been expanded to include new recommendations in women’s health and for sleep problems, as well as screening for asthma, COPD and diabetes. The family physicians who were involved in developing the 2018 guidelines also wanted to highlight the recommendations relating to sexuality, mobility and screening for cancer.
The recommendations should be implemented using adaptations that meet the needs of patients with intellectual and developmental disabilities. For example, improving communication using pictures or easy-read leaflets is recommended. Planning longer or multiple appointments, depending on the preferences of the patient, will also likely be helpful.
The clinical method and comprehensive scope implied by these guidelines match the skills and experience of Canadian family physicians, primary health care nurse practitioners and nurses. This means that patients, family members and health care providers should feel confident that the recommendations can be carried out effectively in primary care.
Ian Casson (MD, MSc, FCFP), is a family doctor with a general practice that includes adults with intellectual and developmental disabilities. He has been involved in clinical service, education and research through Queen’s University’s Department of Family Medicine’s Intellectual and Developmental Disabilities Program.