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Practice parameters are strategies for patient management that assist physicians in clinical decision making. A practice parameter is one or more specific recommendations based on analysis of evidence of a specific clinical problem. The recommendations are rated as Standard, Guideline or Option:

Standard: A principle for patient management that reflects a high degree of clinical certainty (usually this requires class I evidence that directly addresses the clinical question, or overwhelming class II evidence when circumstances preclude randomized clinical trials).

Guideline: A recommendation for patient management that reflects moderate clinical certainty (usually this requires class II evidence or a strong consensus of class III evidence).

Practice option: A strategy for patient management for which the clinical utility is uncertain (inconclusive or conflicting evidence or opinion).

These recommendations are based on the following levels of evidence for therapeutic modalities:

Class I: Evidence provided by one or more well designed randomized controlled clinical trials, including overviews (meta-analyses) of such trials.
Class II: Evidence provided by well designed observational studies with concurrent controls (e.g., case control and cohort studies).
Class III: Evidence provided by expert opinion, case series, case reports, and studies with historical controls.

Practice Advisories:

A practice advisory is a practice recommendation for emerging and/or newly approved therapies or technologies based on evidence from at least one class I study. The evidence may demonstrate only a modest statistical effect or limited (partial) clinical response, or significant cost-benefit questions may exist. Substantial (or potential) disagreement among practitioners or between payers and practitioners may exist. The strength of practice advisory recommendations are based on the practice parameter levels of evidence.

Therapeutic and Technology Assessments:

Technology assessments are statements that assess the safety, utility, and effectiveness of new, emerging, or established therapies and technologies in the field of neurology. Assessment recommendations are rated as follows:

Safe: A judgment of the acceptability of risk in a specified situation, e.g., for a given medical problem, by a provider with specified training, at a specified type of facility.
Effective: Producing a desired effect under conditions of actual use.
Established: Accepted as appropriate by the practicing medical community for the given indication in the specified patient population.
Possibly Useful: Given current knowledge, this technology appears to be appropriate for the given indication in the specified patient population. If more experience and long-term follow-up are accumulated, this interim rating may change.
Investigational: Evidence insufficient to determine appropriateness, warrants further study. Use of this technology for given indication in the specified patient population should be confined largely to research protocols.
Doubtful: Given current knowledge, this technology appears to be inappropriate for the given indication in the specified patient population. If more experience and long-term follow-up are accumulated, this interim rating may change.
Unacceptable: Regarded by the practicing medical community as inappropriate for the given indication in the specified patient population.

These recommendations are based on the following evidence ratings for diagnostic tests:

Class I: Evidence provided by one or more well-designed clinical studies of a diverse population using a "gold standard" reference test in a blinded evaluation appropriate for the proposed diagnostic application.
Class II: Evidence provided by one or more clinical studies of a restricted population using a reference test in a blinded evaluation of diagnostic accuracy.
Class III: Evidence provided by expert opinion, non-randomized historical controls, or observation(s) from case series.

Suggested Strength of Recommendations

Type A: Strong positive recommendations, based on Class I evidence, or overwhelming Class II evidence when circumstances preclude randomized clinical trials.
Type B: Positive recommendation, based on Class II evidence.
Type C: Positive recommendation, based on strong consensus of Class III evidence.
Type D: Negative recommendation, based on inconclusive or conflicting Class II evidence.
Type E: Negative recommendation, based on evidence of ineffectiveness or lack of efficacy, based on Class II or Class I evidence.

Quack Chasers with Apparent Political Agenda

At least some caution is advised for most of these sites. Many have a political agenda and/or too much media hype focus and none are associated with any professional medical or psychological associations. Notably, Politics Usually Corrupts Objectivity. For example, some are overly zealous and prone to overstatement, filtering, confirmatory bias, overgeneralization, uniformity myths, reactive responses, etc, and some have been called "biased" or "not credible" by reputable scientists and/or courts. Hence, these should not be relied upon as single sources or reliable representations of science, and should not be relied upon to accurately represent the empirically based evidence from the previous sites. That is, there are no simple solutions, single sources, or substitutes for conducting your own literature review.

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