Abstract
The goals of evidence-based clinical practice guidelines in medicine are to promote best practices and reduce variations. Ideally they should improve physician performance and patient outcomes. Although controversy exists about the definition of a high quality guideline and how guidelines will be used in our health care system, there is a call for their use to help improve quality patient care. Guidelines related to musculoskeletal topics should be developed by national orthopaedic organisations and subspecialty societies using the best available clinical evidence.
The American Academy of Orthopaedic Surgeons has, since 2007, developed nine evidence-based guidelines in the areas of hand, sports, foot/ankle, shoulder, paediatrics and total joint replacement. The keys to successful guideline development include an expert methodologist, an experienced evidence analysis staff, strict adherence to established rules to minimise bias, and strong communication with relevant subspecialty societies.
The AAOS process allows any individual or group to submit a potential topic for consideration. A physician workgroup of 5-8 members is selected after wide advertisement of the topic. Workgroup members must have no relevant financial conflicts of interest to the topic and are required to fill out an enhanced disclosure form. The workgroup is comprised of orthopaedic surgeons and other specialists with expertise in the topic. There are two in-person meetings between which the staff finds and analyses the data to support the specific initial questions. The final document is 300-350 pages. There is a period of peer review by relevant societies as well as a period of public commentary followed by the formal committee and Board approval.
The final guideline is disseminated widely via press releases, subspecialty societies, AAOS meetings, webinars, JBJS, JAAOS, and related questions on resident and member national examinations. These guidelines now form the basis for future AAOS quality initiatives.
