This article is more than 5 years old. Information may no longer be current.

Evidence-based guidelines explained, highlighted in AAOS exhibit

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

SAN DIEGO — An overview of American Academy of Orthopaedic Surgeons’ recently approved guidelines was presented as a scientific exhibit here, at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

The exhibit, which was created by William Timothy Brox, MD, a member of the American Academy of Orthopaedic Surgeons (AAOS) Evidence Based Practice Committee, also included a section which defined language used in AAOS guidelines based on recommendation grade and level of evidence.

According to the exhibit, a guideline that uses the term “recommend” has a “strong” recommendation grade and is based on level 1 evidence. A guideline that uses the term “suggest” has a “moderate” recommendation grade and is based on level 2 evidence. A guideline that characterizes a treatment as an “option” has a “weak” recommendation grade and is based on level 4 or 5 evidence. A guideline that is unable to recommend “for or against” has an “inconclusive” recommendation grade due to insufficient or conflicting evidence.

Five recently approved AAOS guidelines were featured in the exhibit: treatment of osteoporotic spinal compression fractures; treatment of acute Achilles tendon rupture; treatment of glenohumeral joint arthritis; treatment of distal radius fractures; and diagnosis of periprosthetic joint infections of the hip and knee.

Selected recommendations were included with each guideline, along with its corresponding recommendation grade. Among those recommendations graded as strong were the following:

• against vertebroplasty for patients with osteoporotic spinal compression fractures evidenced on imaging who have correlating clinical signs and symptoms, and are neurologically intact; and
• for erythrocyte sedimentation rate and C-reactive protein testing of patients assessed for periprosthetic joint infection.

Reference:

• Brox WT. Evidence-Based Practice Committee (EBPC) Scientific Exhibit. Scientific exhibit #43. Presented at the2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-18, 2011. San Diego.

Disclosure: Brox has no relevant financial disclosures.

In general, there has been discussion on an international level about who is supposed to be producing guidelines. What I understand from reading the literature is that guidelines from the scientific societies, so-called monospecialistic guidelines, with only one specialty represented, like orthopedic surgeons, are usually not the best ones unless it is a very specific problem, like which pin to use in a fracture — then, they are good. Usually a guideline has a more multidimensional problem to solve, and so you need multiple specialties to be represented.

I work for the Italian guidelines group sometimes and, usually, they are not asking only one society. They call us as orthopedic surgeons but, when they want to do a real national guideline on something, they would also ask rheumatologists, physiatrists, patient representatives and sometimes even industry representatives. All of the stakeholders should be represented, and that is very difficult if you do a guideline only with orthopedic surgeons.

– Gustavo A. Zanoli
Surgical Editor
Cochrane Musculoskeletal Group
Ferrara, Italy

Follow ORTHOSuperSite.com on Twitter