Evaluation of the Clarity and Completeness of Reporting in Orthopedic Clinical Practice Guidelines

Abstract

Background Clinical practice guidelines (CPGs) can positively affect the quality of patient care offered by physicians because they decrease variability in clinical practice and may help reduce unnecessary testing, promoting a more responsible use of resources. Building on existing framework for reporting guideline development, including the work of the Enhancing the Quality and Transparency of Health Research Network, the Reporting Items for Practice Guidelines in Healthcare (RIGHT) Working Group created a 2016 checklist of 35 items considered essential for high-quality reporting of CPGs. Objectives To evaluate how many previously published CPGs in orthopedic surgery met the RIGHT criteria and assess how improvements can be made in future orthopedic CPGs based on any found deficiencies. Methods All 18 CPGs published before January 1, 2018, by the American Academy of Orthopedic Surgeons (AAOS) are publicly available on orthoguidelines.org. Two authors downloaded each file and both of those authors independently scored each CPG using piloted abstraction RIGHT checklist forms. Results Of the 35 RIGHT criteria outlined in 22 checklist items, 23 (65.7%) were met across all AAOS guidelines, 6 (17.1%) were not met by any of the AAOS guidelines, and 6 (17.2%) were met by some of the AAOS guidelines. Conclusion Overall, the AAOS guidelines addressed many important recommendations within the RIGHT checklist. Assessing adherence to the RIGHT checklist can help ensure that future guidelines are more effectively communicated, hopefully assisting end users in efficient implementation and increasing the level of evidence-based patient care.

Clinical Practice Guideline Recommendations in Pediatric Orthopaedic Injury: A Systematic Review

“…High-quality CPGs consistently scored well in rigor of development and clarity of presentation, but lower scores were observed for applicability, particularly for AAOS guidelines. These observations are in line with multiple studies on CPG quality in a wide variety of medical fields, 35,36 including AAOS guidelines 7,8 . Our study highlights the need to provide implementation toolkits to clinicians with more explicit consideration of resources, costs, and other barriers 35 .…”

“…These observations are in line with multiple studies on CPG quality in a wide variety of medical fields, 35,36 including AAOS guidelines. 7,8 Our study highlights the need to provide implementation toolkits to clinicians with more explicit consideration of resources, costs, and other barriers. 35 The Centers for Disease Control and Prevention provides an excellent example of focusing on CPG accessibility; they worked with early adopters to develop guidance on both how to implement and to evaluate the success of CPG recommendations in clinical practice.…”

“…20 To do so, we mapped quality of evidence and strength of recommendation ratings reported in CPGs to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) categories, in consultation with our advisory committee (eTable 3, Supplemental Digital Content 1, http://links.lww.com/BPO/ A648). The advisory committee also identified the following 9 key areas of management to categorize recommendations: (1) history and physical examination, (2) initial diagnostic imaging, (3) consultation, disposition, and discharge, (4) immobilization, (5) operative management, (6) pain management, (7) follow-up diagnostic imaging, (8) patient and family support, and (9) planning for follow-up care and rehabilitation. Discrepancies in all phases of the review were resolved by discussion with a senior member of the research team (S.C.).…”

“…6 Although it is important to balance sound clinical judgement with the use of CPGs, a synthesis of current CPG recommendations is needed to consolidate the strongest evidence-based recommendations, to clarify standards of care in pediatric orthopaedic injury, and to identify the gaps and limitations. Previous studies have evaluated the quality of AAOS guidelines 7,8 and assessed the risk of bias of randomized controlled trials underpinning AAOS recommendations. 9 However, no global synthesis of CPG recommendations for pediatric orthopaedic injury care exists.…”

Analysis of the Evidence Underpinning the American Academy of Orthopedic Surgeons Knee Osteoarthritis Clinical Practice Guidelines

“…29 However, other researchers have suggested that even the highest levels of evidence supporting orthopaedic CPGs may be compromised by publication bias, financial conflicts of interest, underpowered conclusions, and low reproducibility. 4,5,11,33 Orthopaedic CPGs have found difficulties not just in production but also in adherence to the guideline's recommendations. For example, great variability in adherence to recommendations has been well established in the management of knee osteoarthritis, with authors reporting adherence rates low as 21% in some situations.…”