AAOS Evidence-Based Clinical Practice Guidelines

Frequently Asked Questions

1. How can I get copies of an AAOS Guideline?

All approved AAOS guidelines are available free on our website at the following link: http://www.aaos.org/guidelines

2. Who participates on guideline work groups?

Work groups consist of approximately eight physician members of diverse backgrounds. Sometimes physical therapists or other healthcare experts may be asked to participate on a work group depending on the guideline topic. Work group members are generally considered content experts on the guideline topic. Chairpersons of a guideline work group are nominated to participate in the process by the AAOS Guidelines and Technology Oversight Committee (GTOC), the Evidence-Based Practice Committee (EBPC) and the AAOS Council on Research, Quality Assessment and Technology. The AAOS Oversight Chairs, who consist of the Chairs of these committees and council as well as the AAOS Medical Director, must approve participation of any member on a guideline work group. All work group members should have some training in evidence-based medicine. At a minimum, members should have taken the AAOS on-line evidence–based training course. These courses are currently available at the following links:

http://www5.aaos.org/oko/CME/templates/template_2/information.cfm?topic=CME071

http://www5.aaos.org/oko/CME/templates/template_3/information.cfm?course=CME087

3. How long does it take to prepare an AAOS guideline?

AAOS Guidelines take twelve to eighteen months to prepare. This includes the peer review process, period of public commentary and the final approval process. All AAOS guidelines are peer reviewed for a minimum of thirty days by the Guidelines and Technology Oversight Committee (GTOC), the Evidence-Based Practice Committee (EBPC), and peer reviewers who participate on behalf of outside specialty societies.

The period of public commentary follows the peer review and is also approximately thirty days. Members of the AAOS Board of Specialty Societies, Board of Councilors, Council on Research, Quality Assessment and Technology, and the Board of Directors provide public comment. AAOS response to public commentary is general. Individual responses following public comment will only be made if the input provided by a public commentator results in a change to the guideline.

The final approval process requires sequential approval of the document by the, EBPC, GTOC, Council on Research, Quality Assessment and Technology and the Board of Directors. All peer review comments and a list of changes made to the documents as a result of the review processes accompany the guideline through the approval process.

4. How does the AAOS combat bias in its guidelines?

All of the AAOS’ guidelines are prepared using systematic, well-defined processes that make it possible for readers to scrutinize every aspect of the decision-making that went into an AAOS clinical practice guideline. AAOS guidelines strive to be unbiased, transparent, and reproducible.

5. Why are the inclusion criteria for the literature specified before any literature searches are conducted?

These criteria ensure that a guideline does not address only articles that support a particular point of view. To assist in this, searches for literature are as comprehensive as practicable. Finally, these criteria are published in each guideline so that readers can assure themselves that they are objective. Again, this prevents bias, enhances transparency and promotes reproducibility.

6. I read an article used as evidence in one of the AAOS guidelines and the author’s conclusion was different than the conclusion found in the AAOS guideline. I found this very disconcerting. How can this happen?

The research analysts who extract data from included studies never read an author’s conclusions. They read the methods and statistics sections of the articles and extract the data applicable to a given recommendation. AAOS uses all of the available statistical data from all of the studies included for a recommendation to do our own de novo analysis. The conclusions we reach will be based on the body of evidence to support a recommendation and not on individual studies or individual author’s conclusions.

Participation by Specialty Societies

7. When can I get copies of an AAOS Guideline Confidential Draft?

Confidential drafts are available once the Work Group Chair and AAOS Oversight Chairs agree the documents are ready for the review process. Confidential drafts are available approximately thirty to sixty days following the final recommendation meeting. (See this link for tentative guideline meeting schedules: http://www.aaos.org/research/guidelines/Guideline_Progress.asp).

8. How does the AAOS decide what specialty societies will review a specific guideline?

The Guideline Work Group nominates societies to peer review specific guidelines at the beginning of the development process. Outside specialty societies who have a strong interest in the content of the guideline are nominated by the guideline work group a priori to any work being done to develop the guideline. Specialty societies are solicited based on these nominations via a letter from the Guidelines and Technology Oversight Chairperson to the leadership of the specialty society. The society president, and if possible the Executive Director and second vice-president are all solicited. If the society chooses to participate in this process, they provide a member of their choosing to peer review the confidential draft of the guideline. The specialty society provides the name and contact information of a peer reviewer to Janet L. Wies, CPG Manager for AAOS, at wies@aaos.org. The reviewer will receive a copy of the confidential draft via a CD sent second business day FED EX at the beginning of the peer review process. The package will contain a CD with the guideline, structured review form and instructions including specification of all deadlines.

9. Who can participate as a peer reviewer for our specialty society?

A specialty society may contribute up to three peer reviewers for a single guideline. Reviewers should be very knowledgeable of the topic and have some evidence-based training.

Alternately, a specialty society may choose to have their evidence-based practice committee (or other applicable committee) peer review a guideline. The AAOS will provide up to three CDs to a specialty society for distribution. The specialty society will be responsible for copying and distributing additional CDs. We respectfully request that the responses from a committee or group larger than three members be compiled into a single succinct document with duplicate questions and comments removed. This will count as one peer review for the society.

If a specialty society wishes to provide peer review for a specific guideline but are uncertain as to whether or not they have been nominated as a society with an interest in a topic or if a society wishes to be solicited for ALL topics developed by the AAOS, they may contact Jan Wies at wies@aaos.org or at 847-384-4311.

10. Can a specialty society post the confidential draft of an AAOS Guideline to their website for input from our general membership?

Yes, this may be done during the period of public commentary, which follows the thirty day period of peer review, when the return response from the AAOS is a general reply to all commentary. However:

• Your society may NOT post the name of any work group member who participated in the development of the guideline. This information is not published until all review processes are completed for the guideline to limit bias.

• The confidential draft must be posted to a site for members only.

• The specialty society delegate/board/or designee will be responsible to collate all member responses into one succinct document listing all public comments from that society. The society must eliminate duplicate and redundant comments and summarize similar input.

• The society must return the garnered comments to the AAOS within all specified deadlines.

• Peer reviewers who provide review from other specialty societies but do not give explicit permission to be published in the guideline as a peer reviewer must be removed from the document (or the identity of that reviewer blacked out) prior to posting on any specialty societies’ websites.

11. Will the AAOS make changes to the guideline based on our societies input?

AAOS uses all of the available statistical data from all of the studies included for a recommendation to do our own de novo analysis. The conclusions we reach will be based on the body of evidence to support a recommendation and not on individual studies or individual author’s conclusions. We make changes to guideline drafts based only on the evidence; therefore, if a study has been missed or evidence misinterpreted we will make changes based on that evidence. Changes to a guideline are never made based on individual responses that state “in my personal experience” or “this recommendation is not acceptable/liked by our membership”.

A maximum of three formal peer reviews from any single society are accepted. An outside specialty society can post the confidential draft to their “member only” website and solicit their total membership for input; however, that society must manage those responses. The delegate of that society is responsible for compiling all responses, eliminating duplicate questions and submitting one succinct structured peer review (in Microsoft word format) on behalf of the given society. Further, it is the responsibility of the society’s delegate to submit the response within the specified deadlines for peer review. The AAOS will respond to all non-editorial comments. All changes to the guideline must be based on the evidence.

12. How are AAOS guidelines disseminated?

The AAOS issues an official press release once a guideline has been approved. In addition to the press release, guidelines are disseminated in a variety of ways including posting to the National Guidelines Clearinghouse, writing guideline summary articles in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), AAOS Now, the Journal of Bone and Joint Surgery (JBJS), and distributing the guidelines on CDs at specialty society meetings. The guidelines are also used to develop OITE questions, educational webinars, content for Orthopaedic Learning Center courses, and informative displays at the AAOS Annual Meeting.

All AAOS approved guidelines are available for free on our website at the following link:

http://www.aaos.org/research/guidelines/guide.asp

The AAOS schedule for guidelines in development is available at the following link:

http://www.aaos.org/research/guidelines/Guideline_Progress.asp

Additional questions about the AAOS Guideline development process?

CONTACT:

Janet L. Wies is the AAOS Clinical Practice Guidelines Manager and she coordinates all guideline development. Jan can be reached at wies@aaos.org or 847-384-4311.

Fareeha Shuttari-Khan is the AAOS Evidence-based Medicine Coordinator and she is responsible for dissemination and publication of all finished guidelines. Fareeha can be reached at Shuttari@aaos.org or 847-384-4339.