Collaboration is key to AAOS' commitment to evidence-based medicine
In recent years, the AAOS research department started offering services to assist in the development of evidence-based medical products, such as clinical practice guidelines (CPGs) and appropriate use criteria (AUC), for interested medical societies and organizations.

AAOS has been recognized for its expertise and extensive resources, and organizations—such as the Musculoskeletal Tumor Society (MSTS), the American Association of Hip and Knee Surgeons (AAHKS), the American Physical Therapy Association (APTA), and several others— have partnered with the research department on a variety of quality products. Each project not only uses research as a bridge across medical modalities, but also generates evidence-based healthcare guidelines for quality improvement efforts around the world. AAOS plays a leading role in evidence-based medicine and will continue to facilitate and encourage collaboration on product development for quality improvement.

$1.5 million DOD grant awarded to AAOS research department and METRC
The AAOS recently launched a joint effort to create CPGs and AUCs with the Major Extremity Trauma and Rehabilitation Consortium (METRC). METRC, anchored by a data and research center at the Johns Hopkins Bloomberg School of Public Health, develops research to improve the clinical, functional, and quality of life outcomes of both service members and civilians who sustain extremity trauma.

To make this research actionable, AAOS was awarded $1.5 million from the U.S. Department of Defense (DoD) to produce six CPGs and six AUCs over the course of 4 years. The topics, as selected by METRC, are pertinent to military care and include the following:

• acute compartment syndrome (ACS)
• limb salvage and/or amputation procedures
• screening for psychosocial risk and protective factors
• multimodal perioperative pharmacologic pain management
• prevention of post-trauma surgical site infection

Each project topic will also be supported by members of the Orthopaedic Trauma Association (OTA), Society of Military Orthopaedic Surgeons (SOMOS), and other relevant organizations, as needed, to develop evidence-based recommendations and appropriate use criteria.

This effort will not only provide evidence-based recommendations for effective care options, but it will also allow relevant experts to guide appropriate clinical application of that evidence for specific patient scenarios, as seen in the field.

Patrick Osborn, MD, FAOA, a cochair of the ACS workgroup, stated, "It is exciting to be part of the ACS project team, and I look forward to providing guidance on the diagnosis and treatment of ACS. This committee's work will impact the care of patients in the battlefield and at home as well as aid decision making for orthopaedic surgeons, emergency room physicians, and others who treat these patients."

APTA partners with AAOS research department
The APTA sought out the expertise of the AAOS quality and value unit as consultants to assist in the creation of a CPG. The guideline workgroup consisted of members from the AAOS, APTA, the National Association of Orthopaedic Nurses, and a patient safety activist from Consumers United for Evidence-Based Healthcare. The workgroup convened at APTA headquarters in September to construct the specific investigative framework of the guideline.

The topic of interest for the project centers on total knee arthroplasty (TKA) with a focus on pre- and postoperative physical therapy management of adults with osteoarthritis. The workgroup expects to provide recommendations to assist physical therapists gain insights into the efficacy of pre- and postoperative services provided to patients, specifically in the realm of supervised exercise programs, range of motion exercises, pain and swelling management protocols, and other various strength and conditioning practices to limit postoperative complications and improve movement.

Stephen Hunter, PT, DPT, a cochair of the project, is enthusiastic about the initiative. "In my work with Intermountain Healthcare, I have witnessed the valuable results of standardizing care. I am honored to collaborate with AAOS and APTA on a project to develop an evidence-based CPG to improve the continuum of care for TKA patients. Leveraging the expertise of AAOS will accelerate our efforts."

His sentiment was echoed by cochair Diane Jette, PT, DSc, FAPTA, who reinforced the importance of strong association collaboration. "It makes good sense for our profession to [work] with a group who is skilled and has the systems and personnel in place to manage an efficient and effective process. The most important quality of a CPG […] is its validity. I feel as if we will have a valid CPG at the end of the process that our colleagues will view as a high-quality, useful tool. The perception, in part will be due to the combination of physical therapists' multi-focal expertise and the systems approach provided by the AAOS."

Collaborations such as this one will allow participating organizations to create quality, evidence-based guides that will ultimately benefit patients everywhere. Presently, the project is in the abstract review stage, which is slated to be finished sometime in 2018.

AAOS continuously strives to be a leader in the ever-evolving field of research, and collaboration with other organizations is an integral part of that effort. All AAOS quality projects enable clinicians from a variety of disciplines to incorporate their expertise along with best available evidence to guide clinical decision making around the world.

AAOS members or associated organization members who are interested in taking part in upcoming project workgroups or who would like more information about building a collaborative project, are encouraged to contact or submit referrals to ebm@aaos.org.

Kyle Mullen, MPH, is lead research analyst; Danielle Schulte, MS, is research analyst; and Jayson Murray, MA, is manager, quality and value, in the AAOS department of research, quality and scientific affairs.