Guideline Peer Review and Public Comment Responses

Following the final guideline work group meeting, the confidential guideline draft undergoes peer review for additional input from external content experts. Written comments are provided on the structured review form (see Appendix VII). All peer reviewers are required to disclose their conflicts of interest.To guide who participates, the guideline development group identifies specialty societies at the introductory meeting. Organizations, not individuals, are specified. The specialty societies are solicited for nominations of individual peer reviewers approximately six weeks before the final meeting. The peer review period is announced as it approaches and others interested are able to volunteer to review the draft. The chairs of the guideline development group and chair of the AAOS committee on Evidence Based Quality and Value reviews the draft of the guideline prior to dissemination.

Some specialty societies (both orthopaedic and non-orthopaedic) ask their evidence-based practice (EBP) committee to provide review of the guideline. The organization is responsible for coordinating the distribution of our materials and consolidating their comments onto one form. The chair of the external EBP committees provides disclosure of their conflicts of interest (COI) and manages the potential conflicts of their members.Again, the AAOS asks for comments to be assembled into a single response form by the specialty society and for the individual submitting the review to provide disclosure of potentially conflicting interests. The peer review stage gives external stakeholders an opportunity to provide evidence-based direction for modifications that they believe have been overlooked. Since the draft is subject to revisions until its approval by the AAOS Board of Directors as the final step in the guideline development process, confidentiality of all working drafts is essential.

The chairs of the guideline development group and the manager of the AAOS evidence-based medicine unit drafts the initial responses to comments that address methodology. These responses are then reviewed by the chair and co-chair, who respond to questions concerning clinical practice and techniques. The director of the Department of Research and Scientific Affairs may provide input as well. All comments received and the initial drafts of the responses are also reviewed by all members of the guideline development group. All proposed changes to recommendation language as a result of peer review are based on the evidence and undergoes majority vote by the guideline development group members. Final revisions are summarized in a detailed report that is made part of the guideline document throughout the remainder of the review and approval processes.

Guideline Peer Review and Public Comment Responses