FAQ

1. How can I get copies of an AAOS Guideline?
2. Who participates on guideline work groups?
3. How long does it take to prepare an AAOS guideline?
4. How does the AAOS combat bias in its guidelines?
5. Why are the inclusion criteria for the literature specified before any literature searches are conducted?
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?
7. How are AAOS guidelines disseminated?
8. Who do I contact if I have additional questions about AAOS Guidelines?


 




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/Quality/Clinical_Practice_Guidelines/Clinical_Practice_Guidelines/

2. Who participates on guideline work groups?

Work groups consist of physician members of diverse backgrounds. Interest concerning a guideline topic is solicited from numerous AAOS communication sources including but not limited to the Board of Specialty Societies, Board of Councilors and the leadership of outside specialty societies. Sometimes physical therapists or other healthcare experts may be asked to participate on a work group depending on the guideline topic. Larger topics generally include input from additional subspecialty societies with a vested interest in the content of the guideline. 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 Oversight Committee (GOC) and the Evidence-Based Quality and Value Committee (EBQV) or the Chairs of these respective bodies and, in most cases, must be AAOS members. The AAOS Oversight Chairs, who consist of the Chairs of these committees and the AAOS Medical Director when available, 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 are required to complete the AAOS on-line evidence–based training courses. CME credit is available upon completion. These courses are currently available at the following links:

Evidence Based Orthopaedics: An Introduction

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

AAOS Guidelines take twelve to twenty-four 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 Oversight Committee (GOC), the Evidence-Based Quality and Value Committee (EBQV), and peer reviewers who participate on behalf of outside specialty societies. 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. A solicitation letter is sent to each society president from the Chair of the AAOS Guideline Oversight Committee soliciting the societies’ participation in the peer review process. 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. A maximum of three members from any single society may participate in the peer review process. 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 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.

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 and Quality, 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, EBQV, GOC, Council on Research and Quality and the Board of Directors. All peer review comments, our responses 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. In addition, clinical physician experts and methodologists jointly construct the guideline and evaluate the evidence. 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.

7. 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/Quality/Clinical_Practice_Guidelines/Clinical_Practice_Guidelines/

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

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

8. Who do I contact if I have additional questions about AAOS Guidelines?

Kaitlyn Sevarino, MBA, is the AAOS Evidence-Based Quality and Value Coordinator and is responsible for dissemination of all finished guidelines. She can be reached at sevarino@aaos.org or 847-384-4322.