Understanding Guideline Language
Best Evidence Synthesis
We include only the best available evidence for any given outcome addressing a recommendation. Accordingly, we first included the highest quality evidence for any given outcome if it was available. In the absence of two or more occurrences of an outcome at this quality, we considered outcomes of the next lowest quality until at least two or more occurrences of an outcome had been acquired. For example, if there were two ‘moderate’ quality occurrences of an outcome that addressed a recommendation, we did not include ‘low’ quality occurrences of this outcome.
Current Quality Requirements (6/2013 - Present)
| Strong - Two or more HIGH quality studies |
| Moderate - One HIGH or 2 MODERATE quality studies |
| Limited - One MODERATE or 2 or more LOW quality studies |
| Consensus – Expert opinion (no studies) |
Language Stems
To prevent bias in the way recommendations are worded, the AAOS uses specific predetermined language stems that are governed by the evidence strengths. Each recommendation was written using language that accounts for the final strength of the recommendation.
Current Language Stems (10/2019 - Present)
| Required | Suggested |
| Strong - Should; Recommend | the practitioner should/should not do X, because… |
| Moderate - Could; Can | the practitioner could/could not do X, because… |
| Limited - May; Might; May Consider | the practitioner might/might not do X, because… |
| Consensus - In the absence of reliable evidence, it is the opinion of the work group that… |
Retired Quality Requirements and Language Stems
Language Stems
To prevent bias in the way recommendations are worded, the AAOS uses specific predetermined language stems that are governed by the evidence strengths. Each recommendation was written using language that accounts for the final strength of the recommendation.
Retired Language Stems (6/2013 - 9/2019)
| Required |
| Strong - Strong evidence supports that |
| Moderate - Moderate evidence supports that |
| Limited - Limited evidence supports that |
| Consensus - In the absence of reliable evidence, it is the opinion of the work group that… |
Retired Quality Requirements (7/2009 – 5/2013)
| Strong - Two or more HIGH quality studies |
| Moderate - One HIGH or 2 MODERATE quality studies |
| Limited - One MODERATE or 2 LOW quality studies |
| Consensus – Expert opinion (no studies)** |
| Inconclusive – One LOW quality study, Contradictory studies, Lack of evidence (no studies) |
** For the work group to make a consensus-based recommendation, the recommendation must be supported by a rationale that follows specific rules.
Retired Language Stems (7/2009 - 5/2013)
| Strong - We recommend… or We cannot recommend |
| Moderate - We suggest… |
| Limited - It is an option… |
| Consensus - In the absence of reliable evidence, it is the opinion of the work group… |
| Inconclusive - We are unable to recommend for or against… |