Department of Surgery and Cancer, Imperial College, 10th Floor QEQM Building, St Mary's Hospital, London, W2 1NY, UK,
Clin Orthop Relat Res. 2014 Jun;472(6):1982-8. doi: 10.1007/s11999-014-3530-0. Epub 2014 Feb 25.
The American Academy of Orthopaedic Surgeons (AAOS) is a globally recognized leader in musculoskeletal and orthopaedic education. Clinical guidelines are one important focus of the AAOS' educational efforts. Although their recommendations sometimes generate controversy, a critical appraisal of the overall quality of these guidelines has not, to our knowledge, been reported.
QUESTIONS/PURPOSES: We wished to assess the overall quality of the AAOS guidelines using the AGREE II (Advancing Guideline Development, Reporting and Evaluation in Health Care) instrument.
All 14 guidelines available on the AAOS website as of August 2, 2013 were evaluated. Appraisal was performed by three reviewers, independently, using the AGREE II instrument. This is an internationally recognized and validated assessment tool for evaluating guideline quality. Interrater reliability was calculated and descriptive statistics were performed. Strong interrater reliability was shown using a Spearman's Rho test (correlation coefficient ≥ 0.95).
The overall results for AGREE II domains across all 14 guidelines were: scope and purpose (median score, 95%), stakeholder involvement (median score, 83%), rigor of development (median score, 94%), clarity of presentation (median score, 92%), applicability (median score, 48%), and editorial independence (median score, 79%).
This study showed that the overall quality of the AAOS guidelines is high, however their applicability was found to be poor. The value of guidelines that have a high quality but that are difficult for clinicians to implement is questionable. Numerous suggestions have been proposed to improve applicability including; health economist involvement in guideline production, implementation of pilot studies and audit to monitor uptake of the guidelines and clinician feedback sessions and barrier analysis studies. Future AAOS guidelines should consider and implement steps that can improve their applicability.
美国骨科医师学会（AAOS）是全球公认的肌肉骨骼和骨科教育领导者。临床指南是 AAOS 教育工作的一个重要重点。尽管他们的建议有时会引起争议，但据我们所知，尚未对这些指南的总体质量进行批判性评估。
问题/目的：我们希望使用 AGREE II（在医疗保健中推进指南制定、报告和评估）工具评估 AAOS 指南的总体质量。
评估了截至 2013 年 8 月 2 日 AAOS 网站上提供的所有 14 条指南。使用 AGREE II 工具由三名审阅者独立进行评估。这是一种国际公认和验证的评估指南质量的工具。计算了组内相关性并进行了描述性统计。使用 Spearman Rho 检验（相关系数≥0.95）显示出很强的组内相关性。
所有 14 条指南的 AGREE II 领域的总体结果为：范围和目的（中位数评分，95%）、利益相关者参与（中位数评分，83%）、制定的严谨性（中位数评分，94%）、表述的清晰度（中位数评分，92%）、适用性（中位数评分，48%）和编辑独立性（中位数评分，79%）。
本研究表明，AAOS 指南的总体质量很高，但适用性较差。对于难以实施的指南，其质量高的价值是值得怀疑的。已经提出了许多建议来提高适用性，包括：指南制定过程中纳入卫生经济学家、实施试点研究和审计以监测指南的采用情况以及临床医生反馈会议和障碍分析研究。未来的 AAOS 指南应考虑并实施能够提高其适用性的步骤。
