Developing guidelines in musculoskeletal disorders.
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patients on healthcare decisions. They provide recommendations for the average patient, which should take into account individual clinical judgment and the patient's values and expectations. Quality benchmarks differ from CPGs in that they are best practices that are medically necessary under almost all circumstances, and constitute a standard by which quality of care can be measured. Scientifically rigorous CPGs should be evidence-based and evolve from multidisciplinary and systematic development processes. To maximize their validity, the available evidence must be graded according to its methodological quality and the strength of the recommendations should be based on these ratings. We conducted a systematic review of the literature and relevant websites, which identified 276 CPGs for the diagnosis and/or treatment of musculoskeletal disorders. Of these, 61 were retrieved from 3 sources: 1) the American College of Rheumatology (ACR); 2) the European League against Rheumatism (EULAR); and 3) musculoskeletal CPGs retrieved from the National Guideline Clearinghouse. While use of scientific evidence was commonly cited in the discussion, methodological information was often lacking, without specification as to whether the evidence had been systematically reviewed and graded. We also observed substantial overlap between organizations in the development of CPGs for a given disease.CPGs can improve quality of care by providing evidence-based recommendations. However, it is imperative that they be developed with the utmost transparency, and using a careful and systematic appraisal of the totality of evidence, with recommendations graded according a systematic approach to avoid bias. While many CPGs exist in the rheumatology field, the consensus processes followed in their development is not always explicit, leading to limitations in their interpretations that can hamper broader acceptance and adoption.
Lopez-Olivo
M A
MA
Section of Rheumatology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Suarez-Almazor
M E
ME
D006801:Humans; D009140:Musculoskeletal Diseases / Q000628:therapy*; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D012219:Rheumatology / Q000592:standards