title: A Systematic Review and Appraisal of Clinical Practice Guidelines for Musculoskeletal Soft Tissue Injuries and Conditions.
abstract: BACKGROUND
  Clinical practice guidelines (CPGs) are published by several sports medicine institutions. A systematic evaluation can help identify the highest quality CPGs for clinical use and identify any deficiencies that remain.
  
  
  OBJECTIVE
  To identify and appraise CPGs relevant to clinical sports medicine professionals.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Predetermined selection criteria were utilized by 2 reviewers who independently identified published CPGs before January 1, 2014. CPGs were excluded if they focused on injured workers, radiological criteria, medical pathology, or the axial skeleton (back/neck). The remaining guidelines were scored by 6 reviewers with different clinical backgrounds using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Scores lower than 50% indicated deficiency. Scores were also stratified by the publishing institution and anatomic location and compared using Kruskal-Wallis tests. The Spearman correlation coefficient was used to assess the range of interobserver agreement between the evaluators.
  
  
  RESULTS
  Seventeen CPGs met the inclusion criteria. The majority of guidelines pertained to the knee, ankle, or shoulder. Interobserver agreement was strong ( r = 0.548-0.740), and mean total scores between nonsurgical (107.8) and surgical evaluators (109.3) were not statistically different. Overall guideline quality was variable but not deficient for 16 of 17 guidelines (>50%), except regarding clinical "applicability" and "editorial independence." No difference was found between CPGs of the knee, shoulder, foot/ankle, or chronic conditions. However, CPG publishing institutions had significantly different scores; the American Academy of Orthopaedic Surgeons (AAOS) guidelines scored significantly higher (141.4) than the total mean score (108.0).
  
  
  CONCLUSIONS
  The overall quality of sports medicine CPGs was variable but generally not deficient, except regarding applicability and editorial independence. Bias through poor editorial independence is a concern. To improve future guideline quality, authors should pay particular attention to these areas and use existing highest quality guidelines, or the AGREE II instrument, as templates. CPGs dedicated to anatomic areas other than the knee, ankle, and shoulder are needed.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pincus
authors.affiliation: Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Kuhn
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ujash
authors.initials: U
authors.lastname: Sheth
authors.affiliation: Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Rizzone
authors.affiliation: Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Kristi
authors.initials: K
authors.lastname: Colbenson
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tim
authors.initials: T
authors.lastname: Dwyer
authors.affiliation: Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Karpinos
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.|Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Marks
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.|Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.|Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Wasserstein
mesh_terms: D001265:Athletic Injuries / Q000628:therapy*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D017695:Soft Tissue Injuries / Q000628:therapy*; D013178:Sports Medicine / Q000592:standards*
keywords: clinical assessment; clinical practice guidelines; epidemiology; statistics