ArticleClinical orthopaedics and related research2014
High methodologic quality but poor applicability: assessment of the AAOS guidelines using the AGREE II instrument.
Article in Clinical orthopaedics and related research, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 30 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
30 citing papers in PubMed, 7 syntheses or guidelines pooled it, 77 citations in OpenAlex.
- Evidence-based clinical practice guidelines for the management of acute ankle injuries according to: a PRISMA systematic review and quality appraisal with AGREE II.BMC musculoskeletal disorders · 2024Pooled it
- Appraisal of the current guidelines for the management of diverticular disease using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument.Annals of the Royal College of Surgeons of England · 2021Pooled it
- Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia.BMJ open · 2021Pooled it
- Quality of biosafety guidelines for dental clinical practice throughout the world in the early COVID-19 pandemic: a systematic review.Epidemiology and health · 2021Pooled it
- Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments.PloS one · 2017Pooled it
- Clinical practice guidelines for the management of neuropathic pain: a systematic review.BMC anesthesiology · 2016Pooled it
- Pooled it
- Determining the methodological rigor and overall quality of out-of-hospital clinical practice guidelines: a scoping review.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Article
- Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty.Scientific reports · 2024Article
- Assessment of the AAOS guidelines using the AGREE II instrument: An update.Journal of orthopaedics · 2023Article
- Clinical Practice Guidelines in an Era of Accountability, Saudi Arabia: A Call for Action.Journal of epidemiology and global health · 2023Article
- Modern Paediatric Emergency Department: Potential Improvements in Light of New Evidence.Children (Basel, Switzerland) · 2023Review
- A critical appraisal of Evicore's guidelines for advanced diagnostic imaging of the spine for lower extremity pain with neurological features.Journal of spine surgery (Hong Kong) · 2023Article
- Patient and public involvement in implementation of evidence-based guidance for musculoskeletal conditions: a scoping review of current advances and gaps.BMC rheumatology · 2022Article
- COVID-19 therapies for inpatients: a review and quality assessment of clinical guidelines.ERJ open research · 2022Review
- Quality of recent clinical practice guidelines in anaesthesia publications using the Appraisal of Guidelines for Research and Evaluation II instrument.British journal of anaesthesia · 2022Review
- Abdominal aortic aneurysm clinical practice guidelines: a methodological assessment using the AGREE II instrument.BMJ open · 2022Article
- The Quality of Six Clinical Practice Guidelines in Health and Social Sciences: Are We on the Right Track?Administration and policy in mental health · 2021Article
- Protocol of an interdisciplinary consensus project aiming to develop an AGREE II extension for guidelines in surgery.BMJ open · 2020Article
Corrections and comments
- Erratum issuedThanos, Athansiou [corrected to Athanasiou, Thanos]
Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 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.
methodsAll 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).
resultsThe 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%).
conclusionsThis 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.