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Evidence-Based Clinical Practice Guidelines

Evidence-based clinical practice guidelines are developed with a prospective, systematic approach. Clinical questions are developed for a particular topic and a targeted literature search is conducted to find pertinent research articles that can address the clinical questions. Articles are critically appraised for study quality using critical appraisal checklists according to criteria referenced in key publications on evidence-based medicine.1-6

Depending on type of study (prognostic, diagnostic, or therapeutic) and quality of study, each article is assigned a corresponding level of evidence according to the ASPS Evidence Rating Scales, which were modified from scales developed by other surgical specialties and authorities on evidence-based medicine.6, 7

Practice recommendations are developed through review of the critically appraised literature and consensus of the ASPS Health Policy Committee. Recommendations are based on the strength of supporting evidence and are graded according to the ASPS Grade Recommendation Scale, which was modified from scales used by other surgical specialties and authorities in the practice of evidence-based medicine. 6,7

In March 2011, The Institute of Medicine published "Standards for Developing Trustworthy Clinical Practice Guidelines" in an effort to standardize the clinical practice guideline development process. To ensure compliance with IOM recommendations, the ASPS Health Policy Committee updated and approved it's Guideline Development Process in September 2011. A full list of current ASPS Evidence-Based Guidelines can be found in the Evidence-Based Guidelines/Practice Parameters section.


1. Greenhalgh, T. How to read a paper: the basics of evidence-based medicine, Third Ed. Oxford: Blackwell Publishing, 2006.

2. Lang, T. A., Secic, M. How to report statistics in medicine, Second Ed. Philadelphia: American College of Physicians, 2006.

3. Straus, S. E., Richardson, W. S., Glasziou, P., Haynes, R. B. Evidence-based medicine: How to practice and teach EBM, Third Ed. Philadelphia: Elsevier Churchill Livingstone, 2005.

4. Guyatt, G. and Rennie, D. The evidence-based medicine working group Users' guides to the medical literature. Essentials of evidence-based clinical practice. Chicago: American Medical Association, 2002.

5. Critical Appraisal Skills Program Tools. 2006. Accessed 6-17-2011.

6. Center for Evidence Based Medicine. Levels of evidence and grades of recommendations. Center for Evidence Based Medicine website. 2001. Accessed 6-14-2013.

7. The Journal of Bone and Joint Surgery. Instructions to authors: Levels of evidence for primary research question. JBJS Online. 2007. Accessed 6-14-2013


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