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Clinical Decisionmaking

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Clinical practice guidelines in musculoskeletal disorders are often based on expert opinion

The development of clinical practice guidelines began in the 1950s and continues to evolve. These guidelines recommend courses of action to help medical practitioners treat the average patient. However, a new study looking at clinical practice guidelines for musculoskeletal disorders found they were often based on expert opinion rather than systematic reviews of scientific studies.

Maria A. Lopez-Olivo, M.D., Ph.D., and Maria E. Suarez-Almazor, M.D., Ph.D., of the University of Texas M.D. Anderson Cancer Center for Education and Research in Therapeutics (CERT), examined the history of clinical practice guideline development and focused on guidelines dealing with rheumatology conditions, such as arthritis and osteoporosis.

The authors found 276 clinical practice guidelines addressing rheumatology. After selecting guidelines from three sources (the American College of Rheumatology, the European League Against Rheumatism, and the National Guideline Clearinghouse), they narrowed their field to 61 guidelines. Slightly more than half of the studied guidelines were based on expert opinion. For the most part, guidelines did not offer background on the process used to develop them, leaving readers without information to determine whether the guidelines were based on evidence and were without bias. This shortcoming made many guidelines fall short of the researchers' requirement that authors of clinical practice guidelines ensure the process for developing guidelines is transparent to anyone reading them.

Consumers are relying on clinical practice guidelines more frequently to guide their health care, and decisionmakers are using the guidelines to improve the quality of health care. This increased popularity has spurred many programs across the globe to create guidelines. In turn, this has caused redundant efforts. The authors suggest collaborative development and review as a means to curb much of the duplication. Finally, they state that for guidelines to be truly useful, they must be disseminated and implemented quickly once they are sanctioned.

This study was funded in part by the Agency for Healthcare Research and Quality (HS16093).

See "Developing guidelines in musculoskeletal disorders," by Drs. Lopez-Olivo and Suarez-Almazor in Clinical and Experimental Rheumatology 25 (Suppl 47), pp. S28-S36, 2007.

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