Practice Guideline Resources
This
list, prepared by AAPM&R staff, includes a select listing of guidelines that
are developed as educational tools to improve patient care by outlining
reasonable information-gathering and decision-making processes used in the
management of various diagnoses relative to the practice of physical medicine
and rehabilitation. The listing will be periodically updated and suggestions
for additional guidelines to include are welcome.
Practice Guideline Resources Disclaimer
Practice Guidelines developed and/or endorsed by the Academy are intended to
provide guidance for particular patterns of practice and not to dictate the
care of a particular patient. Physicians are advised to make individual
treatment decisions according to their own medical judgment in light of each
patient’s individual circumstances. Guidelines are intended to promote
beneficial or desirable outcomes but cannot guarantee any specific outcome.
Guidelines developed or endorsed by the Academy are subject to periodic
revision as warranted by the evolution of medical knowledge, technology and
practice.
AAPM&R Guideline Endorsement Policy
Clink here to view
the Academy’s guideline endorsement policy.
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The American Academy of
Physical Medicine and Rehabilitation (AAPM&R), American Academy of Neurology
(AAN), and American Association of Neuromuscular and Electrodiagnostic
Medicine (AANEM) formed the Neuromuscular Guidelines Steering Committee
(NGSC) in 2000. The writing commission of the NGSC, called the polyneuropathy
task force, developed a case definition, Distal Symmetrical Polyneuropathy: A
Definition for Clinical Research. In January 2005, the Archives of Physical
Medicine and Rehabilitation published a “Case Definition for
Clinical Research: Evidence and Consensus-based Definition – Distal
Symmetrical Polyneuropathy.” Academy member Gregory T. Carter,
MD, represents the Academy on the task force. To download a copy of the case
definition, click on the following link:
www.aan.com/professionals/practice/guideline/index.cfm.
"Practice Parameter
for
Electrodiagnostic Studies in Carpal Tunnel Syndrome: Summary Statement"
was developed by the American Association of Neuromuscular and
Electrodiagnostic Medicine (AANEM), American Academy of Neurology and the
American Academy of Physical Medicine and Rehabilitation (AAPM&R). It was
published in the Archives of Physical Medicine and Rehabilitation, V.
75, Jan. 1994, p. 124-125. It is a summary of the AANEM’s "Practice
Parameter for Electrodiagnostic Studies in Carpal Tunnel Syndrome." For more
information about the complete carpal tunnel syndrome parameter (which
includes an extensive literature review), please contact the AANEM at 421
First Avenue SW, Suite 300 East, Rochester, MN 55902. Telephone:
(507)288-0100. To obtain a copy, visit their Web site at
www.aanem.org. A revised version of the “Practice Parameter for
Electrodiagnostic Studies in Carpal Tunnel Syndrome: Summary Statement”
was endorsed by the AAPM&R Board of Governors in February 2002. This updated
version is now available on the AANEM Web site.
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Practice Guidelines, Parameters,
Standards, and Reports Endorsed by AAPM&R
“Clinical
Practice Guideline for the Management of Stroke Rehabilitation in the
Primary Care Setting” was developed by the Department of Veterans Affairs
(VA) / Department of Defense (DoD). This practice guideline was endorsed by
the AAPM&R Board of Governors in February 2003. An update for the clinical
practice guideline is targeted for late 2005. To download a copy of the
guideline for free, in addition to algorithms, key points, and a pocket card
for quick reference, visit the VA Office of Quality and Performance (OQP)
Clinical Practice Guidelines Web site at
www.oqp.med.va.gov/cpg/cpg.htm, scroll down to the subject heading
“REHABILITATION” and click on “Stroke Rehabilitation.” Additional
practice guidelines developed by the VA OQP can be accessed on this site as
well.
“Physician’s Guide to
Assessing and Counseling Older Drivers” was developed by the American
Medical Association (AMA) in cooperation with the National Highway Traffic
Safety Administration (NHTSA). AAPM&R members Carol Bodenheimer, MD, and
Arthur Gershkoff, MD, worked on the guideline on behalf of the AAPM&R. AAPM&R
Practice Guidelines Committee Chair Richard Zorowitz, MD, also worked on the
guideline, representing the National Stroke Association (NSA). The Guide
was reviewed by the Practice Guidelines Committee in March 2004 and was found
to be extremely useful, practical, and a great overall resource. The Guide
was endorsed by the AAPM&R Board of Governors in April 2004. A copy of the
Guide can be downloaded from the following Web site:
www.ama-assn.org/ama/pub/category/10791.html.
“Practice Parameter for Antiepileptic Drug Prophylaxis in Severe Traumatic Brain Injury” was developed by the American Academy of Neurology (AAN). The Practice Guidelines Committee found the practice parameter to be an excellent resource and endorsed it in October 2005. The AAPM&R Board of Governors endorsed the practice parameter in January 2006. A copy of the practice parameter can be downloaded from the AAN Web site:
www.aan.com/professionals/practice/guideline/index.cfm.
"Practice
Parameter for Electrodiagnostic Studies in Ulnar Neuropathy at the Elbow"
was developed by the American Association of Neuromuscular and
Electrodiagnostic Medicine (AANEM). This practice parameter was approved by
the AAPM&R Board of Governors in September, 1998. The practice parameter
summary statement was published in the Archives of Physical Medicine and
Rehabilitation, V. 80, March 1999, p. 357-359. For more information about
the complete ulnar neuropathy parameter (which includes an extensive
literature review), please contact the AANEM at 421 First Avenue SW, Ste 300
East, Rochester, MN 55902. Telephone: (507)288-0100. To access this as well as
other practice parameters, visit their Web site at
www.aanem.org.
"Practice Parameter for Needle
Electromyographic Evaluation of Patients with Suspected Cervical
Radiculopathy" was developed by the American Association
of Neuromuscular and Electrodiagnostic Medicine (AANEM). This practice
parameter was approved by the AAPM&R Board of Governors in March, 1999. It was
published in Chapter 9 of Guidelines in Electrodiagnostic Medicine. Muscle
Nerve 22: Supplement 8: S209-S221, 1999. For more information about the
cervical radiculopathy parameter, please contact the AANEM at 421 First Avenue
SW, Suite 300 East, Rochester, MN 55902. Telephone: (507)288-0100. To access
this as well as other practice parameters, visit their Web site at
www.aanem.org.
The American Academy of Physical Medicine and Rehabilitation has approved the following practice
guidelines published by The Paralyzed
Veterans of America (PVA). AAPM&R is one of the participating organizations in
The Consortium for Spinal Cord Medicine,
a multi-organizational effort to develop spinal cord injury
guidelines funded by the PVA.
- Acute Management of Autonomic Dysreflexia: Adults with Spinal
Cord Injury Presenting to Health-Care Facilities (2/97)
- Prevention of Thromboembolism in Spinal Cord Injury
(2/97)
- Autonomic Dysreflexia: What You Should Know (Consumer Guide)
(8/97)
- Neurogenic Bowel Management in Adults with Spinal Cord Injury
(3/98)
- Depression Following Spinal Cord Injury: A Clinical Practice
Guideline for Primary Care Physicians (8/98)
- Outcomes Following Traumatic Spinal Cord Injury: Clinical
Practice Guidelines for Health-Care Professionals (7/99)
- Depression: What you Should Know (Consumer Guide) (9/99)
- Pressure Ulcer Prevention and Treatment Following Spinal Cord
Injury: A Clinical Practice Guideline for Health-Care Professionals
(8/00)
- Respiratory Management Following
Spinal Cord Injury (5/05)
Also available are
publications of evidence-based clinical practice guidelines by
The Multiple Sclerosis Council for Clinical Practice Guidelines.
AAPM&R is one of the participating members of
the Council, which receives administrative and financial support from the
Paralyzed Veterans of America. AAPM&R’s Board of Governors endorsed both
multiple sclerosis guidelines in November 1998.
- Fatigue and Multiple Sclerosis:
Evidence-Based Management Strategies (10/98)
- Urinary Dysfunction and Multiple
Sclerosis: Evidence-Based Management Strategies (3/99)
These and additional
practice guidelines are available on the PVA Web site:
http://www.pva.org/pvastore/, or by calling toll free: (888) 860-7244. For
information about other projects, contact: J. Paul Thomas, PVA Practice
Guidelines Program Coordinator, Health Policy Department, PVA America, 801
18th Street, N.W., Washington, DC 20006, Phonne: (800) 424-8200.
“Spasticity Management in Multiple Sclerosis”
practice guidelines were
developed by the Multiple Sclerosis Council for Clinical Practice Guidelines.
The AAPM&R Practice Guidelines Committee endorsed the guidelines in January
2005 and the AAPM&R Board of Governors approved the practice guideline in
March 2005. To download a free copy of this practice guideline, click on the
following link
www.mscare.org/professional.cfm?doc_id=324 or visit the Consortium
of Multiple Sclerosis Centes’ Web Site
www.mscare.org.
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Selecting and Implementing
Clinical Practice Guidelines in Hospitals
(2002) is a publication produced by the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO). The
JCAHO developed this guide to help hospitals of all sizes and resource levels
choose, adapt, and use clinical practice guidelines. Included are guideline
appraisal tools and in-depth case studies showing how various organizations
adapted and implemented national guidelines. For more information call JCAHO
at (630) 792-5800 or visit their Web site:
www.jcaho.org.
The Brain Trauma Foundation and the American Association
of Neurological Surgeons (AANS) have prepared
Guidelines for
the Management of Severe Head Injury." The guidelines are
being distributed throughout the United States to neurosurgeons. Copies are
being distributed through the AANS. For more information, contact the AANS at
(847) 692-9500. Web site:
www.neurosurgery.org.
"Guideline for the
Prevention of Falls in Older Persons" was published by the American
Geriatric Society Panel on Falls in Older Persons, the British Geriatrics
Society, and the American Academy of Orthopaedic Surgeons Panel on Falls
Prevention in the Journal of the American Geriatrics Society V. 49, N.
5, May 2001, p. 664-672. The Academy participated in the peer-review of the
guidelines.
"Clinical Practice Guidelines: The
Management of Chronic Pain in Older Persons" was published
by the American Geriatrics Society Panel on Chronic Pain in Older Persons in
the Journal of the American Geriatrics Society V. 46, N. 5, May 1998,
p. 635-651. The Academy participated in the peer-review of the guidelines.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases, a division of the NIH, has produced a multidisciplinary
guide to lupus, entitled
"LUPUS: A Patient Care Guide for Nurses and
Other Health Professionals." This 144-page publication
contains 8 chapters on lupus symptoms, testing, medication, nursing, and
research, as well as 16 reproducible patient education handouts. Single copies
are free and may be ordered by phone, fax, or e-mail. Phone: (301) 495-4484. Fax:
(301) 718-6366. E-mail:
NAMSIC@mail.nih.gov.
“Phase III: Clinical Guidelines for Multidisciplinary Spine Care Specialists”
was developed by the North American Spine Society
(NASS). Within the guidelines, there are specific practice guidelines for the
diagnosis of herniated disc, unremitting low back pain, spinal stenosis, and
spondylolisthesis. The guidelines were reviewed by the AAPM&R Practice
Guidelines Committee (Committee) in December 2004 who found the practice
guidelines to be a useful reference tools for physiatrists.
“Phase
III: Clinical Guidelines for Multidisciplinary Spine Care Specialists” are
available on the National Guidelines Clearinghouse Web site:
www.guideline.gov. They can also be purchased with a NASS
membership for $25 for each disease-specific unit, or $85 for a complete set.
Nonmembers cost is $30/unit or $100 for the set. For more information or to
obtain an order form, click on the link below or contact NASS toll-free at
(877) SpineDr ((877) 774-6337) or e-mail:
info@spine.org.
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Additional On-Line Resources
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The
American Academy of Neurology (AAN)
produces practice parameters through its Quality Standards Subcommittee and
Therapeutics and Technology Assessment Subcommittee. For information, contact:
Wendy Edlund, Senior Manager, American Academy
of Neurology, 1080 Montreal Ave, St. Paul, MN 55116, Phone: (651)695-2761.
Web site:
www.aan.com.
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Through the
American Academy of Orthopaedic Surgeons (AAOS)
home page
www.aaos.org, physicians can access information on clinical policies and
clinical algorithms developed by or being developed by the AAOS. Phone:
(800) 346-AAOS.
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The American Academy of Pediatrics (AAP) and its member pediatricians
dedicate their efforts and resources to the health, safety and well-being of
infants, children, adolescents and young adults. For further information on
clinical practice guidelines for children, click on the following link:
http://aappolicy.aappublications.org/.
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American College of Chest
Physicians Practice Guidelines Through the American College of Chest Physicians (ACCP)
Web site, physicians can access information on evidence-based practice
guidelines, consensus statements, and patient education guides developed by or
being developed by the ACCP, as well as "CHEST -- The Cardiopulmonary and
Critical Care Journal," published by the ACCP. Telephone:
(800) 343-2227.
www.chestnet.org.
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The American Medical Association
(AMA) has guidelines on the treatment
of various clinical diagnoses. A few examples of guidelines the AMA has
developed are hypertension, child abuse, and bioterrorism. Please visit the
AMA Web site for further practice resources published by the AMA:
www.ama-assn.org.
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The Physician
Consortium for Performance Improvement (Consortium) is a group of clinical
and methodological experts convened by the American Medical Association (AMA)
to develop evidence-based clinical performance measures and clinical outcomes
reporting tools to support physicians in quality improvement efforts. Learn
more about the Consortium and performance measures by clicking on the
following link:
www.ama-assn.org/ama/pub/category/2946.html.
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The Cochrane Collaboration
The Cochrane Collaboration prepares, maintains, and promotes the accessibility
of systematic reviews of the effects of health care interventions.
Over 11,500 members hand search journals in 90
countries, produce Cochrane reviews, moderate feedback, ensure that
methodology, statistics and software used in the writing of reviews is state
of the art and that consumer and other groups are represented. The main output
of The Cochrane Collaboration is systemic reviews published electronically in
successive issues of The Cochrane Library.
www.cochrane.org
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The Cochrane Library
The Cochrane Library is an electronic publication prepared by The Cochrane
Collaboration supplying high quality evidence to inform people providing and
receiving care, and those responsible for research, funding, teaching, and
administration. Abstracts of Cochrane Reviews are available free of charge,
and can be browsed or searched.
www.update-software.com/cochrane/
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Endocrinology Practice Guidelines
American Association of Clinical Endocrinologists:
www.aace.com
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The
2005 Healthcare Standards Directory, published
by ECRI (formally the Emergency Care Research Institute), is a comprehensive
reference source that indexes more than 36,000 healthcare standards, clinical
practice guidelines, laws, and regulations from over 1,200 organizations.
Contact ECRI at 5200 Butler Pike, Plymouth Meeting, PA 19462-1298. Phone:
(610) 825-6000. ECRI is a nonprofit agency.
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In January 1999, the Agency for Healthcare Research and
Quality (AHRQ), in cooperation with the American Association of Health Plans
and the American Medical Association, officially launched the Web-based
National Guideline Clearinghouse.
The Clearinghouse is a comprehensive electronic repository of evidence-based
clinical practice guidelines available to medical professionals and the
public. The Clearinghouse can be accessed on the Web at
www.guideline.gov and currently catalogues more than
1,400 guidelines. For more information about
the Clearinghouse, please contact Ms. Mary Nix, National Guideline
Clearinghouse Project Officer at the AHRQ, by calling (301) 427-1600.
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The National Research Register is an
amalgam of records that have been submitted by over 350 organizations and
indexed using the Medical Subject Headings (MeSH) of the U.S. National Library
of Medicine. Free access to the database is available to all:
www.update-software.com/national.
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North American Spine Society
(NASS) is a multidisciplinary organization for health care providers that
advances quality spine care through education, research and advocacy. Click on
the following link for additional information:
www.spine.org.
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Pain Guidelines
Guidelines and position statements from the American Pain Society (APS)
www.ampainsoc.org.
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Radiology Practice Guidelines
American College of Radiology:
www.acr.org
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The Scottish Intercollegiate
Guidelines Network (SIGN) objective is to improve the quality of health care for patients by
reducing variation in practice and outcome, through the development and
dissemination of national clinical guidelines containing recommendations for
effective practice based on current evidence. To search these guidelines,
click on the following link:
www.sign.ac.uk/.
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TALARIA: The Hypermedia Assistant for Cancer
Pain Management www.talaria.org
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The
archived resources are documents that
have been withdrawn from the Academy Web site since they
are more than six years old and are no longer viewed as guidance for current
medical practice. They are maintained for archival purposes only.
"Practice Parameter: Antiepileptic
Drug Treatment of Posttraumatic Seizures" was developed
and published by the Brain Injury Special Interest Group of the American
Academy of Physical Medicine and Rehabilitation. It was published in the
Archives of Physical Medicine and Rehabilitation, V. 79, May 1998, p.
594-597. The practice parameter was approved by the AAPM&R Board of
Governors in April 1997.
"Standards for Psychologists & Social
Workers in SCI Rehabilitation - Second Edition," developed
by the American Association of Spinal Cord Injury Psychologists and Social
Workers (AASCIPSW), was endorsed by the AAPM&R Board of Governors in June,
1999. The first edition was endorsed by sixty rehabilitation centers and
twenty-five service organizations. For a free copy of the standards, please
contact the AASCIPSW at 75-20 Astoria Blvd., Jackson Heights, NY 11370-1177.
Phone: (718) 803-3782.
"Clinical Practice Guidelines for
Chronic Non-Malignant Pain Syndrome Patients," was
published by Steven H. Sanders, PhD, Karen Rucker, MD, and others and was
approved by the AAPM&R Board of Governors in August, 1996. It was published in
the Journal of Back and Musculoskeletal Rehabilitation, V. 5,1995,
p. 115-120.
"Guidelines for Program Evaluation
in Chronic Non-Malignant Pain Management" was published by
Steven H. Sanders, PhD, Karen Rucker, and others and was approved by the
AAPM&R Board of Governors in November, 1997. It was published in the
Journal of Back and Musculoskeletal Rehabilitation, V. 7, 1996, p. 19-25.
"Quality Improvement Guidelines for
the Treatment of Acute Pain and Cancer Pain" was published
by the American Pain Society Quality of Care Committee in: Journal of the
American Medical Association, V. 274, N. 23, December 20, 1995. The
guidelines were approved by the American Academy of Physical Medicine and
Rehabilitation Board of Governors in April 1997.
The Agency for Healthcare Research and Quality - AHRQ
(formerly the Agency for Health Care Policy and Research - AHCPR) has produced
several practice guidelines. Those endorsed by the AAPM&R include those for
cardiac rehabilitation,
post stroke rehabilitation,
and smoking cessation. The complete guidelines are available
by calling the U.S. Government Printing Office at (202) 512-1800 or via the
clinical practice guidelines section of the AHRQ Web site. For the guidelines
as well as access to an extensive library of AHRQ-produced clinical resources,
visit their Web site at
www.ahrq.gov.
The
"Final Report of the National Conference on
Medical Indications for Air Bag Disconnection" was
approved by the AAPM&R Board of Governors in March, 1998. The report is
available from The Ronald Reagan Institute of Emergency Medicine, The George
Washington University Medical Center, 2140 Pennsylvania Avenue, NW,
Washington, DC 20037. Telephone: 202/994-8583.
"The Fibromyalgia Syndrome: A
Consensus Report on Fibromyalgia and Disability" was
published in The Journal of Rheumatology, V. 23, N. 3, 1996, p.
534-539. The three sections of the report include information on the current
state of knowledge, consensus statements, and recommendations.
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