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 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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Practice Parameters Developed by AAPM&R

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.healthquality.va.gov, 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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Additional Practice Guideline Resources

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

• 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.

• 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.

• 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/.

• 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.

• 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.

• 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.

• 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

• 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/

• Endocrinology Practice Guidelines
  American Association of Clinical Endocrinologists:
  www.aace.com

• 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.

• 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.

• 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.

• 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.

• Pain Guidelines
  Guidelines and position statements from the American Pain Society (APS) www.ampainsoc.org.

• Radiology Practice Guidelines
  American College of Radiology: www.acr.org  

• 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/.

• TALARIA: The Hypermedia Assistant for Cancer Pain Management www.talaria.org

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Archived Resources

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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rev 07/05