Podiatric Clinical Practice Guidelines:
It’s Time for a Rewrite
In last week's Practice Perfect, I started to make the argument that our clinical practice guidelines in podiatry do not satisfy the purposes for which they were created. I identified the purpose and general characteristics of a practice guideline and proposed a basic method to evaluate them. This week, we let the rubber hits the road. Will our representative sample pass muster? Let’s see…
First, let me reiterate a point I made last week. I have great respect for those podiatric physicians who clearly took much time, effort, and leadership to create our guidelines. They should receive commendations for their excellent work, and the guidelines themselves have value and should be on all of our shelves. I will attempt to show that our guidelines, though well written and important, need to be rewritten to make them more evidence-based and more effective.
Ok. Let’s get to it.
I examined three published podiatric clinical practice guidelines, all three published in the Journal of Foot and Ankle Surgery:
- Forefoot Trauma Guidelines1
- Adult Flatfoot Guidelines2
- Diabetic Foot Disorders Guidelines3
For comparison, I also examined one non-podiatric guideline that pertains to the lower extremity:
- Peripheral Arterial Disease Guidelines4
Using the checklist I presented last week, I evaluated each of the guidelines. Follow this link for the Appendix that shows the checklist results. According to my examination, the forefoot trauma and adult flatfoot guidelines almost completely failed to adequately satisfy the chosen criteria with a “Yes” answer in only 2 of 15 characteristics. The diabetic foot guidelines did a little better with 4 of 15 characteristics answered with a “Yes.” In comparison, the PAD guidelines satisfied 15 of 15 characteristics. All three podiatric guidelines failed to provide adequate information about the development group, formulate a stated consensus based on a systematic evaluation of the literature, or demonstrate appropriate peer review.
Please share your thoughts and concerns regarding Podiatric Clinical Practice Guidelines...
1. Thomas J, et al. Diagnosis and Treatment of Forefoot Disorders. Section 5. Trauma. JFAS, Mar 2009; 48(2): 264-272.
2. Lee M, et al. Diagnosis and Treatment of Adult Flatfoot. JFAS, March 2005; 44(2): 78-113.
3. Frykberg R, et al. Diabetic Foot Disorders: A Clinical Practice Guideline (2006 Revision). JFAS, Sept 2006; 45 (5): S1-S66.
4. Olin J, et al. ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 Performance
Measures for Adults With Peripheral Artery Disease. Circulation, Dec 2010; 122: 2583-2618.