Therapist Perception Of The Clarity And Implementability Of Relevant Recommendations From American Academy Of Orthopedic Surgeon’s Distal Radius Fracture Clinical Practice Guidelines

Fractures of the distal radius are common and can cause substantial either transient or permanent impairment and disability.\nClinical practice guidelines (CPGs) are systematically developed statements or recommendations based on the best available evidence and aimed at assisting health care practitioners in clinical decision-making. Many professional organizations have developed practice guidelines for common clinical conditions. The overall objective of this thesis is to evaluate the therapist's perception of the clarity and implementability of rehabilitation relevant recommendations from The American Academy of Orthopaedic Surgeons (AAOS) CPG for distal radius fractures (DRF) and to identify the quality of CPG related to DRF. To address my study objective, first, I categorized the AAOS DRF CPG using the International Classification of Functioning Disability and Health (ICF) and International Classification of Diseases ICD-10 using linking procedures and compare the content codes of the CPG with the ICF hand core sets as the reference standard. Then I conducted a cognitive interview study to understand the therapist's perceptions of the clarity and implementability of the recommendations.\nTo further understand the implementability of the AAOS DRF CPG, I conducted a cross-sectional survey on the implementability of the AAOS DRF guidelines using the guideline implementability appraisal tool (GLIA). And we conducted a systematic literature review to identify and appraise CPGs relevant to the management of DRF s using the AGREE II tool.\nThe results of the thesis indicate that the AAOS DRF CPG focuses on surgical interventions and has minimal linkage to the constructs of the CF constructs (activity or participation) and the ICF Hand Core Set. In my qualitative study, I found that eight of ten recommendations sampled from the AAOS DRF CPG were considered vague and unimplementable by therapists in their clinical practice, due to the lack of clarity and information on what to implement, how to implement, and to measure the adherence and outcomes of the recommendation. In the systematic review I found that for the selected CPGs developed by professional organizations in the UK, Canada, USA, Denmark, and Norway, the AGREE score for the scope and purpose domain ranged from 61% to 94% and the stakeholder involvement domain ranged from 13% to 97%. The rigor of the development domain score ranged from 38% to 95%. and for the clarity of the presentation domain score ranged from 63% to 83%. Scores were lowest on the domain of applicability and ranged from 18% to 60% and the score for the editorial independence domain ranged from 54% to 79%\nThis work implicates that CPG that focus on rehabilitation after DRF are needed and improving the implementability of the CPG recommendations by making them more specific and actionable while providing resources would assist with the implementation. Therapists need to be aware and understand variability existing in quality, the rigor of development, and the applicability of these guidelines. The future guideline should consider implementation during development including ready access to the details about the level recommended in intervention reporting guidelines.

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