July 1996 Bulletin

Academy updating clinical policies

Will be replaced with more comprehensive tools

The development of Phase I and Phase II clinical algorithms on acute low back pain is part of a larger Academy program under the direction of the Oversight Committee on Guidelines.

The committee has been charged with completing the Academy's existing clinical policies and Phase I and Phase II clinical algorithms. Six work groups-foot and ankle, hip, hand, knee, spine, and upper extremity-were formed to review and update the Academy's original clinical policies.

Twelve of the Academy's 15 clinical policies were peer-reviewed by orthopaedists and other organizations last year and will be available for publication in the fall. The policies are:

Three spine-related clinical policies-Spinal Stenosis, Low Back Musculoligamentous Injury and Herniated Lumbar Disc-are undergoing peer review to confirm consistency with the Academy's Phase II Acute Low Back Pain Algorithm. Herniated Lumbar Disc was not peer-reviewed last year. Two ankle-related clinical policies-Hallux Valgus and Pes Planus-will undergo peer review during the summer.

All 15 of the clinical policies will be submitted this fall to the American Medical Association for inclusion in its Specialty Practice Parameters Directory.

The oversight committee has recommended that all 15 clinical policies be published and available by the end of this year.

Upon completion of this work, the oversight committee recommended terminating the clinical policy work groups and phasing out the clinical policies in three years, replacing them with more comprehensive practice parameters, guidelines and evaluations.

Meanwhile, in addition to the acute low back pain algorithm, Phase I algorithms for knee pain, hip pain, wrist pain, shoulder pain, and knee injury were reviewed last year and are being revised. Final drafts of these documents will be available by December. The ankle injury algorithm will undergo peer review this year and a final draft also will be available in December.

Phase II of the Knee Pain Algorithm is undergoing peer review and a final draft will be available in December.

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