Cross-sectional Analysis of Recommendations for the Treatment of Hip and Knee Osteoarthritis in Clinical Guidelines |
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| Institution: | 1. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern;2. Kinderklinik, Kantonsspital Aarau, Aarau;3. Doktorzentrum Mutschellen, Berikon, Switzerland;1. Swallowing Research Laboratory, University of Central Florida, Orlando, FL;2. School of Health Sciences, University of Texas San Antonio Health Sciences Center, San Antonio, TX;3. Neurosciences, Experimental Otorhinolaryngology, Deglutology, Faculty of Medicine, University of Leuven, Leuven, Belgium;4. Pediatric Neurology, CP reference Center, University Hospitals Leuven, Leuven, Belgium;1. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada;2. Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada;3. Section of Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ;4. School of Kinesiology and Health Studies, Queens University, Kingston, ON, Canada;1. Speech and Language Therapy Department, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom;2. Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom;3. Centre for Gastrointestinal Sciences, University of Manchester, Manchester, United Kingdom;4. Speech Language Therapy Department, University of Patras, Patras, Greece;5. Leeds Institute of Medical Research at St James''s, University of Leeds, Leeds, United Kingdom;6. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom;7. Department of Podiatry, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom;1. Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC;2. Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA;3. Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh, PA;4. Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA;5. Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA;6. Department of Cognitive Sciences, University of California, Irvine, CA;1. Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel;2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;3. School of Mathematical Sciences, Tel Aviv University, Tel Aviv, Israel;4. Indian Spinal Injuries Centre, New Delhi, India;5. Istituto Auxologico Italiano, IRCCS;6. Università degli Studi, Milan, Italy;7. Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel;8. Physical Medicine and Rehabilitation Institute, Udine, Italy;9. Unita'' Spinale - Ospedale C.T.O. Rome, Italy;10. The Spinal unit Dpt, Careggi University Hospital, Florence, Italy;11. Montecatone Rehabilitation Inst., Italy;12. Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China;13. CMRRC-RP, Rovisco Pais Hospital, Portugal;14. Universidade de São Paulo, Ribeirão Preto, Brazil;15. Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India;p. Department of Physical Medicine and Rehabilitation, Rehabilitation Research Center, SMS Medical College & Associated Hospitals, Jaipur, India;q. Institut de réadaptation Gingras-Lindsay-de-Montréal, Canada;r. The Ottawa Hospital Rehabilitation Centre, Ottawa, Canada;s. St Olav University Hospital, Clinic of Physical Medicine and Rehabilitation, Department of Spinal Cord Injuries, Trondheim, Norway;t. Department of Innovation, technology and e-health, Sunnaas Rehabilitation Hospital HF, Nesoddtangen, Norway;u. Department of Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Denmark;v. Istanbul Physical Medicine and Rehabilitation University of Health Sciences, Turkey;w. Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK;1. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI;2. Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI;3. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA |
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| Abstract: | ObjectiveTo compare guideline recommendations for hip and knee osteoarthritis (OA) and their level of evidence.Data SourcesMEDLINE, Embase, the Cochrane Library, and websites of professional societies were searched in June 2020 using keywords such as knee or hip osteoarthritis, degenerative arthritis, guideline, and practice guideline.Study SelectionGeneral treatment guidelines for OA of the hip or knee published in English. After 461 abstracts were screened, 31 publications (17 guidelines from 10 professional societies) were included for analysis.Data ExtractionThree reviewers assessed the quality of the guidelines according to the Appraisal of Guidelines for Research and Evaluation II tool. The rating of evidence and strength of recommendation was extracted and standardized into the Grading of Recommendations Assessment, Development, and Evaluation criteria.Data SynthesisOf the 17 guidelines included, 6 (35%) were of high quality, 10 (59%) of moderate quality, and 1 (6%) of low quality. Guidelines published after 2017 were of good quality. Although guidelines generally agreed on a nonsurgical multimodal concept, including patient education, exercise, and weight loss in obese, some recommendations remained vague and the level of evidence varied widely. In pharmacologic treatment, oral nonsteroidal anti-inflammatory drugs were the mainstay for pain management. Guidelines published after 2017 were more cautious in their recommendation for the use of paracetamol and strong opioids. Disagreement was observed for chondroitin sulfate, glucosamine, and intra-articular hyaluronic acid injections. Recommendations were conflicting for the use of insoles, braces, and transcutaneous electrical stimulation. The main indications for hip/knee arthroplasty were severe, persisting pain and loss of function despite nonsurgical treatment. No guideline defined a minimum time of conservative treatment before surgery.ConclusionsWe found a wide variation in evidence and strength of recommendations for OA treatment. Recommendations on when to refer patients for surgery remained unclear. |
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| Keywords: | Analgesia Arthroplasty Pain |
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