Abstract
Objective
Data Sources
Study Selection
Data Extraction
Data Synthesis
Conclusions
Keywords
List of abbreviations:
AGREE II (Appraisal of Guidelines for REsearch and Evaluation II), LOE (level of evidence), MA (meta-analysis), NICE (National Institute of Clinical Excellence), OA (osteoarthritis), RCT (randomized controlled trial), SOR (strength of recommendation)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012.
National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012.
Methods
Electronic database searches
Internet searches
Eligibility criteria
Selection of guidelines

Quality appraisal
AGREE. Appraisal of Guidelines for REsearch & Evaluation II: AGREEII instrument 2009. Available at: http://www.agreetrust.org/. Accessed January 14, 2013.
AGREE. Appraisal of Guidelines for REsearch & Evaluation II: AGREEII instrument 2009. Available at: http://www.agreetrust.org/. Accessed January 14, 2013.
Synthesis of recommendations
Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013.
National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012.
LOE | SOR | Individual Weighting |
---|---|---|
High: I, II, 1++, 1+, 1−, Ia, Ib, IIa | High: Strong, A, B, 60%–100% | 4 |
High: I, II, 1++, 1+, 1−, Ia, Ib, IIa | Low or multiple SOR within 1 recommendation: Weak, C, D, inconclusive, <60%, not stated | 3 |
Low: III-1, III-2, III-3, IV, 2++, 2+, 2−, 3, 4, IIb, III, IV, not stated | High: Strong, A, B, 60%–100% | 2 |
Low: III-1, III-2, III-3, IV, V, 2++, 2+, 2−, 3, 4, IIb, III, IV, not stated | Low: Weak, C, D, inconclusive, <60%, not stated | 1 |
High to low | High to low | −1 to −4 |
Median Value of Intervention | Overall Recommendation Level |
---|---|
3–4 | Strongly recommended |
2–2.9 | Recommended |
1.1–1.9 | Recommended with caution |
0–1 | Unsupported |
(−1 to −4) to 0 | Not recommended |
Results
Izquierdo R, Voloshin I, Edwards S, et al. The treatment of glenohumeral joint osteoarthritis: guideline and evidence report. Rosemont: American Academy of Orthopaedic Surgeons; 2009. Available at: http://www.aaos.org/research/guidelines/gloguideline.pdf. Accessed January 14, 2013.
AGREE II appraisal results
Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013.
Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013.
National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012.
National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012.
Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013.
Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013.
Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013.
Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013.
National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012.
Organization (Year) | Scope and Purpose | Stakeholder Involvement | Rigor of Development | Clarity of Presentation | Applicability | Editorial Independence | Overall Quality Assessment Rating • Comment |
---|---|---|---|---|---|---|---|
AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | 94 | 67 | 96 | 100 | 0 | 58 | Recommended |
ACR 19 (2012) | 89 | 56 | 79 | 83 | 4 | 8 | Recommended with modifications
|
BSR 21 (2005) | 83 | 44 | 63 | 67 | 0 | 58 | Recommended with modifications
|
EULAR 26 (2013) | 89 | 83 | 56 | 100 | 8 | 58 | Recommended |
EULAR 24 (2007) | 78 | 33 | 60 | 78 | 21 | 8 | Recommended |
EULAR 23 (2005) | 83 | 6 | 73 | 72 | 0 | 8 | Recommended with modifications
|
EULAR 20 (2003) | 83 | 28 | 67 | 83 | 4 | 8 | Recommended |
EULAR 29 (2001) | 83 | 39 | 56 | 83 | 4 | 8 | Recommended with modifications
|
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | 100 | 61 | 88 | 83 | 29 | 58 | Recommended |
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | 72 | 100 | 54 | 50 | 42 | 33 | Recommended with modifications
|
OARSI 25 (2008) | 89 | 56 | 94 | 89 | 21 | 58 | Recommended |
Ottawa 5 (2012) | 83 | 50 | 71 | 39 | 25 | 50 | Recommended with modifications
|
Ottawa 27 (2011) | 94 | 67 | 65 | 56 | 0 | 8 | Recommended with modifications
|
Ottawa 18 (2011) | 94 | 50 | 67 | 39 | 8 | 0 | Recommended with modifications
|
Ottawa 28 (2005) | 83 | 61 | 52 | 44 | 0 | 8 | Recommended with modifications
|
KNGF 30 (2011) | 89 | 33 | 50 | 83 | 4 | 8 | Recommended with modifications
|
TLAR 22 (2012) | 89 | 39 | 58 | 83 | 0 | 100 | Recommended with modifications
|
Interventions
Guideline | Grouped Interventions | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Organization: (Date) | Exercise | Education | Equipment | Weight Loss/Diet | Taping, Heat/Ice | Electrical-Based Therapy | Self- Management | Acupuncture | Manual Therapy | Psychosocial Interventions | Balneotherapy/Spa |
AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | X | X | X | X | X | X | |||||
ACR 19 (2012) | X | X | X | X | X | X | X | X | X | X | |
BSR 21 (2005) | X | X | X | ||||||||
EULAR 26 (2013) | X | X | X | X | X | ||||||
EULAR 24 (2007) | X | X | X | X | X | ||||||
EULAR 23 (2005) | X | X | X | X | |||||||
EULAR 20 (2003) | X | X | X | X | |||||||
EULAR 29 (2001) | X | X | X | X | X | X | X | ||||
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | X | X | X | X | X | X | X | X | X | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | X | X | X | X | X | X | X | X | X | ||
OARSI 25 (2008) | X | X | X | X | X | X | X | X | X | ||
Ottawa 5 (2012) | X | ||||||||||
Ottawa 27 (2011) | X | X | |||||||||
Ottawa 18 (2011) | X | ||||||||||
Ottawa 28 (2005) | X | X | |||||||||
KNGF 30 (2011) | X | X | X | X | X | X | |||||
TLAR 22 (2012) | X | X | X | X | X | X | X | X |
Guideline intervention recommendations
Intervention | Guideline (Date) | LOE | SOR | Individual Weighting | Median (Overall Recommendation) |
---|---|---|---|---|---|
Exercise | |||||
Combined exercise or unspecified type | AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | V | C | 1 | 3 (strongly recommended) |
BSR 21 (2005) | IV | D | 1 | ||
EULAR 26 (2013) | Ia | 89% | 4 | ||
EULAR 23 (2005) | NS | 72% | 2 | ||
EULAR 20 (2003) | 1B | A | 4 | ||
EULAR 29 (2001) | IB | A | 4 | ||
Ottawa 5 (2012) | 1 | A–D | 3 | ||
Ottawa 27 (2011) | 1 | A–D | 3 | ||
Ottawa 28 (2005) | 1 | A–C | 3 | ||
KNGF 30 (2011) | I–II | NS | 3 | ||
TLAR 22 (2012) | 1a, 1b | 97% | 4 | ||
Aerobic | AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | I | A | 4 | 3 (strongly recommended) |
ACR 19 (2012) | NS | Strongly recommended | 2 | ||
BSR 21 (2005) | Ib–IV | A–C | 4, 1 | ||
EULAR 26 (2013) | Ia | NS | 3 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | Ia–IV | 96% | 4, 2 | ||
Ottawa 5 (2012) | 1 | A–C | 3 | ||
Ottawa 28 (2005) | 1 | A–C | 3 | ||
Strengthening | AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | II | B | 4 | 3 (strongly recommended) |
ACR 19 (2012) | NS | Strongly recommended | 2 | ||
BSR 21 (2005) | Ib–IV | A–C | 4, 1 | ||
EULAR 26 (2013) | Ia | NS | 3 | ||
EULAR 24 (2007) | IV | C | 1 | ||
EULAR 29 (2001) | IB | A | 4 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | Ia–IV | 96% | 4, 2 | ||
Ottawa 28 (2005) | 1 | A–C | 3 | ||
Aquatic/hydrotherapy | ACR 19 (2012) | NS | Strongly recommended | 2 | 3 (strongly recommended) |
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | C | 2 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | Ib | 96% | 4 | ||
Ottawa 28 (2005) | 1 | A–C | 3 | ||
KNGF 30 (2011) | I | NS | 3 | ||
Land-based | NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | B | 3 | 3 (strongly recommended) |
Yoga | Ottawa 28 (2005) | 1 | A–C | 3 | 3 (strongly recommended) |
Electrical-based therapy | |||||
Transcutaneous electrical nerve stimulation | ACR 19 (2012) | NS | Conditionally recommended | 1 | 3 (strongly recommended) |
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | C | 2 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | 1a | 58% | 4 | ||
KNGF 30 (2011) | IV | NS | 1 | ||
TLAR 22 (2012) | Ib | 96% | 4 | ||
Equipment Knee bracing | EULAR 20 (2003) | 1B | B | 4 | 4 (strongly recommended) |
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | B | 3 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | Ia | 76% | 4 | ||
TLAR 22 (2012) | III, Ia | 86% | 2 | ||
Appropriate footwear | EULAR 26 (2013) | Ib | 87% | 4 | 3 (strongly recommended) |
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | IV | 77% | 2 | ||
TLAR 22 (2012) | IV | 86% | 2 | ||
Wedged insoles | AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | II | B | 4 | 4 (strongly recommended) |
ACR 19 (2012) | NS | Conditionally recommended | 1 | ||
EULAR 26 (2013) | Ib | 80% | −4 | ||
EULAR 23 (2005) | IV | 61.7% | 2 | ||
EULAR 20 (2003) | 1B | B | 4 | ||
EULAR 29 (2001) | IIA | B | 4 | ||
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | B | 3 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | Ia | 77% | 4 | ||
TLAR 22 (2012) | Ib | 86% | 4 | ||
Education | |||||
Education type unspecified | AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | II | B | 4 | 4 (strongly recommended) |
ACR 19 (2012) | NS | Conditionally recommended | 1 | ||
BSR 21 (2005) | IV | D | 1 | ||
EULAR 24 (2007) | IV | 59% | 1 | ||
EULAR 23 (2005) | Ib | 72% | 4 | ||
EULAR 20 (2003) | 1A | A | 4 | ||
EULAR 29 (2001) | IA | A | 4 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | Ia | 97% | 4 | ||
KNGF 30 (2011) | II | NS | 3 | ||
TLAR 22 (2012) | Ib, III, IV | 96%, 94% | 4 | ||
Pain management program | Ottawa 18 (2011) | 1 | A–D | 3 | 3 (strongly recommended) |
Individual education | EULAR 26 (2013) | Ia | 84% | 4 | 3.5 (strongly recommended) |
Ottawa 18 (2011) | 1 | A–D | 3 | ||
Group education | Ottawa 18 (2011) | 1 | A–D | 3 | 3 (strongly recommended) |
Preoperative education | Ottawa 18 (2011) | 1 | A–D | 3 | 3 (strongly recommended) |
Collective information | Ottawa 18 (2011) | 1 | A–D | 3 | 3 (strongly recommended) |
Manual therapy | |||||
Manual therapy with supervised exercise | ACR 19 (2012) | NS | Conditionally recommended | 1 | 3 (strongly recommended) |
Ottawa 28 (2005) | I | A–C | 3 | ||
KNGF 30 (2011) | II | NS | 3 | ||
Manipulation and stretching | NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | 4 (strongly recommended) |
Diet and weight loss | |||||
Weight loss | AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | I | A | 4 | 4 (strongly recommended) |
ACR 19 (2012) | NS | Strongly recommended | 2 | ||
EULAR 26 (2013) | Ia–III | 98% | 4–2 | ||
EULAR 23 (2005) | III | 68% | 2 | ||
EULAR 20 (2003) | 1B | B | 4 | ||
EULAR 29 (2001) | IB | B | 4 | ||
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | B | 3 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | Ia | 96% | 4 | ||
TLAR 22 (2012) | III | NS | 1 | ||
Diet | Ottawa 27 (2011) | I | A–D | 3 | 3 (strongly recommended) |
Combinations of diet, physical activity, and social cognitive theory | Ottawa 27 (2011) | I | A–D | 3 | 3 (strongly recommended) |
Self-management and psychosocial-based therapy | |||||
Self-management | AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | II | B | 4 | 3 (strongly recommended) |
ACR 19 (2012) | NS | Conditionally recommended | 1 | ||
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | C | 1 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | N/S | 4 | ||
OARSI 25 (2008) | IV | 97% | 2 | ||
Ottawa 18 (2011) | I | C–D | 3 | ||
KNGF 30 (2011) | II | NS | 3 | ||
Balneotherapy/spa | |||||
Balneotherapy | TLAR 22 (2012) | Ia, Ib, III | 91% | 4 | 4 (strongly recommended) |
Spa | EULAR 29 (2001) | IB | C | 3 | 3 (strongly recommended) |
Intervention | Guideline (Date) | LOE | SOR | Individual Weighting | Median (Overall Recommendation) |
---|---|---|---|---|---|
Exercise | |||||
Tai chi | ACR 19 (2012) | NS | Conditionally recommended | 1 | 2 (recommended) |
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | C | 2 | ||
Ottawa 28 (2005) | I | A–C | 3 | ||
Electrical-based therapy | |||||
Electrical stimulation | NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | B | 3 | 2 (recommended) |
KNGF 30 (2011) | III | NS | −1 | ||
TLAR 22 (2012) | NS | 88% | 2 | ||
Equipment | |||||
Devices to assist with activities of daily living | ACR 19 (2012) | NS | Conditionally recommended | 1 | 2.5 (recommended) |
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
Walking aids | ACR 19 (2012) | NS | Conditionally recommended | 1 | 2 (recommended) |
EULAR 26 (2013) | III | 89% | 2 | ||
EULAR 23 (2005) | IV | 61% | 2 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | IV | 90% | 2 | ||
TLAR 22 (2012) | Ib | 96% | 4 | ||
Acupuncture | NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | C | 2 | 2 (recommended) |
OARSI 25 (2008) | Ia | 59% | 3 | ||
TLAR 22 (2012) | NS | 93% | 2 | ||
Manual therapy | |||||
Multimodal physical therapy | NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | C | 2 | 2 (recommended) |
Taping | AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | II | B | 4 | 2.5 (recommended) |
ACR 19 (2012) | NS | Conditionally recommended | 1 | ||
EULAR 29 (2001) | Ib | B | 4 | ||
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | D | 1 | ||
KNGF 30 (2011) | II | NS | 3 | ||
TLAR 22 (2012) | III | 86% | 2 | ||
Thermal-based therapy | ACR 19 (2012) | NS | Conditionally recommended | 1 | 2 (recommended) |
EULAR 24 (2007) | IV | 77% | 2 | ||
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | C | 2 | ||
NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | 4 | ||
OARSI 25 (2008) | Ia | 64% | 4 | ||
KNGF 30 (2011) | IV | NS | 1 | ||
TLAR 22 (2012) | Ib | 86% | 4 | ||
Self-management and psychosocial-based therapy | |||||
Adherence strategies | BSR 21 (2005) | IV | D | 1 | 2.5 (recommended) |
OARSI 25 (2008) | Ib | 97% | 4 | ||
Telephone support | AAOS 17 (2008)Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | IV | C | 1 | 2.5 (recommended) |
EULAR 29 (2001) | Ib | B | 4 | ||
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | D | 1 | ||
OARSI 25 (2008) | Ia, IV | 66%, 66% | 4, 2 | ||
Ottawa 18 (2011) | I | C–D | 3 |
Intervention | Guideline (Date) | LOE | SOR | Individual Weighting | Median (Overall Recommendation) |
---|---|---|---|---|---|
Electrical-based therapy | |||||
Ultrasound | EULAR 24 (2007) | IV | 25% | 1 | 1.5 (recommended with caution) |
NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | C | 2 | ||
KNGF 30 (2011) | II | NS | −3 | ||
TLAR 22 (2012) | Ia, Ib, III | 95% | 4 | ||
Equipment | |||||
Hand splints | ACR 19 (2012) | NS | Conditionally recommended | 1 | 1.5 (recommended with caution) |
EULAR 24 (2007) | IV | 67% | 2 |
Intervention | Guideline (Date) | LOE | SOR | Individual Weighting | Median (Overall Recommendation) |
---|---|---|---|---|---|
Electrical-based therapy | |||||
Laser therapy | NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | D | 1 | 0 (unsupported) |
KNGF 30 (2011) | IV | NS | −1 | ||
Equipment | |||||
Magnetic bracelets | NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | D | 1 | 1 (unsupported) |
Acupuncture | |||||
Chinese acupuncture | ACR 19 (2012) | NS | Conditionally recommended | 1 | 1 (unsupported) |
Manual therapy | |||||
Massage therapy | NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | D | 1 | 0 (unsupported) |
KNGF 30 (2011) | II | NS | −1 | ||
Self-management and psychosocial-based therapy | |||||
Psychosocial interventions | ACR 19 (2012) | NS | Conditionally recommended | 1 | 1 (unsupported) |
Cognitive behavior therapy (CBT) | NHMRC 14 (2009)Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | NS | D | 1 | 1 (unsupported) |
Intervention | Guideline (Date) | LOE | SOR | Individual Weighting | Median (Overall Recommendation) |
---|---|---|---|---|---|
Acupuncture | |||||
Electroacupuncture | NICE 1 (2008)National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | NS | NS | −4 | −4 (not recommended) |
National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012.
Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013.
National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012.
Discussion
Izquierdo R, Voloshin I, Edwards S, et al. The treatment of glenohumeral joint osteoarthritis: guideline and evidence report. Rosemont: American Academy of Orthopaedic Surgeons; 2009. Available at: http://www.aaos.org/research/guidelines/gloguideline.pdf. Accessed January 14, 2013.
Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013.
Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013.
Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013.
Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013.
Study limitations
Conclusions
Organization Name |
---|
3e Initiative in Rheumatology |
African League of Associations for Rheumatology |
American Academy of Orthopaedic Surgeons |
American College of Rheumatology |
American Geriatrics Society |
American Pain Society |
Arthritis.com |
Arthritis New Zealand |
Arthritis Research UK |
Arthritis Society—Canada |
Asia Pacific League of Associations for Rheumatology |
Assessment of SpondyloArthritis International Society |
Brazilian Society of Rheumatology |
British Paediatric Rheumatology Group |
British Society for Rheumatology |
Canadian Medical Association Clinical Guidelines |
Canadian Rheumatology Association |
Centers for Disease Control and Prevention Guidelines |
Cochrane Review—Osteoarthritis |
European League Against Rheumatism |
Group for Research in Psoriasis and Psoriatic Arthritis |
Hong Kong Society of Rheumatology |
Institute for Clinical Systems Improvement |
International League of Association for Rheumatology |
Italian Society of Rheumatology |
Medical Journal of Australia Clinical Guidelines |
National Guidelines Clearinghouse |
National Health and Medical Research Council |
National Institute for Health and Care Excellence |
New South Wales Therapeutic Assessment Group |
New Zealand Guidelines Group (completed voluntary liquidation mid-2012) |
Orthopedic Research Society |
Osteoarthritis Research Society International |
Ottawa Panel Evidence |
Pan-American League of Associations for Rheumatology |
Queensland University Clinical Practice Guidelines |
Royal Dutch Society for Physical Therapy |
Scottish Intercollegiate Guidelines Network |
South Africa Arthritis Foundation |
Therapeutic Goods Administration |
Therapeutic Guidelines |
Turkish League Against Rheumatism |
U.S. Agency for Healthcare Research & Quality |
Author Criteria for LOEs/Recommending Grading | |||
---|---|---|---|
AAOS 17 Richmond J, Hunter D, Irrgang J, et al. Treatment of osteoarthritis of the knee (non-arthroplasty): full guideline. Rosemont: American Academy of Orthopaedic Surgeons; 2008. Available at: http://www.aaos.org/research/guidelines/oakguideline.pdf. Accessed January 14, 2013. | |||
Grading the recommendations | |||
A | Good evidence (level I studies with consistent finding) for or against recommending intervention | ||
B | Fair evidence (level II or III studies with consistent findings) for or against recommending intervention | ||
C | Poor-quality evidence (level IV or V) for or against recommending intervention | ||
I | Insufficient or conflicting evidence not allowing a recommendation for or against intervention | ||
LOE | Study type | ||
Level I | Systematic reviews, high-quality RCTs | ||
Level II or III | Poor-quality RCTs, prospective or retrospective comparative studies, case-control | ||
Level IV or V | Case series, expert opinion | ||
None or conflicting | |||
ACR 19 | |||
Strong recommendation to use | |||
Weak (or conditional) recommendation to use | |||
No recommendation | |||
Weak (or conditional) recommendation not to use | |||
Strong recommendation not to use | |||
Strong recommendations mean that most informed patients would choose the recommended management and that clinicians can structure their interactions with patients accordingly. | |||
Conditional recommendations mean that the majority of informed patients would choose the recommended management but many would not, and so clinicians must ensure that patients’ care is in keeping with their values and preferences. | |||
BSR 21 | |||
SOR | |||
A | Directly based on category I evidence | ||
B | Directly based on category II evidence or extrapolated recommendation from category I evidence | ||
C | Directly based on category III evidence or extrapolated recommendation from category I or II evidence | ||
D | Directly based on category IV evidence or extrapolated recommendation from category I, II, or III evidence | ||
Categories of evidence | |||
Ia | MA of RCT | ||
Ib | At least 1 RCT | ||
IIa | At least 1 controlled study without randomization | ||
IIb | At least 1 type of quasi-experimental study | ||
III | Descriptive studies (comparative, correlation, case-control) | ||
IV | Expert committee reports/opinions and/or clinical opinion of respected authorities | ||
EULAR 20 , 23 , 24 , 26 , 29 | |||
SOR | |||
A | Category I evidence | ||
B | Category II evidence or extrapolated recommendation from category I evidence | ||
C | Category III evidence or extrapolated recommendation from category I or II evidence | ||
D | Category IV evidence or extrapolated recommendation from category II or III evidence | ||
Categories of evidence | |||
Ia | MA or RCTs | ||
Ib | At least 1 RCT | ||
IIa | At least 1 controlled study without randomization | ||
IIb | At least 1 quasi-experimental study | ||
III | Descriptive studies, such as comparative, correlation, or case-control studies | ||
IV | Expert committee reports or opinions and/or clinical experience of respected authorities | ||
NHMRC 14 Brand C, Buchbinder R, Wluka A, et al. Guideline for the nonsurgical management of hip and knee osteoarthritis 2009. Available at: http://www.nhmrc.gov.au/guidelines/. Accessed January 14, 2013. | |||
Grade of recommendations | |||
A | Body of evidence can be trusted to guide practice | ||
B | Body of evidence can be trusted to guide practice in most situations | ||
C | Body of evidence provides some support for recommendation(s), but care should be taken in its application | ||
D | Body of evidence is weak, and recommendation must be applied with caution | ||
Note: A recommendation cannot be graded A or B unless the volume and consistency of evidence components are both graded either A or B | |||
LOE | |||
I | Evidence obtained from a systematic review of all relevant RCTs | ||
II | Evidence obtained from at least 1 properly designed RCT | ||
III-1 | Evidence obtained from well-designed pseudo RCTs (alternate allocation or some other method) | ||
III-2 | Evidence obtained from comparative studies with concurrent controls and allocation not randomized (cohort studies), case-control studies, or interrupted time series with a control group | ||
III-3 | Evidence obtained from comparative studies with historical control, 2 or more single-arm studies, or interrupted time series without a parallel control group | ||
IV | Evidence obtained from case series, either posttest or pretest and posttest | ||
NICE 1 National Collaborating Centre for Chronic Conditions. Osteoarthritis: national clinical guideline for care and management in adults: Royal College of Physicians. 2008. Available at: http://www.nice.org.uk/CG059. Accessed November 26, 2012. | |||
Grading the evidence statements | |||
1++ | High-quality MAs, systematic reviews of RCTs, or RCTs with a very low risk of bias | ||
1+ | Well-conducted MAs, systematic reviews of RCTs, or RCTs with a low risk of bias | ||
1– | MAs, systematic reviews of RCTs, or RCTs with a high risk of bias | ||
2++ | High-quality systematic reviews of case-control or cohort studies | ||
2+ | High-quality case-control or cohort studies with a very low risk of confounding, bias, or chance and a high probability that the relation is causal | ||
2− | Well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relation is causal | ||
3 | Case-control or cohort studies with a high risk of confounding, bias, or chance and a significant risk that the relation is not causal | ||
4 | Nonanalytic studies (eg, case reports, case series) Expert opinion, formal consensus | ||
OARSI 22 , 25 | |||
SOR: VAS (0%–100%) | |||
Evidence hierarchy | |||
Ia | MA of RCTs | ||
Ib | At least 1 RCT | ||
IIa | At least 1 well-designed controlled study, but without randomization | ||
IIb | At least 1 well-designed quasi-experimental study | ||
III | At least 1 nonexperimental descriptive study (comparative, correlation, or case-controlled study) | ||
IV | Expert committee reports, opinions, and/or experience of respected authorities | ||
Ottawa Panel 5 , 18 , 27 , 28 | |||
Grade | Clinical Importance (%) | Statistical Significance | Study Design |
A (strongly recommended) | ≥15 | <.05 | RCT (single or meta-analysis) |
B (recommended) | ≥15 | <.05 | CCT or observational (single or meta-analysis) |
C+ (suggested used) | ≥15 | Not significant | RCT/CCT or observational (single or meta-analysis) |
C (neutral) | <15 | Not significant | Any study design |
D (neutral) | <15 (favors control) | Not significant | Any study design |
D+ (suggested no use) | <15 (favors control) | Not significant | RCT/CCT or observational (single or meta-analysis) |
D− (strongly not recommended) | ≤15 (favors control) | <.05 (favors control) | Well-designed RCT with >100 patients (if <100 patients, becomes grade D) |
KNGF 30 | |||
LOE | |||
I | One A1 study or at least 2 A2 studies | ||
II | One A2 study or at least 2 B studies | ||
II | 1 B or multiple C studies | ||
IV | Expert opinion | ||
Grades of recommendation | |||
A1 | MA (systematic reviews) that includes at least 2 RCTs at quality level A2 that show consistent results between studies | ||
A2 | RCTs of a good methodological quality (randomized double-blind controlled studies) with sufficient power and consistency | ||
B | RCT of a moderate methodological quality of insufficient power, or nonrandomized, cohort of patient-control group study involving intergroup comparisons | ||
C | Patient series | ||
D | Expert opinion |
Acknowledgments
References
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No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.