Review article (meta-analysis)
Systematic Review of Guidelines for the Physical Management of Osteoarthritis

https://doi.org/10.1016/j.apmr.2013.10.011Get rights and content

Abstract

Objective

To undertake a systematic critical appraisal of guidelines to provide a summary of recommendations for the physical management of osteoarthritis (OA).

Data Sources

The Cochrane Library, MEDLINE, CINAHL, SPORTDiscus with Full Text, Scopus, ScienceDirect, PEDro, and Google Scholar databases were searched (2000–2013) to identify all guidelines, protocols, and recommendations for the management or treatment of OA. In addition, Internet searches of all relevant arthritis organizations were undertaken. All searches were performed between July 2012 and end of April 2013. Guidelines that included only pharmacological, injection therapy, or surgical interventions were excluded. Guidelines published only in English were retrieved.

Study Selection

OA guidelines developed from evidence-based research, consensus, and/or expert opinion were retrieved. There were no restrictions on severity or site of OA, sex, or age. Nineteen guidelines were identified for evaluation.

Data Extraction

The quality of all guidelines was critically appraised using the Appraisal of Guidelines for REsearch and Evaluation II instrument. Each guideline was independently reviewed. All relevant recommendations for the physical management of OA were synthesized, graded, and ranked according to available evidence.

Data Synthesis

Seventeen guidelines with recommendations on the physical management of OA met the inclusion criteria and underwent a full critical appraisal. There were variations in the interventions, levels of evidence, and strength of recommendations across the guidelines. Forty different interventions were identified. Recommendations were graded from “strongly recommended” to “unsupported.” Exercise and education were found to be strongly recommended by most guidelines.

Conclusions

Exercise and education were key recommendations supporting the importance of rehabilitation in the physical management of OA. This critical appraisal can assist health care providers who are involved in the management of people with OA.

Section snippets

Electronic database searches

A systematic literature search was performed. The Cochrane Library, MEDLINE, CINAHL, SPORTDiscus with Full Text, Scopus, ScienceDirect, PEDro, and Google Scholar databases were searched (2000–2013) to identify all guidelines, protocols, and recommendations for the management or treatment of OA. An experienced health science librarian assisted with the development of the search strategy. MEDLINE, CINAHL, and SPORTDiscus with Full Text databases were searched using key word proximity searches to

Results

The systematic literature search yielded 19 guidelines. One15 was excluded because there were no stated methods for evidence gathering or developing recommendations, recommendations were not clear, and no method for grading recommendations was stated. One16 was excluded because no conclusive recommendations were provided for the physical management of glenohumeral joint OA. This resulted in 17 guidelines available for full data extraction.

Discussion

This review is the first published critical appraisal of guidelines for the physical management of OA. Of the 19 guidelines that we identified, 2 were excluded. First, the South Africa Arthritis Foundation guideline15 was not included because recommendations were not clearly stated. Second, the recommendations from the American Academy of Orthopaedic Surgeons glenohumeral OA guideline16 were not included because the focus of the guideline was surgical and pharmacological, with no conclusive

Conclusions

The objective of this appraisal was to review the available guidelines and present the treatment recommendations for the physical management of OA in a format that was useful to the user. Throughout the research, there is strong evidence to support aspects of the use of exercise, electrical-based therapy, equipment, education, diet and weight loss, manual therapy, and self-management. Laser therapy, magnetic bracelets, Chinese acupuncture, massage therapy, aspects of psychosocial-based therapy,

Acknowledgments

We thank Andrew South, MSocSci (Hons), GradDipLib, a library technician at the Auckland University of Technology, for his assistance with designing the literature search criteria.

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