Quality and content analysis of clinical practice guidelines which include nonpharmacological interventions for knee osteoarthritis

2020 ◽  
Author(s):  
Brenda J. Tittlemier ◽  
Kristy D. Wittmeier ◽  
Sandra C. Webber
Keyword(s):  
Content Analysis ◽  
Clinical Practice ◽  
Knee Osteoarthritis ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines

Clinical practice guidelines for rest orthosis, knee sleeves, and unloading knee braces in knee osteoarthritis

2009 ◽  
Vol 76 (6) ◽  
pp. 629-636 ◽  
Author(s):  
Johann Beaudreuil ◽  
Samy Bendaya ◽  
Marc Faucher ◽  
Emmanuel Coudeyre ◽  
Patricia Ribinik ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Knee Osteoarthritis ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Knee Braces

scholarly journals AB0597 COMPLIANCE WITH CLINICAL PRACTICE GUIDELINES IN KNEE OSTEOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1335.2-1335
Author(s):  
M. Yasmine ◽  
L. Souebni ◽  
S. Miladi ◽  
A. Fazaa ◽  
S. Mariem ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Clinical Practice ◽  
Knee Osteoarthritis ◽  
Alternative Medicine ◽  
General Practitioners ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Platelet Rich Plasma ◽  
Knee Oa ◽  
Comprehensive Management

Background:Knee osteoarthritis (OA) is a leading cause of disability among older adults. Recently, evidence-based guidelines for the comprehensive management of osteoarthritis (OA) were developed by the American College of Rheumatology (ACR).Objectives:The aim of this study was to assess compliance of doctors with ACR 2019 clinical practice guidelines for the management of knee OA.Methods:We conducted a prospective study including rheumatologists and general practitioners. The doctors were invited to answer a structured questionnaire via Google Form. The outcomes of interest concerned the medical management of knee OA as well as alternative medicine.Results:The study included 100 doctors: 75 rheumatologists and 25 general practitioners. Almost half of them (49%) have been practicing medicine for more than 10 years. Forty four percent of doctors see between 10 to 20 patients with knee OA per month and 47% of them declared seeing more than 20 patients. Regarding the pharmacological treatment of knee OA flares, oral Non-steroidal Anti-inflammatory drug (NSAIDs) was the initial molecule of choice (91%) followed by grade I analgesics (86 %) and topical NSAIDs (68%). Tramadol and non-Tramadol opioids as well as intraarticular glucocorticoid injections were prescribed respectively in 41% and 46 % of cases. Glucosamine and chondroitin sulfate were prescribed in 49% and 54% of cases respectively and as a combination in 20% of cases. The reasons for non-prescribing these molecules were non-affordable prices (n=19), a lack of efficacy (n=6) and potential sides effects (n=1). Seventy three percent of doctors prescribe hyaluronic acid injections, with a frequency of three weekly injections in 38.7 % of cases and according to the response to the first injection in 61.3% of cases. The combination of both corticosteroids and hyaluronic acid injection was preferred in 38% of cases. The majority of doctors (84%) referred their patients to physical therapy as a first-line prescription (82.1%) or after medical treatment failure (17.9%). The use of alternative medicine was at follows: acupuncture (42.7%), prolotherapy (28.1%) and platelet-rich plasma injections (16.7%). Thirty eight doctors recommended against alternative medicine.Conclusion:Our study showed a poor compliance to guidelines regarding the use of intra-articular injections and alternative medicine. Even though, these guidelines provide direction for clinicians, doctors and patients should engage in shared decision-making that accounts for patients’ values, preferences, and susceptibilities.Disclosure of Interests:None declared.

scholarly journals A Systematic Review of Current Clinical Practice Guidelines on Intra-articular Hyaluronic Acid, Corticosteroid, and Platelet-Rich Plasma Injection for Knee Osteoarthritis: An International Perspective

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110302
Author(s):  
Mark Phillips ◽  
Mohit Bhandari ◽  
John Grant ◽  
Asheesh Bedi ◽  
Thomas Trojian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Clinical Practice ◽  
Knee Osteoarthritis ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Platelet Rich Plasma ◽  
Symptom Relief ◽  
Current Evidence ◽  
Knee Oa

Background: There are many clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of knee osteoarthritis (OA). They differ by region, considering local health care systems, along with cultural and economic factors. Currently, there are conflicting CPG recommendations across the various publications, which makes it difficult for clinicians to fully understand the optimal treatment decisions for knee OA management. Purpose: To summarize the current published CPG recommendations for the role of injections in the nonoperative management of knee OA, specifically with the use of intra-articular hyaluronic acid (IA-HA), intra-articular corticosteroids (IA-CS), and platelet-rich plasma (PRP). Study Design: Systematic review. Methods: A comprehensive search identified all nonoperative knee OA CPGs within the ECRI (formerly Emergency Care Research Institute) Guidelines Trust database, the Guidelines International Network database, Google Scholar, and the Trip (formerly Turning Research Into Practice) database. Guideline recommendations were categorized into strong, conditional, or uncertain recommendations for or against the use of IA-HA, IA-CS, or PRP. Guideline recommendations were summarized and depicted graphically to identify trends in recommendations over time. Results: The search strategy identified 27 CPGs that provided recommendations. There were 20 recommendations in favor of IA-HA use, 21 recommendations in favor of IA-CS use, and 9 recommendations that were uncertain or unable to make a formal recommendation for or against PRP use based on current evidence. Most recommendations considered IA-HA and IA-CS use for symptom relief when other nonoperative options are ineffective. IA-CS were noted to provide fast and short-acting symptom relief for acute episodes of disease exacerbation, while IA-HA may demonstrate a relatively delayed but prolonged effect in comparison. The CPGs concluded that PRP recommendations currently lack evidence to definitively recommend for or against use. Conclusion: Available CPGs provide recommendations on injectables for knee OA treatment. General guidance from a global perspective concluded that IA-CS and IA-HA are favored for different needed responses and can be utilized within the knee OA treatment paradigm, while PRP currently has insufficient evidence to make a conclusive recommendation for or against its use.

How Do People Communicate about Knee Osteoarthritis? A Discourse Analysis

Pain Medicine ◽  
2021 ◽  
Author(s):  
Samantha Bunzli ◽  
Nicholas Taylor ◽  
Penny O'Brien ◽  
Michelle Dowsey ◽  
Jason Wallis ◽  
...  
Keyword(s):  
Physical Activity ◽  
Clinical Practice ◽  
Discourse Analysis ◽  
Knee Osteoarthritis ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Joint Damage ◽  
Qualitative Synthesis ◽  
Systematic Review Methods ◽  
Critical Appraisal Skills

Abstract Objective To explore the ways in which people talk about knee osteoarthritis and how this may influence engagement in physical activity and activity-based interventions as recommended by clinical practice guidelines. Design A qualitative synthesis using discourse analysis methods. Methods Systematic review methods were used to identify qualitative studies exploring the perceptions of people with knee osteoarthritis, their carers and/or clinicians. Methodological quality was evaluated using the Critical Appraisal Skills Programme. Raw quotes extracted from each study were analysed using inductive discourse analysis. Results A search of five electronic databases from inception until August 2019 yielded 778 articles. Sixty-two articles from 56 studies were included, reporting data (1673 direct quotes) from people with knee osteoarthritis, carers and clinicians in 16 countries. Two overarching discourses were identified—impairment and participation. The overarching impairment discourse prevailed in all participant groups and study settings. In this discourse, knee osteoarthritis was likened to a machine that inevitably wore-down over time and required a doctor to repair. The overarching participatory discourse almost always co-existed alongside an impairment discourse. According to this discourse, a ′busy body′ was perceived as ′healthy′ and people could remain active despite knee osteoarthritis. Conclusion The prevailing impairment discourse may potentially discourage people from using knees that have passed their ′use-by-date′ and increase reliance on doctors to repair joint damage. Consistent with recommendations in clinical practice guidelines, a participatory discourse may provide an alternative way of communicating, which may encourage people with knee osteoarthritis to continue to engage in physical activity by focusing on what they can do, rather than what they cannot do.

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