Effectiveness of Nonpharmacological and Nonsurgical Interventions for Hip Osteoarthritis: An Umbrella Review of High-Quality Systematic Reviews

Abstract

An increasing number of systematic reviews are available regarding nonpharmacological and nonsurgical interventions for hip osteoarthritis (OA). The objectives of this article are to identify high-quality systematic reviews on the effect of nonpharmacological and nonsurgical interventions for hip OA and to summarize available high-quality evidence for these treatment approaches. The authors identified and screened 204 reviews. Two independent reviewers using a previously pilot-tested quality assessment form assessed the full text of 58 reviews. Six reviews were of sufficient high quality and could be included for further analyses. There was moderate-quality evidence that acupuncture and diacerein have no effect on pain and function. There was low-quality evidence that strengthening exercises and avocado/soybean unsaponifiables reduce pain and that diacerein decreases radiographic OA progression. There was insufficient high-quality evidence regarding nonpharmacological and nonsurgical interventions for hip OA, and further primary studies and reviews are needed.

Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review

“…To assess the overall quality of evidence of all included systematic reviews, we applied an adapted form of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles 23. There are five GRADE categories: high; moderate; low; very low; and no evidence from systematic review.…”

What works to prevent falls in older adults dwelling in long term care facilities and hospitals? An umbrella review of meta-analyses of randomised controlled trials

“…The AMSTAR tool consists of 11 items which are rated as 'met', 'unclear' or 'unmet' and scores are given ranging from 0 (low quality) to 11 (highest quality) [17,18]. AMSTAR scores are graded as high (8)(9)(10)(11), medium (4-7) and low quality (0-3) [17][18][19].…”

“…Indeed, conclusions based on systematic reviews of RCTs are considered the top of the hierarchy of evidence [10]. Despite the fact that metaanalyses are the cornerstone of evidence based medicine and considered the "gold standard", there is an increasing realisation that even a perfect meta-analysis with perfect data can only provide a partial overview of an intervention available to clinicians [12].…”

Managing hip and knee osteoarthritis with exercise: what is the best prescription?

“…The integration of nonpharmacologic interventions such as therapeutic exercise, manual therapy, splinting, bracing, orthotics and assistive devices are recommended and provide a low-cost and minimal-risk option for patients to manage their disease. Among these nonpharmacologic interventions, therapeutic exercise is the most studied and supported in the literature [Fransen et al 2009a[Fransen et al , 2009bMoe et al 2007;Zhang et al 2007Zhang et al , 2005Hochberg et al 1995]. In fact, exercise is a component of the management guidelines for hip and knee osteoarthritis among numerous professional rheumatologic and health societies (Figure 1).…”