OARSI recommendations for the management of hip and knee osteoarthritis, Part I: Critical appraisal of existing treatment guidelines and systematic review of current research evidence

Abstract

Twenty-three guidelines have been developed for the treatment of hip and/or knee OA, based on opinion alone, research evidence or both. Twenty of 51 modalities of therapy are universally recommended by these guidelines. Although this suggests that a core set of recommendations for treatment exists, critical appraisal shows that the overall quality of existing guidelines is sub-optimal, and consensus recommendations are not always supported by the best available evidence. Guidelines of optimal quality are most likely to be achieved by combining research evidence with expert consensus and by paying due attention to issues such as editorial independence, stakeholder involvement and applicability. This review of existing guidelines provides support for the development of new guidelines cognisant of the limitations in existing guidelines. Recommendations should be revised regularly following SR of new research evidence as this becomes available.

Effects of AIF on Knee Osteoarthritis Patients: Double-blind, Randomized Placebo-controlled Study

“…Moreover, optimal treatment often requires a combination of non-pharmacological and pharmacological modalities (Peat et al, 2001;Zhang et al, 2007).…”

Influence of foot positions on the spine and pelvis

“…Because of a lack of randomized long-term clinical studies, the benefit of wedged shoe insoles in the treatment of knee OA is still controversial. Nevertheless, shoe insoles are recommended in 13 of 14 guidelines for nonoperative treatment of knee OA (31,32). In this present study we investigated the immediate effects of different foot positions, such as how they could be achieved by shoe insoles, on the pelvic position and the spinal posture.…”

NICE on OA: surprisingly commendable

“…2 But, beware, these guidelines include an updated health technology appraisal of COX-2 inhibitors, and health technology appraisals carry a governmental obligation for implementation in England. This appraisal and an economic analysis were included because the previous guidance for COX-2 inhibitors was out of date.…”