Appraisal of quality and analysis of the similarities and differences between osteoarthritis Clinical Practice Guideline recommendations: A systematic review.
Gray, Bimbi; Gibbs, Alison; Bowden, Jocelyn Let al.
Clinical practice guideline; Evidence-to-practice; Implementation; Osteoarthritis; Rheumatology; Biomedical Engineering; Orthopedics and Sports Medicine
Abstract :
[en] [en] OBJECTIVE: Clinical Practice Guidelines (CPGs) aim to support management of hip and knee osteoarthritis (OA), but recommendations are often conflicting and implementation is poor, contributing to evidence-to-practice gaps. This systematic review investigated the contextual and methodological factors contributing to conflicting recommendations for hip and knee OA.
METHOD: Our systematic review appraised CPGs for managing hip and knee OA in adults ≥18 years (PROSPERO CRD42021276635). We used AGREE-II and AGREE-REX to assess quality and extracted data on treatment gaps, conflicts, biases, and consensus. Heterogeneity of recommendations was determined using Weighted Fleiss Kappa (K). The relationship between (K) and AGREE-II/AGREE-REX scores was explored.
RESULTS: We identified 25 CPGs across eight countries and four international organisations. The ACR, EULAR, NICE, OARSI and RACGP guidelines scored highest for overall AGREE-II quality (83%). The highest overall AGREE-REX scores were for BMJ Arthroscopy (80%), RACGP (78%) and NICE (76%). CPGs with the least agreement for pharmacological recommendations were ESCEO and NICE (-0.14), ACR (-0.08), and RACGP (-0.01). The highest agreements were between RACGP and NICE (0.53), RACGP and ACR (0.61), and NICE and ACR (0.91). Decreased internal validity determined by low-quality AGREE scores(<60%) in editorial independence were associated with less agreement for pharmacological recommendations.
CONCLUSION: There were associations between guideline quality and agreement scores. Future guideline development should be informed by robust evidence, editorial independence and methodological rigour to ensure a harmonisation of recommendations. End-users of CPGs must recognise the contextual factors associated with the development of OA CPGs and balance these factors with available evidence.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Gray, Bimbi ; Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. Electronic address: bimbi.gray@sydney.edu.au
Gibbs, Alison; La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia. Electronic address: a.gibbs@latrobe.edu.au
Bowden, Jocelyn L; Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. Electronic address: Jocelyn.bowden@sydney.edu.au
Eyles, Jillian P; Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. Electronic address: jillian.eyles@sydney.edu.au
Bennell, Kim; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia, Level 7, Alan Gilbert Building, Carlton, VIC 3052, Australia
Geenen, Rinie ; Utrecht University, Department of Psychology, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands. Electronic address: R.Geenen@uu.nl
Sharon, Kolasinski; Division of Rheumatology, University of Pennsylvania. Electronic address: sharon.kolasinski@pennmedicine.upenn.edu
Barton, Christian ; La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia. Electronic address: c.barton@latrobe.edu.au
Conaghan, Philip G; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom. Electronic address: p.conaghan@leeds.ac.uk
McAlindon, Timothy; Tufts University School of Medicine and Tufts Medical Center, 800 Washington Street Boston, MA 02111, USA. Electronic address: tmcalindon@tuftsmedicalcenter.org
Bruyère, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Géczy, Quentin; Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. Electronic address: qgec6670@uni.sydney.edu.au
Hunter, David J; Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. Electronic address: david.hunter@sydney.edu.au
Appraisal of quality and analysis of the similarities and differences between osteoarthritis Clinical Practice Guideline recommendations: A systematic review.
NIHR - National Institute for Health and Care Research NIHR Leeds Musculoskeletal Biomedical Research Unit
Funding text :
We gratefully acknowledge the contribution from the chairs of the ACR, ESCEO, EULAR, NICE, OARSI, and RACGP, OA CPGs. We also acknowledge the contribution from Venkatesha (biostatistician) from the Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Australia for their assistance throughout the process of this review. PGC was a member of the development group for the NICE guideline on osteoarthritis (NG226) and is funded in part by the National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. No funding was received for this study. The data supporting the findings of this study is available from the corresponding author upon reasonable request.We gratefully acknowledge the contribution from the chairs of the ACR, ESCEO, EULAR, NICE, OARSI, and RACGP, OA CPGs. We also acknowledge the contribution from Venkatesha Venkatesha (biostatistician) from the Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Australia for their assistance throughout the process of this review. PGC was a member of the development group for the NICE guideline on osteoarthritis (NG226) and is funded in part by the National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. No funding was received for this study.
Cui, A., Li, H., Wang, D., et al. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine, 29-30, 2020, 100587, 10.1016/j.eclinm.2020.100587.
Briggs, A.M., Shiffman, J., Shawar, Y.R., et al. Global health policy in the 21st century: challenges and opportunities to arrest the global disability burden from musculoskeletal health conditions. Best Pract Res Clin Rheumatol, 34(5), 2020, 101549, 10.1016/j.berh.2020.101549.
Safiri, S., Kolahi, A.A., Smith, E., et al. Global, regional and national burden of osteoarthritis 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017. Ann Rheum Dis 79:6 (2020), 819–828, 10.1136/annrheumdis-2019-216515.
Abrams, E.M., Akombi, B., Alam, S., et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396:10258 (2020), 1204–1222, 10.1016/S0140-6736(20)30925-9.
Ackerman, I.N., Bohensky, M.A., Zomer, E., et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord, 20(1), 2019, 90, 10.1186/s12891-019-2411-9.
Ferket, B.S., Feldman, Z., Zhou, J., et al. Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. BMJ, 356, 2017, 1131, 10.1136/bmj.j1131.
Bennell, K.L., Bayram, C., Harrison, C., et al. Trends in management of hip and knee osteoarthritis in general practice in Australia over an 11-year window: a nationwide cross-sectional survey. Lancet Reg Health West Pac, 12, 2021, 100187, 10.1016/j.lanwpc.2021.100187.
Nalamachu, S.R., Robinson, R.L., Viktrup, L., et al. Multimodal treatment patterns for osteoarthritis and their relationship to patient-reported pain severity: a cross-sectional survey in the United States. J Pain Res 13 (2020), 3415–3425, 10.2147/JPR.S285124.
Moleman, M., Jerak-Zuiderent, S., van de Bovenkamp, H., et al. Evidence-basing for quality improvement; bringing clinical practice guidelines closer to their promise of improving care practices. J Eval Clin Pract(6), 2022, 1003–1026, 10.1111/jep.13659.
Guidelines CoSfDTCP, Clinical Practice Guidelines We Can Trust, 2011, National Academies Press.
Lewin, S., Glenton, C., Munthe-Kaas, H., et al. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Med, 12(10), 2015, e1001895, 10.1371/journal.pmed.1001895.
Lunny, C., Ramasubbu, C., Puil, L., et al. Over half of clinical practice guidelines use non-systematic methods to inform recommendations: a methods study. PLoS One, 16(4), 2021, e0250356, 10.1371/journal.pone.0250356.
Allen, K.D., Golightly, Y.M., White, D.K., Gaps in appropriate use of treatment strategies in osteoarthritis. Best Pract Res Clin Rheumatol 31:5 (2017), 746–759, 10.1016/j.berh.2018.05.003.
Gibbs, A.J., Gray, B., Wallis, J.A., et al. Recommendations for the management of hip and knee osteoarthritis: a systematic review of clinical practice guidelines. Osteoarthritis Cartil S1063-4584:23 (2023), 00832–00834, 10.1016/j.joca.2023.05.015.
Page, M.J., McKenzie, J.E., Bossuyt, P.M., et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev, 10(1), 2021, 89, 10.1136/bmj.n71.
Higgins, J.P.T., Cochrane Handbook for Systematic Reviews of Interventions, Second ed., 2019, Wiley-Blackwell, Hoboken, NJ.
Institute of medicine committee on standards for systematic reviews of comparative effectiveness R. Eden, J., Levit, L., Berg, A., Morton, S., (eds.) Finding What Works in Health Care: Standards for Systematic Reviews, 2011, National Academies Press (US) Copyright 2011 by the National Academy of Sciences, Washington (DC), 10.17226/13059.
Brouwers, M.C., Kho, M.E., Browman, G.P., et al. AGREE II: advancing guideline development, reporting and evaluation in health care. Can. Med. Assoc. J. 182:18 (2010), E839–E842, 10.1503/cmaj.090449.
AGREE NSC. The AGREE II Instrument [Electronic Version]. Published 2013. Accessed October 22, 2022.
Brosseau, L., Rahman, P., Toupin-April, K., et al. A systematic critical appraisal for non-pharmacological management of osteoarthritis using the appraisal of guidelines research and evaluation II instrument. PLoS One, 9(1), 2014, e82986, 10.1371/journal.pone.0082986.
Tittlemier, B.J., Wittmeier, K.D., Webber, S.C., Quality and content analysis of clinical practice guidelines which include nonpharmacological interventions for knee osteoarthritis. J Eval Clin Pract 27:1 (2021), 93–102, 10.1111/jep.13391.
Brouwers, M.C., Spithoff, K., Kerkvliet, K., et al. Development and validation of a tool to assess the quality of clinical practice guideline recommendations. JAMA Netw Open, 3(5), 2020, e205535, 10.1001/jamanetworkopen.2020.5535.
McHugh, M.L., Interrater reliability: the kappa statistic. Biochem Med 22:3 (2012), 276–282.
Fleiss, J.L., Measuring nominal scale agreement among many raters. Psychol Bull 76:5 (1971), 378–382, 10.1037/h0031619.
Cibulka, M.T., Bloom, N.J., Enseki, K.R., et al. Hip pain and mobility deficits-hip osteoarthritis: revision 2017. J Orthop Sports Phys Ther 47:6 (2017), A1–A37, 10.2519/jospt.2017.0301.
Kolasinski, S.L., Neogi, T., Hochberg, M.C., et al. 2019 American College of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res 72:2 (2020), 149–162, 10.1002/art.41142.
American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline; 2021. Accessed October 2, 2022.
Surgical Management of Osteoarthritis of the Knee Evidence-Based Clinical Practice Guideline; 2015. Accessed October 2, 2022.
American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Hip Evidence-Based Clinical Practice Guideline; 2017. Accessed October 2, 2022.
The US Veterans Affairs/Department of Defence (VA/DoD). The Non-Surgical Management of Hip & Knee Osteoarthritis; 2020. 〈https://www.healthquality.va.gov/guidelines/cd/oa/index.asp〉. Accessed October 2, 2022.
Brosseau, L., Wells, G.A., Tugwell, P., et al. Ottawa panel evidence-based clinical practice guidelines for the management of osteoarthritis in adults who are obese or overweight. Phys Ther 91:6 (2011), 843–861, 10.2522/ptj.20100104.
Brosseau, L., Wells, G.A., Pugh, A.G., et al. Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercise in the management of hip osteoarthritis. Clin Rehabil 30:10 (2016), 935–946, 10.1177/0269215515606198.
Brosseau, L., Taki, J., Desjardins, B., et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs. Clin Rehabil 31:5 (2017), 582–595, 10.1177/0269215517691083.
Brosseau, L., Taki, J., Desjardins, B., et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Clin Rehabil 31:5 (2017), 596–611, 10.1177/0269215517691084.
Brosseau, L., Taki, J., Desjardins, B., et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs. Clin Rehabil 31:5 (2017), 612–624, 10.1177/0269215517691085.
Korownyk, C.S., Montgomery, L., Young, J., et al. PEER simplified chronic pain guideline: management of chronic low back, osteoarthritic, and neuropathic pain in primary care. Can. Fam. Physician. 68:3 (2022), 179–190, 10.46747/cfp.6803179.
Royal Australian College of General Practitioners. Guideline for the Management of Knee and Hip Osteoartthritis. RACGP. 〈https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf〉. Published 2018. Accessed 2021.
Sellam, J., Courties, A., Eymard, F., et al. Recommendations of the French Society of Rheumatology on pharmacological treatment of knee osteoarthritis. JT Bone Spine 87:6 (2020), 548–555, 10.1016/j.jbspin.2020.09.004.
Tuncer, T., Cay, F.H., Altan, L., et al. 2017 update of the Turkish League Against Rheumatism (TLAR) evidence-based recommendations for the management of knee osteoarthritis. Rheumatol Int 38:8 (2018), 1315–1331, 10.1007/s00296-018-4044-y.
Zhang, Z., Huang, C., Jiang, Q., et al. Guidelines for the diagnosis and treatment of osteoarthritis in China (2019 edition). Ann Trans Med, 8(19), 2020, 1213, 10.21037/atm-20-4665.
Ministry of Health Singapore. Osteoarthritis of the Knees Clinical Practice Guideline; 2007. https://www.moh.gov.sg/docs/librariesprovider4/guidelines/cpg_oa-kness_booklet.pdf. Accessed October 2, 2022.
Ministry of Health Malaysia. Management of Osteoarthritis Clinical Practice Guideline; 2013. https://www.moh.gov.my/moh/attachments/8933.pdf. Accessed October 2, 2022.
Rillo, O., Riera, H., Acosta, C., et al. PANLAR consensus recommendations for the management in osteoarthritis of hand, hip, and knee. J Clin Rheumatol 22:7 (2016), 345–354, 10.1097/RHU.0000000000000449.
Doormaal, M.C.M., Meerhoff, G.A., Vliet Vlieland, T.P.M., Peter, W.F., A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskelet Care 18:4 (2020), 575–595, 10.1002/msc.1492.
NICE. Osteoarthritis in over 16s: diagnosis and management. National Institute for Health and Clinical Excellence. 〈https://www.nice.org.uk/guidance/ng226〉 Published 2022. Accessed November 11, 2022.
Bruyère, O., Honvo, G., Veronese, N., et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum 49:3 (2019), 337–350, 10.1016/j.semarthrit.2019.04.008.
Geenen, R., Overman, C.L., Christensen, R., et al. EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis 77:6 (2018), 797–807, 10.1136/annrheumdis-2017-212662.
Bannuru, R.R., Osani, M.C., Vaysbrot, E.E., et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartil 27:11 (2019), 1578–1589, 10.1016/j.joca.2019.06.011.
Siemieniuk, R.A.C., Harris, I.A., Agoritsas, T., et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ, 357, 2017, j1982, 10.1136/bmj.j1982.
Meneses, S.R., Goode, A.P., Nelson, A.E., et al. Clinical algorithms to aid osteoarthritis guideline dissemination. Osteoarthritis Cartil 24:9 (2016), 1487–1499, 10.1016/j.joca.2016.04.004.
Nelson, A.E., Allen, K.D., Golightly, Y.M., et al. A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Semin Arthritis Rheum 43:6 (2014), 701–712, 10.1016/j.semarthrit.2013.11.012.
Hagen, K.B., Smedslund, G., Østerås, N., Jamtvedt, G., Quality of community-based osteoarthritis care: a systematic review and meta-analysis. Arthritis Care Res 68:10 (2016), 1443–1452, 10.1002/acr.22891.
Oral, A., Arman, S., Tarakci, E., et al. A systematic review of clinical practice guidelines for persons with osteoarthritis. A “Best Evidence for Rehabilitation” (be4rehab) paper to develop the WHO's Package of Interventions for Rehabilitation. Int J Rheum Dis 25:4 (2022), 383–393, 10.1111/1756-185X.14292.
Phillips, M., Bhandari, M., Grant, J., et al. 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. Orthop J Sports Med, 9(8), 2021, 23259671211030272, 10.1177/23259671211030272.
Conley, B., Bunzli, S., Bullen, J., et al. What are the core recommendations for osteoarthritis care? A systematic review of clinical practice guidelines. Arthritis Care Res, 2010, 2023, 10.1002/acr.25101.
Chua, J., Hansen, P., Briggs, A.M., et al. Stakeholders' preferences for osteoarthritis interventions in health services: a cross-sectional study using multi-criteria decision analysis. Osteoarthritis Cartil, 2(4), 2020, 100110–100110, 10.1016/j.ocarto.2020.100110.
