Poitras Stéphane, Avouac Jérôme, Rossignol Michel, Avouac Bernard, Cedraschi Christine, Nordin Margareta, Rousseaux Chantal, Rozenberg Sylvie, Savarieau Bernard, Thoumie Philippe, Valat Jean-Pierre, Vignon Eric, Hilliquin Pascal
Département d'épidémiologie, biostatistiques et de santé au travail, Université McGill, Montréal, Canada.
Arthritis Res Ther. 2007;9(6):R126. doi: 10.1186/ar2339.
Clinical practice guidelines have been elaborated to summarize evidence related to the management of knee osteoarthritis and to facilitate uptake of evidence-based knowledge by clinicians. The objectives of the present review were summarizing the recommendations of existing guidelines on knee osteoarthritis, and assessing the quality of the guidelines using a standardized and validated instrument--the Appraisal of Guidelines Research and Evaluation (AGREE) tool. Internet medical literature databases from 2001 to 2006 were searched for guidelines, with six guidelines being identified. Thirteen clinician researchers participated in the review. Each reviewer was trained in the AGREE instrument. The guidelines were distributed to four groups of three or four reviewers, each group reviewing one guideline with the exception of one group that reviewed two guidelines. One independent evaluator reviewed all guidelines. All guidelines effectively addressed only a minority of AGREE domains. Clarity/presentation was effectively addressed in three out of six guidelines, scope/purpose and rigour of development in two guidelines, editorial independence in one guideline, and stakeholder involvement and applicability in none. The clinical management recommendation tended to be similar among guidelines, although interventions addressed varied. Acetaminophen was recommended for initial pain treatment, combined with exercise and education. Nonsteroidal anti-inflammatory drugs were recommended if acetaminophen failed to control pain, but cautiously because of gastrointestinal risks. Surgery was recommended in the presence of persistent pain and disability. Education and activity management interventions were superficially addressed in most guidelines. Guideline creators should use the AGREE criteria when developing guidelines. Innovative and effective methods of knowledge translation to health professionals are needed.
临床实践指南已经制定出来，以总结与膝关节骨关节炎管理相关的证据，并促进临床医生采用基于证据的知识。本综述的目的是总结现有膝关节骨关节炎指南的建议，并使用标准化和经过验证的工具——指南研究与评价（AGREE）工具来评估这些指南的质量。检索了2001年至2006年的互联网医学文献数据库以查找指南，共识别出六项指南。13名临床研究人员参与了该综述。每位评审员都接受了AGREE工具的培训。这些指南被分发给四组，每组三或四名评审员，除了一组评审两项指南外，每组评审一项指南。一名独立评估员评审了所有指南。所有指南仅有效地涉及了少数AGREE领域。六项指南中有三项有效地涉及了清晰性/呈现，两项涉及了范围/目的和制定的严谨性，一项涉及了编辑独立性，没有一项涉及利益相关者参与和适用性。尽管所涉及的干预措施各不相同，但指南中的临床管理建议往往相似。对乙酰氨基酚被推荐用于初始疼痛治疗，并与运动和教育相结合。如果对乙酰氨基酚未能控制疼痛，则推荐使用非甾体抗炎药，但由于胃肠道风险需谨慎使用。在存在持续疼痛和残疾的情况下推荐手术。大多数指南只是表面上涉及了教育和活动管理干预措施。指南制定者在制定指南时应使用AGREE标准。需要创新且有效的向卫生专业人员进行知识转化的方法。
