Peter W F, Jansen M J, Hurkmans E J, Bloo H, Dekker J, Dilling R G, Hilberdink W, Kersten-Smit C, de Rooij M, Veenhof C, Vermeulen H M, de Vos R J, Schoones J W, Vliet Vlieland T P
Department of Rheumatology, Leiden University Medical Center, The Netherlands.
Acta Reumatol Port. 2011 Jul-Sep;36(3):268-81.
An update of a Dutch physiotherapy practice guideline in Hip and Knee Osteoarthritis (HKOA) was made, based on current evidence and best practice.
A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters: initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated. A first draft of the guideline was reviewed by 17 experts from different professional backgrounds. A second draft was field-tested by 45 physiotherapists.
In total 11 topics were selected. For the initial assessment, three recommendations were formulated, pertaining to history taking, red flags, and formulating treatment goals. Concerning treatment, 7 recommendations were formulated; (supervised) exercise therapy, education and self management interventions, a combination of exercise and manual therapy, postoperative exercise therapy and taping of the patella were recommended. Balneotherapy and hydrotherapy in HKOA, and thermotherapy, TENS, and Continuous Passive Motion in knee OA were neither recommended nor discouraged. Massage therapy, ultrasound, electrotherapy, electromagnetic field, Low Level Laser Therapy, preoperative physiotherapy and education could not be recommended. For the evaluation of treatment goals the following measurement instruments were recommended: Lequesne index, Western Ontario and McMaster Universities osteoarthritis index, Hip disability and Osteoarthritis Outcome Score and Knee injury and Osteoarthritis Outcome Score, 6-minute walktest, Timed Up and Go test, Patient Specific Complaint list, Visual Analoge Scale for pain, Intermittent and Constant OsteoArthritis Pain Questionnaire, goniometry, Medical Research Council for strength, handheld dynamometer.
This update of a Dutch physiotherapy practice guideline on HKOA included 11 recommendations on the initial assessment, treatment and evaluation. The implementation of the guideline in clinical practice needs further evaluation.
基于当前证据和最佳实践，对荷兰髋膝关节骨关节炎（HKOA）物理治疗实践指南进行了更新。
一个由10名物理治疗专家组成的指南指导委员会，选择了与指南章节相关的主题：初始评估、治疗和评估。关于治疗，使用各种数据库进行了系统的文献检索，并对证据进行了分级（1 - 4级）。对于初始评估和评估，主要使用综述论文和教科书。基于证据和专家意见，制定了建议。指南初稿由来自不同专业背景的17名专家进行了评审。第二稿由45名物理治疗师进行了实地测试。
共选择了11个主题。对于初始评估，制定了三项建议，涉及病史采集、警示信号和制定治疗目标。关于治疗，制定了7项建议；推荐（监督下的）运动疗法、教育和自我管理干预、运动与手法治疗相结合、术后运动疗法以及髌骨贴扎。不推荐也不反对在HKOA中使用水疗和水疗法，以及在膝关节OA中使用热疗、经皮电刺激神经疗法（TENS）和持续被动运动。不推荐按摩疗法、超声波、电疗法、电磁场、低强度激光疗法、术前物理治疗和教育。对于治疗目标的评估，推荐了以下测量工具：Lequesne指数、西安大略和麦克马斯特大学骨关节炎指数、髋关节残疾和骨关节炎结果评分以及膝关节损伤和骨关节炎结果评分、6分钟步行试验、计时起立行走试验、患者特定投诉清单、疼痛视觉模拟量表、间歇性和持续性骨关节炎疼痛问卷、测角法、医学研究委员会肌力评分、手持测力计。
这份荷兰HKOA物理治疗实践指南的更新包括了关于初始评估、治疗和评估的11项建议。该指南在临床实践中的实施需要进一步评估。
