National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Ann Rheum Dis. 2013 Jul;72(7):1125-35. doi: 10.1136/annrheumdis-2012-202745. Epub 2013 Apr 17.
The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I-IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.
目的在于为髋和膝关节骨关节炎（OA）的非药物管理制定循证建议和研究与教育议程。多学科工作组由 21 名专家组成：护士、职业治疗师、物理治疗师、风湿病学家、矫形外科医生、全科医生、心理学家、营养师、临床流行病学家和患者代表。在初步文献回顾、第一次工作组会议和五次 Delphi 回合之后，制定了临时建议，以便进行系统评价。对 Medline 和其他 8 个数据库进行了截至 2012 年 2 月的文献检索。证据分为 I-IV 类，通过 0（完全不同意）到 10（完全同意）的分数来确定对建议的同意程度。针对髋和膝关节 OA 的非药物核心管理制定了 11 项非药物建议，涉及以下 9 个主题：评估、一般方法、患者信息和教育、生活方式改变、运动、减肥、辅助技术和适应、鞋类和工作。平均同意程度在 8.0 到 9.1 之间。拟议的研究议程包括对髋 OA 的非药物干预措施进行更多研究的总体需求、优化个体化治疗的调节剂、具有经济评估和长期随访的健康生活方式以及预防和减少工作残疾的需要。拟议的教育活动包括教授、启动和建立生活方式改变所需的技能。这 11 项建议为髋或膝关节 OA 患者提供了非药物干预措施的指导。需要开展更多的研究和教育活动，特别是在生活方式改变领域。
