School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
PLoS One. 2014 Jan 10;9(1):e82986. doi: 10.1371/journal.pone.0082986. eCollection 2014.
Clinical practice CPGs (CPGs) have been developed to summarize evidence related to the management of osteoarthritis (OA). CPGs facilitate uptake of evidence-based knowledge by consumers, health professionals, health administrators and policy makers. The objectives of the present review were: 1) to assess the quality of the CPGs on non-pharmacological management of OA; using a standardized and validated instrument--the Appraisal of Guidelines Research and Evaluation (AGREE II) tool--by three pairs of trained appraisers; and 2) to summarize the recommendations based on only high-quality existing CPGs. Scientific literature databases from 2001 to 2013 were systematically searched for the state of evidence, with 17 CPGs for OA being identified. Most CPGs effectively addressed only a minority of AGREE II domains. Scope and purpose was effectively addressed in 10 CPGs on the management of OA, stakeholder involvement in 12 CPGs, rigour of development in 10 CPGs, clarity/presentation in 17 CPGs, editorial independence in 2 CPGs, and applicability in none of the OA CPGs. The overall quality of the included CPGs, according to the 7-point AGREE II scoring system, is 4.8 ± 0.41 for OA. Therapeutic exercises, patient education, transcutaneous electrical nerve stimulation, acupuncture, orthoses and insoles, heat and cryotherapy, patellar tapping, and weight control are commonly recommended for the non-pharmacological management of OA by the high-quality CPGs. The general clinical management recommendations tended to be similar among high-quality CPGs, although interventions addressed varied. Non-pharmacological management interventions were superficially addressed in more than half of the selected CPGs. For CPGs to be standardized uniform creators should use the AGREE II criteria when developing CPGs. Innovative and effective methods of CPG implementation to users are needed to ultimately enhance the quality of life of arthritic individuals.
临床实践指南(CPGs)已经被开发出来,以总结与骨关节炎(OA)管理相关的证据。CPGs 有助于消费者、卫生专业人员、卫生管理人员和政策制定者吸收循证知识。本研究的目的是:1)使用经过标准化和验证的工具——评估指南研究和评估(AGREE II)工具——由三对经过培训的评估人员评估非药物治疗 OA 的 CPGs 的质量;2)仅根据高质量的现有 CPG 总结建议。从 2001 年到 2013 年,系统地搜索了科学文献数据库,以确定 OA 的证据状态,共确定了 17 项 OA 的 CPG。大多数 CPG 仅有效地解决了 AGREE II 领域的少数几个方面。10 项关于 OA 管理的 CPG 有效地解决了范围和目的,12 项 CPG 涉及利益相关者参与,10 项 CPG 解决了开发的严谨性,17 项 CPG 解决了清晰度/演示,2 项 CPG 解决了编辑独立性,而没有一项 OA CPG 解决了适用性。根据 7 分制的 AGREE II 评分系统,纳入的 CPG 总体质量为 4.8±0.41。运动疗法、患者教育、经皮神经电刺激、针灸、矫形器和鞋垫、热疗和冷疗、髌腱叩击和体重控制是高质量 CPG 推荐的 OA 非药物治疗的常用方法。尽管干预措施不同,但高质量 CPG 中的一般临床管理建议往往相似。在选择的 CPG 中,超过一半的 CPG 对非药物治疗干预措施的描述都比较肤浅。为了使 CPG 标准化,统一的创建者应该在制定 CPG 时使用 AGREE II 标准。需要创新和有效的 CPG 实施方法来提高最终关节炎患者的生活质量。
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