Department of Physical Medicine & Rehabilitation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China.
Clin Rehabil. 2023 Jul;37(7):986-1008. doi: 10.1177/02692155221144892. Epub 2022 Dec 20.
This systematic review summarized the rehabilitation recommendations for treating and managing knee osteoarthritis (OA) in practice guidelines and evaluated their applicability and quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
PubMed, the Cochrane Library, EMBASE, CINAHL, PEDro, Guideline central, Guideline International Network and Agency for Healthcare Research and Quality (AHRQ) were used to search for relevant studies published between 1 January 2008 and 31 May 2022.
AGREE II was used to evaluate the included guidelines quality, SPSS 25.0 statistical software was used for data analysis, and the intra-group correlation coefficient value was calculated to verify the consistency between the raters. The two-way random effects model was used to calculate concordance scores, and each domain's total scores were calculated. Additionally, the median and interquartile range for domain and total scores were calculated.
Twenty-four guidelines recommending knee OA rehabilitation were included. Inter-rater consistency evaluation ranged from 0.62 to 0.90. The domains where the guideline's overall and rehabilitation parts scored highest and lowest were scope and purpose (domain 1) and applicability (domain 5), respectively. The highly recommended rehabilitation opinions included aerobic exercise programs (21/24), weight control (16/24), self-education and management (16/24), gait/walking aids (7/24), and tai chi (6/24). However, the orthopedic insole and hot/cold therapy roles remain controversial.
The clinical practice guidelines' overall quality for knee OA rehabilitation is good; however, the applicability is slightly poor. Therefore, we should improve the promoting factors and hindering factors, guideline application recommendations, tools, and resources when developing relevant guidelines.
本系统综述总结了治疗和管理膝关节骨关节炎（OA）的康复建议，使用 AGREE II 工具评估了实践指南中的推荐意见，并评估了其适用性和质量。
使用 PubMed、Cochrane 图书馆、EMBASE、CINAHL、PEDro、Guideline Central、Guideline International Network 和美国卫生保健研究与质量局（AHRQ）检索 2008 年 1 月 1 日至 2022 年 5 月 31 日发表的相关研究。
使用 AGREE II 评估纳入指南的质量，使用 SPSS 25.0 统计软件进行数据分析，计算组内相关系数值以验证评分者之间的一致性。使用双向随机效应模型计算一致性评分，并计算每个域的总分。此外，还计算了域和总分的中位数和四分位间距。
共纳入 24 条推荐膝关节 OA 康复的指南。评价者间一致性评估范围为 0.62-0.90。指南的整体和康复部分得分最高和最低的领域分别是范围和目的（第 1 域）和适用性（第 5 域）。高度推荐的康复意见包括有氧运动方案（21/24）、体重控制（16/24）、自我教育和管理（16/24）、步态/助行器（7/24）和太极拳（6/24）。然而，矫形鞋垫和冷热疗法的作用仍存在争议。
膝关节 OA 康复的临床实践指南的总体质量良好，但适用性略差。因此，在制定相关指南时，应改进促进因素和阻碍因素、指南应用建议、工具和资源。
