The University of Melbourne, Melbourne, Victoria, Australia.
The University of Melbourne, Melbourne, Victoria, Australia, Griffith University, Nathan, Queensland, Australia, and Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Arthritis Care Res (Hoboken). 2023 Sep;75(9):1897-1907. doi: 10.1002/acr.25101. Epub 2023 Mar 17.
OBJECTIVE: To evaluate the quality of clinical practice guidelines (CPGs) for interventions in management of osteoarthritis (OA) and to provide a synthesis of high-quality CPG recommendations. METHODS: Five databases (OvidSP Medline, Cochrane, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, and the Physiotherapy Evidence Database [PEDro]) and 4 online guideline repositories were searched. CPGs for the management of OA were included if they were 1) written in English and published from January 2015 to February 2022, focused on adults age ≥18 years, and met the criteria of a CPG as defined by the Institute of Medicine; and 2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. CPGs for OA were excluded if they were available via institutional access only, only addressed recommendations for the system/organization of care and did not include interventional management recommendations, and/or included other arthritic conditions. RESULTS: Of 20 eligible CPGs, 11 were appraised as high quality and included in the synthesis. Of interest were the hip, knee, hand, and glenohumeral joints and/or polyarticular OA. Consistent recommendations were that care should be patient centered and include exercise, education, and weight loss (where appropriate). Nonsteroidal antiinflammatory drugs and surgical interventions were recommended for disabling OA that had not improved with nonsurgical care. Hand orthoses should be recommended for patients with hand OA. CONCLUSION: This synthesis of high-quality CPGs for OA management offers health care providers with clear, simple guidance of recommended OA care to improve patient outcomes.
目的:评估针对骨关节炎(OA)管理干预措施的临床实践指南(CPG)的质量,并综合高质量 CPG 推荐意见。
方法:检索了 5 个数据库(OvidSP Medline、Cochrane、护理学和联合健康文献累积索引 [CINAHL]、Embase 和物理治疗证据数据库 [PEDro])和 4 个在线指南库。纳入的管理 OA 的 CPG 须符合以下标准:1)用英文撰写,发表于 2015 年 1 月至 2022 年 2 月,针对年龄≥18 岁的成年人,符合医学研究所定义的 CPG 标准;2)在评估指南研究和评价 II(AGREE II)工具上被评为高质量。仅通过机构访问获得、仅涉及对护理系统/组织的建议且不包括干预管理建议的 OA CPG 以及包含其他关节炎疾病的 CPG 除外。
结果:在 20 项符合条件的 CPG 中,有 11 项被评估为高质量并纳入综合分析。值得关注的是髋关节、膝关节、手部和肩关节以及/或多关节 OA。一致的推荐意见是,应将以患者为中心的护理包括运动、教育和减肥(如有必要)。对于非手术治疗后仍未改善的致残性 OA,应推荐使用非甾体抗炎药和手术干预。对于手部 OA 患者,应推荐手部矫形器。
结论:本项针对 OA 管理的高质量 CPG 综合分析为医疗保健提供者提供了推荐 OA 护理的清晰、简单指导,以改善患者的治疗结果。
Arthritis Care Res (Hoboken). 2023-9
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