Larmer PJ,et al. Show allJournal
Arch Phys Med Rehabil. 2013 Oct 31. pii: S0003-9993(13)01105-2. doi: 10.1016/j.apmr.2013.10.011. [Epub ahead of print]

Affiliation
Head, School of Rehabilitation and Occupation Studies, Faculty of Health and Environmental Sciences, AUT University, Private Bag 92006, Auckland 1142, New Zealand. Electronic address: peter.larmer@aut.ac.nz.

Abstract
OBJECTIVE: To undertake a systematic critical appraisal of guidelines to provide a summary of recommendations for the physical management of Osteoarthritis (OA).

DATA SOURCES: The Cochrane Library, MEDLINE, CINAHL, SPORTDiscuss with Full Text, Scopus, ScienceDirect, PEDro and Google Scholar databases were searched (2000 to 2013) to identify all guidelines, protocols and recommendations for the management or treatment of osteoarthritis. In addition internet searches of all relevant arthritis organisations were undertaken. All searches were performed between July 2012 and end of April 2013. Guidelines that included only pharmacological, injection therapy or surgical interventions were excluded. Only guidelines published in English were retrieved.

STUDY SELECTION: Osteoarthritis guidelines developed from evidence based research, consensus and/or expert opinion were retrieved. There were no restrictions on severity or site of OA, gender or age. Nineteen guidelines were identified for evaluation.

DATA EXTRACTION: The quality of all guidelines was critically appraised using the AGREE II instrument. Each guideline was independently reviewed. All relevant recommendations for the physical management of OA were synthesised, graded and ranked according to available evidence.

DATA SYNTHESIS: Seventeen guidelines with recommendations on the physical management of OA met the inclusion criteria and underwent a full critical appraisal. There were variations in the interventions, levels of evidence and strength of recommendations across the guidelines. Forty different interventions were identified. Recommendations were graded from ‘strongly recommended’ to ‘unsupported’. Exercise and education were found to be strongly recommended by most guidelines.

CONCLUSION: Exercise and education were key recommendations supporting the importance of rehabilitation in the role in the physical management of OA. This critical appraisal can assist health care providers who are involved in the management of people with OA.

PubMed Reference:  http://www.ncbi.nlm.nih.gov/m/pubmed/24184307/