Abstract：
Guideline adherence for hip and knee osteoarthritis management is often poor, possibly related to the quality and/or inconsistent recommendations. This systematic review of hip and knee osteoarthritis guidelines aimed to appraise the quality and consistency in recommendations across higher-quality guidelines.
Eight databases, guideline repositories, and professional associations websites were searched on 27/10/2022. Guideline quality was appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II tool) (six domains). Higher quality was defined as scoring ≥60% for domains 3 (rigour of development), 6 (editorial independence), plus one other. Consistency in recommendations across higher-quality guidelines was reported descriptively. This review was registered prospectively (CRD42021216154).
Seven higher-quality and 18 lesser-quality guidelines were included. AGREE II domain scores for higher-quality guidelines were > 60% except for applicability (average 46%). Higher-quality guidelines consistently recommended in favour of education, exercise, and weight management and non-steroidal anti-inflammatory drugs (hip and knee), and intra-articular corticosteroid injections (knee). Higher quality guidelines consistently recommended against hyaluronic acid (hip) and stem cell (hip and knee) injections. Other pharmacological recommendations in higher-quality guidelines (e.g., paracetamol, intra-articular corticosteroid (hip), hyaluronic acid (knee)) and adjunctive treatments (e.g., acupuncture) were less consistent. Arthroscopy was consistently recommended against in higher-quality guidelines. No higher-quality guidelines considered arthroplasty.
Higher-quality guidelines for hip and knee osteoarthritis consistently recommend clinicians implement exercise, education, and weight management, alongside consideration of Non-Steroidal Anti-Inflammatory Drugs and intra-articular corticosteroid injections (knee). Lack of consensus on some pharmacological options and adjunctive treatments creates challenges for guideline adherence. Future guidelines must prioritise providing implementation guidance, considering consistently low applicability scores.
Eight databases, guideline repositories, and professional associations websites were searched on 27/10/2022. Guideline quality was appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II tool) (six domains). Higher quality was defined as scoring ≥60% for domains 3 (rigour of development), 6 (editorial independence), plus one other. Consistency in recommendations across higher-quality guidelines was reported descriptively. This review was registered prospectively (CRD42021216154).
Seven higher-quality and 18 lesser-quality guidelines were included. AGREE II domain scores for higher-quality guidelines were > 60% except for applicability (average 46%). Higher-quality guidelines consistently recommended in favour of education, exercise, and weight management and non-steroidal anti-inflammatory drugs (hip and knee), and intra-articular corticosteroid injections (knee). Higher quality guidelines consistently recommended against hyaluronic acid (hip) and stem cell (hip and knee) injections. Other pharmacological recommendations in higher-quality guidelines (e.g., paracetamol, intra-articular corticosteroid (hip), hyaluronic acid (knee)) and adjunctive treatments (e.g., acupuncture) were less consistent. Arthroscopy was consistently recommended against in higher-quality guidelines. No higher-quality guidelines considered arthroplasty.
Higher-quality guidelines for hip and knee osteoarthritis consistently recommend clinicians implement exercise, education, and weight management, alongside consideration of Non-Steroidal Anti-Inflammatory Drugs and intra-articular corticosteroid injections (knee). Lack of consensus on some pharmacological options and adjunctive treatments creates challenges for guideline adherence. Future guidelines must prioritise providing implementation guidance, considering consistently low applicability scores.
摘要：
目的：髋关节和膝关节骨性关节炎治疗指南的依从性通常较差，可能与质量和/或不一致的建议有关。这项对髋和膝骨关节炎指南的系统评价旨在评估高质量指南中建议的质量和一致性。
方法：八个数据库，指南库，和专业协会网站在2022年10月27日进行了搜索。使用AGREEII工具(六个领域)评估指南质量。更高质量的定义为领域3的得分≥60%(发展的严谨性)，6（编辑独立），再加上一个。描述性报告了高质量指南中建议的一致性。这篇综述是前瞻性注册的(CRD42021216154)。
结果：共纳入了7项质量较高的指南和18项质量较低的指南。更高质量指南的平均AGREEII领域得分>60%，适用性除外（46%）。一贯推荐更高质量的指导方针来支持教育，锻炼,和体重管理和非甾体抗炎药（髋关节和膝关节），和关节内皮质类固醇注射（膝盖）。更高质量的指南始终建议反对透明质酸（臀部）和干细胞（臀部和膝盖）注射。更高质量指南中的其他药理学建议(例如，扑热息痛,关节内皮质类固醇（髋关节），透明质酸(膝盖))和辅助治疗(例如，针灸）不太一致。在更高质量的指南中始终建议反对关节镜检查。没有更高质量的指南考虑关节成形术。
结论：更高质量的髋关节和膝关节骨性关节炎指南始终建议临床医生实施运动，教育,和体重管理，同时考虑NSAIDs和关节内皮质类固醇注射（膝关节）。在某些药物选择和辅助治疗方面缺乏共识，这给指南的遵守带来了挑战。未来的指导方针必须优先提供实施指导，考虑到始终较低的适用性分数。
方法：八个数据库，指南库，和专业协会网站在2022年10月27日进行了搜索。使用AGREEII工具(六个领域)评估指南质量。更高质量的定义为领域3的得分≥60%(发展的严谨性)，6（编辑独立），再加上一个。描述性报告了高质量指南中建议的一致性。这篇综述是前瞻性注册的(CRD42021216154)。
结果：共纳入了7项质量较高的指南和18项质量较低的指南。更高质量指南的平均AGREEII领域得分>60%，适用性除外（46%）。一贯推荐更高质量的指导方针来支持教育，锻炼,和体重管理和非甾体抗炎药（髋关节和膝关节），和关节内皮质类固醇注射（膝盖）。更高质量的指南始终建议反对透明质酸（臀部）和干细胞（臀部和膝盖）注射。更高质量指南中的其他药理学建议(例如，扑热息痛,关节内皮质类固醇（髋关节），透明质酸(膝盖))和辅助治疗(例如，针灸）不太一致。在更高质量的指南中始终建议反对关节镜检查。没有更高质量的指南考虑关节成形术。
结论：更高质量的髋关节和膝关节骨性关节炎指南始终建议临床医生实施运动，教育,和体重管理，同时考虑NSAIDs和关节内皮质类固醇注射（膝关节）。在某些药物选择和辅助治疗方面缺乏共识，这给指南的遵守带来了挑战。未来的指导方针必须优先提供实施指导，考虑到始终较低的适用性分数。
