Knee osteoarthritis clinical practice guidelines -- how are we doing?
OBJECTIVE
To determine the degree to which documented knee osteoarthritis (OA) care in a teaching rheumatology clinic corresponds to evidence-based treatment guidelines.


METHODS
The charts of 105 randomly selected patients meeting criteria for knee OA were reviewed. The patients received care from 3 rheumatologists working in a major Canadian teaching center between 2002 and 2005. The chart abstraction tool was based on European League Against Rheumatism, American College of Rheumatology, and The Arthritis Society guidelines for OA treatment. Descriptive statistics were used for patient demographics and the proportion of patients receiving recommended care.


RESULTS
The most frequently recommended nonpharmacologic treatments were any kind of exercise (58.1%), weight loss in those overweight (50.0%), physiotherapy (42.9%), and strengthening exercise (40.0%). Other nonpharmacologic treatments were documented in less than 30% of patient charts. The most frequently prescribed pharmacologic treatments were acetaminophen (68.6%), intraarticular (IA) corticosteroids (65.7%), nonsteroidal antiinflammatory drugs/cyclooxygenase-2-selective inhibitors (COXIB; 50.5%), and IA hyaluronans (43.8%). Topical pharmaceuticals, glucosamine/chondroitin, and opioid analgesics were recommended to less than 20% of the patients. Exploratory analyses suggested the following factors may be associated with increased documentation of recommended care: female sex, younger age, overweight, more clinic visits, decreased symptom length, and the individual rheumatologist.


CONCLUSIONS
Nonpharmacologic knee OA treatments currently recommended by practice guidelines were seldom documented in patients' charts in this Canadian rheumatology teaching center. These findings are similar to studies conducted before the practice guidelines became available and to results reported from general practices. This suggests the need for reminder systems or other strategies to promote physician adherence to current guidelines.
DeHaan
Melanie N
MN
Division of Physiatry, Department of Medicine, University of Toronto, Canada.
Guzman
Jaime
J
Bayley
Mark Theodore
MT
Bell
Mary J
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010820:Physicians; D017410:Practice Guidelines as Topic; D012219:Rheumatology