Quality and consistency of clinical practice guidelines for diagnosis and management of osteoarthritis of the hip and knee: a descriptive overview of published guidelines.
OBJECTIVE
To present a descriptive overview of the quality and recommendations of clinical practice guidelines (CPGs) on diagnosis or management of osteoarthritis (OA) of the hip and/or knee.


METHODS
CPGs were identified from several research databases (MEDLINE, EMBASE and The Cochrane Library) and guideline-specific databases from 1966 to August 2005. GUIDELINE RETRIEVAL: Thirty-four relevant CPGs were identified.


METHODS
Recommendations were extracted from CPGs and categorised into: assessment and diagnosis, pharmacological management, nonpharmacological management, complementary/alternative therapy, or surgery. The quality of the CPGs were assessed by two appraisers using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument.


RESULTS
Most recommendations for aspects of diagnosis and treatment of OA of the hip and/or knee were consistent among the CPGs included in this study. However, quality varied considerably, with few CPGs being "strongly recommended" according to the AGREE quality appraisal instrument.


CONCLUSIONS
Given the number of CPGs available relevant to OA, and the consistency of recommendations within them, and considering the time and resources required for CPG development, future efforts to guide management of OA of the hip and/or knee may be better directed towards adapting existing CPGs to the local context, implementing practices known to be effective, and facilitating research to answer important questions where there is little evidence.
Monash Institute of Health Services Research, University, Melbourne, VIC. marie.misso@med.monash.edu.au
Marie L
ML
Misso
Veronica J
VJ
Pitt
Kay M
KM
Jones
Hayley N
HN
Barnes
Leon
L
Piterman
Sally E
SE
Green
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001182:Arthroscopy; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D006801:Humans; D015207:Osteoarthritis, Hip / Q000175:diagnosis* / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000175:diagnosis* / Q000628:therapy*; D010027:Osteotomy; D017410:Practice Guidelines as Topic / Q000592:standards*; D016896:Treatment Outcome; D015431:Weight Loss
D000894:Anti-Inflammatory Agents, Non-Steroidal