title: Systematic review of guidelines for the physical management of osteoarthritis.
abstract: OBJECTIVE
  To undertake a systematic critical appraisal of guidelines to provide a summary of recommendations for the physical management of osteoarthritis (OA).
  
  
  METHODS
  The Cochrane Library, MEDLINE, CINAHL, SPORTDiscus with Full Text, Scopus, ScienceDirect, PEDro, and Google Scholar databases were searched (2000-2013) to identify all guidelines, protocols, and recommendations for the management or treatment of OA. In addition, Internet searches of all relevant arthritis organizations 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. Guidelines published only in English were retrieved.
  
  
  METHODS
  OA guidelines developed from evidence-based research, consensus, and/or expert opinion were retrieved. There were no restrictions on severity or site of OA, sex, or age. Nineteen guidelines were identified for evaluation.
  
  
  METHODS
  The quality of all guidelines was critically appraised using the Appraisal of Guidelines for REsearch and Evaluation II instrument. Each guideline was independently reviewed. All relevant recommendations for the physical management of OA were synthesized, graded, and ranked according to available evidence.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Exercise and education were key recommendations supporting the importance of rehabilitation in the physical management of OA. This critical appraisal can assist health care providers who are involved in the management of people with OA.
authors.affiliation: Faculty of Health and Environmental Sciences, School of Rehabilitation and Occupation Studies, AUT University, Auckland. Electronic address: peter.larmer@aut.ac.nz.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Larmer
authors.affiliation: Faculty of Health and Environmental Sciences, Department of Physiotherapy, AUT University, Auckland.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Reay
authors.affiliation: Faculty of Health and Environmental Sciences, Department of Physiotherapy, AUT University, Auckland.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Aubert
authors.affiliation: Faculty of Health and Environmental Sciences, Person Centred Research Centre, School of Rehabilitation and Occupation Studies, AUT University, Auckland, New Zealand.
authors.forename: Paula
authors.initials: P
authors.lastname: Kersten
mesh_terms: D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D006801:Humans; D010003:Osteoarthritis / Q000534:rehabilitation*; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic
keywords: AGREE II; Appraisal of Guidelines for REsearch and Evaluation II; Guideline; LOE; MA; NICE; National Institute of Clinical Excellence; OA; Osteoarthritis; RCT; Rehabilitation; SOR; Systematic review; level of evidence; meta-analysis; osteoarthritis; randomized controlled trial; strength of recommendation