title: Systematic analysis of the quality of the scientific evidence and conflicts of interest in osteoarthritis of the hip and knee practice guidelines.
abstract: OBJECTIVE
  To determine the validity of the hip and knee osteoarthritis guidelines.
  
  
  METHODS
  A systematic search of PubMed using a combination of Mesh and text terms with limitations to guidelines was performed to identify hip and knee osteoarthritis guidelines. The study was performed from April 17, 2014 to October 1, 2014. Guidelines were reviewed for graded levels of evidence, methods used to grade the evidence, and disclosures of conflicts of interest. Additionally, guidelines were also assessed for key quality measures using the AGREE II system for assessing the quality of guidelines.
  
  
  RESULTS
  A total of 13 guidelines relevant to the diagnosis and/or treatment of hip/knee osteoarthritis was identified. The 180 recommendations reviewed were supported by 231 pieces of evidence. In total, 35% (n = 80; range: 0-26) were supported by level A evidence, 15% (n = 35; range: 0-10) were by level B, and 50% (n = 116; range: 0-62) were by level C. Median age of the guidelines was 4 years (±4.8; range: 0-16) with no comments on planned updates. In total, 31% of the guidelines included patients in the development process. Only one guideline incorporated cost consideration, and only 15% of the guidelines addressed the surgical management of osteoarthritis. Additionally, 46% of guidelines did not comment on conflicts of interest (COI). When present, there was an average 29.8 COI. Notably, 82% of the COI were monetary support/consulting.
  
  
  CONCLUSIONS
  In total, 50% of the hip/knee osteoarthritis guideline recommendations are based on lower quality evidence. Nearly half the guidelines fail to disclose relevant COI and when disclosed, multiple potential COI are present. Future hip/knee osteoarthritis guideline development committees should strive to improve the transparency and quality of evidence used to formulate practice guidelines.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St 8E, Boston, MA 02215. Electronic address: jfeuerst@bidmc.harvard.edu.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Feuerstein
authors.affiliation: Stone Research Foundation, San Francisco, CA.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Pelsis
authors.affiliation: Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St 8E, Boston, MA 02215.
authors.forename: Samuel
authors.initials: S
authors.lastname: Lloyd
authors.affiliation: Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St 8E, Boston, MA 02215.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Cheifetz
authors.affiliation: Stone Research Foundation, San Francisco, CA; Department of Orthopedics, The Stone Clinic, San Francisco, CA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Stone
mesh_terms: D016265:Conflict of Interest; D030881:Disclosure; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012955:Societies, Medical
keywords: Conflicts of interest; Guidelines; Osteoarthritis; Quality