Clinical algorithms to aid osteoarthritis guideline dissemination.
Numerous scientific organisations have developed evidence-based recommendations aiming to optimise the management of osteoarthritis (OA). Uptake, however, has been suboptimal. The purpose of this exercise was to harmonize the recent recommendations and develop a user-friendly treatment algorithm to facilitate translation of evidence into practice.



We updated a previous systematic review on clinical practice guidelines (CPGs) for OA management. The guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation for quality and the standards for developing trustworthy CPGs as established by the National Academy of Medicine (NAM). Four case scenarios and algorithms were developed by consensus of a multidisciplinary panel.



Sixteen guidelines were included in the systematic review. Most recommendations were directed toward physicians and allied health professionals, and most had multi-disciplinary input. Analysis for trustworthiness suggests that many guidelines still present a lack of transparency. A treatment algorithm was developed for each case scenario advised by recommendations from guidelines and based on panel consensus.



Strategies to facilitate the implementation of guidelines in clinical practice are necessary. The algorithms proposed are examples of how to apply recommendations in the clinical context, helping the clinician to visualise the patient flow and timing of different treatment modalities.
Department of Physiotherapy, Occupational Therapy and Speech Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia. Electronic address: sarah.meneses@usp.br.
S R F
SR
Meneses
Department of Orthopedic Surgery, Duke University, Durham, NC, USA.
A P
AP
Goode
Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.
A E
AE
Nelson
Institute of Bone and Joint, Peking University People's Hospital, Peking, China.
J
J
Lin
Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA; Gillings School of Global Public Health, Department of Epidemiology, USA; Department of Orthopaedics, University of North Carolina at Chapel Hill, USA.
J M
JM
Jordan
Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA; Health Services Research and Development Service, U.S. Department of Veterans Affairs Medical Center, Durham, NC, USA.
K D
KD
Allen
Centre for Health, Exercise and Sports Medicine (CHESM), Department of Physiotherapy, The University of Melbourne, Victoria, Australia.
K L
KL
Bennell
Orthopaedics, Department of Clinical Sciences, Lund University, Sweden.
L S
LS
Lohmander
Department of Rehabilitation, Odense University Hospital, Odense C, Denmark.
L
L
Fernandes
Department Epidemiology and Public Health, University of Maryland School of Medicine, and Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA.
M C
MC
Hochberg
Warwick Clinical Trials Unit, Warwick Medical School, UK.
M
M
Underwood
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
P G
PG
Conaghan
Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
S
S
Liu
Department of Rheumatology, Tufts Medical Center, Boston, MA, USA.
T E
TE
McAlindon
Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA.
Y M
YM
Golightly
Royal North Shore Hospital, Rheumatology Department, and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia.
D J
DJ
Hunter
D000465:Algorithms; D032921:Consensus; D006801:Humans; D010003:Osteoarthritis; D017410:Practice Guidelines as Topic
Guidelines; Management; Osteoarthritis