Article type
Year
Abstract
Objective: The purpose of this presentation is to outline a structured and rigorous methodology for the development of EBCPGs for selected rehabilitation interventions in the treatment of OA.
Methods: The Ottawa Panel of experts was formed by a group of health professionals of patients specialized in the treatment of rheumatic conditions as well as a representative from the rheumatology community. This panel developed a set of criteria for grading the strength of draft EBCPGs pertaining to rehabilitation interventions in the treatment of OA. The draft EBCPG s that were presented to this panel were derived from evidence found in randomized controlled trials (RCTs) and comparative controlled trials (CCTs) identified and synthesized using methods defined by the Cochrane Collaboration. The Cochrane methodology was chosen to minimize bias since it outlines a systematic approach to literature search, study selection, data extraction and data synthesis. The strength of the evidence was graded as level I for RCT(s) or level II for non-randomized studies. The Ottawa Panel decided to define evidence of clinically important benefit as scores greater than 15% for the treatment group relative to the control group for outcomes that were considered important for the patient. Statistical significance was also required, but insufficient alone. Patient-important outcomes were determined both by referring to the literature and by consensus as being pain, range of motion (ROM), muscle strength, functional status, patient global assessment, disease activity and quality of life. These were assessed with a validated scale.
Results: More than twenty EBCPGs related to positive outcomes for the treatment group were developed. Specific functional strengthening exercises for knee and hip, global functional strengthening as well as physical activity programs, such as aerobic walking program and jogging in water, proved to have a clinically important benefit relative to the control group for pain relief, ROM, strength and functional status. Continuous Passive Motion (CPM) following a Total Knee Arthroplasty was effective to reduce flexion deformity and time to achieve 90 degrees flexion. Manual therapy combined with exercises was found to be beneficial for pain relief of the knee. Patient education demonstrated a clinically important benefit for pain relief and for improved hand function and self-efficacy. Thermotherapy and electrotherapy modalities were also effective for pain relief and improved functional status for patients with OA.
Conclusion: The Ottawa Panel methodology provided a structured approach to assessing scientific evidence and developing EBCPGs. The approach used can be used as a model for the development of EBCPGs in other fields of study.
Methods: The Ottawa Panel of experts was formed by a group of health professionals of patients specialized in the treatment of rheumatic conditions as well as a representative from the rheumatology community. This panel developed a set of criteria for grading the strength of draft EBCPGs pertaining to rehabilitation interventions in the treatment of OA. The draft EBCPG s that were presented to this panel were derived from evidence found in randomized controlled trials (RCTs) and comparative controlled trials (CCTs) identified and synthesized using methods defined by the Cochrane Collaboration. The Cochrane methodology was chosen to minimize bias since it outlines a systematic approach to literature search, study selection, data extraction and data synthesis. The strength of the evidence was graded as level I for RCT(s) or level II for non-randomized studies. The Ottawa Panel decided to define evidence of clinically important benefit as scores greater than 15% for the treatment group relative to the control group for outcomes that were considered important for the patient. Statistical significance was also required, but insufficient alone. Patient-important outcomes were determined both by referring to the literature and by consensus as being pain, range of motion (ROM), muscle strength, functional status, patient global assessment, disease activity and quality of life. These were assessed with a validated scale.
Results: More than twenty EBCPGs related to positive outcomes for the treatment group were developed. Specific functional strengthening exercises for knee and hip, global functional strengthening as well as physical activity programs, such as aerobic walking program and jogging in water, proved to have a clinically important benefit relative to the control group for pain relief, ROM, strength and functional status. Continuous Passive Motion (CPM) following a Total Knee Arthroplasty was effective to reduce flexion deformity and time to achieve 90 degrees flexion. Manual therapy combined with exercises was found to be beneficial for pain relief of the knee. Patient education demonstrated a clinically important benefit for pain relief and for improved hand function and self-efficacy. Thermotherapy and electrotherapy modalities were also effective for pain relief and improved functional status for patients with OA.
Conclusion: The Ottawa Panel methodology provided a structured approach to assessing scientific evidence and developing EBCPGs. The approach used can be used as a model for the development of EBCPGs in other fields of study.