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Abstract
Background: In the last 10 years, various clinical practice guidelines (CPGs) have been developed to guide the pharmacologic and non-pharmacologic management of knee and hip osteoarthritis (OA). Evidence-based recommendations rely on a wide range of evidence, including Cochrane systematic reviews (SRs).
Objectives: To determine the extent of use and quality of evidence provided by Cochrane Reviews in the development of CPGs for OA.
Methods: All CPGs addressing both OA pharmacologic and non-pharmacologic interventions from the last 10 years were reviewed. We selected the 2012 American College of Rheumatology (ACR) CPGs for OA because they used the most recent evidence. The best available evidence in the ACR CPGs was identified by searching for the most recent SR for each treatment comparison and patient important outcome (i.e. pain, function, adverse effects, adherence, withdrawals). If no SR was identified, the most recent randomized controlled trial of sufficient quality was chosen. Evidence quality for each outcome was appraised using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method.
Results: Cochrane evidence was chosen as the best available, most recent evidence for 5 of 10 pharmacologic interventions and 4 of 14 non-pharmacologic interventions. Cochrane Review GRADE scores for pharmacologic interventions were moderate for 32% of reviews and high for 65%, while scores for non-pharmacologic interventions were moderate for 37% of reviews and high for 29%. Non-Cochrane SR evidence was generally rated lower, with some of the outcomes of interest not reported. Evidence was high for 53% of pharmacologic treatments and high for 14% of non-pharmacologic (61% low).
Conclusions: Cochrane Reviewswere used extensively as evidence for the most recent OA CPG, especially the pharmacological interventions. Cochrane evidence quality was generally high for pharmacologic treatments and moderate or high for non-pharmacologic treatments. Cochrane evidence was of higher quality than other SRs.
Objectives: To determine the extent of use and quality of evidence provided by Cochrane Reviews in the development of CPGs for OA.
Methods: All CPGs addressing both OA pharmacologic and non-pharmacologic interventions from the last 10 years were reviewed. We selected the 2012 American College of Rheumatology (ACR) CPGs for OA because they used the most recent evidence. The best available evidence in the ACR CPGs was identified by searching for the most recent SR for each treatment comparison and patient important outcome (i.e. pain, function, adverse effects, adherence, withdrawals). If no SR was identified, the most recent randomized controlled trial of sufficient quality was chosen. Evidence quality for each outcome was appraised using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method.
Results: Cochrane evidence was chosen as the best available, most recent evidence for 5 of 10 pharmacologic interventions and 4 of 14 non-pharmacologic interventions. Cochrane Review GRADE scores for pharmacologic interventions were moderate for 32% of reviews and high for 65%, while scores for non-pharmacologic interventions were moderate for 37% of reviews and high for 29%. Non-Cochrane SR evidence was generally rated lower, with some of the outcomes of interest not reported. Evidence was high for 53% of pharmacologic treatments and high for 14% of non-pharmacologic (61% low).
Conclusions: Cochrane Reviewswere used extensively as evidence for the most recent OA CPG, especially the pharmacological interventions. Cochrane evidence quality was generally high for pharmacologic treatments and moderate or high for non-pharmacologic treatments. Cochrane evidence was of higher quality than other SRs.