Quality of clinical practice guidelines relevant to rehabilitation of knee osteoarthritis: A systematic review

Author: Lechi Zhang1,2, Yanqin Wang1, Tianfen Ye2, Yinqi Hu2, Shujia Wang2, Tingting Qian2, Chengfan Wu2, Shouwei Yue1, Xiubin Sun3, Yang Zhang1
1 Department of Physical Medicine & Rehabilitation, Qilu Hospital, Cheeloo College of Medicine, 12589Shandong University, Jinan, China.
2 Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China.
3 Department of Biostatistics, School of Public Health, Cheeloo Collage of Medicine, Shandong University, Jinan, China.
Conference/Journal: Clin Rehabil
Date published: 2022 Dec 20
Other: Special Notes: doi: 10.1177/02692155221144892. , Word Count: 255

This systematic review summarized the rehabilitation recommendations for treating and managing knee osteoarthritis (OA) in practice guidelines and evaluated their applicability and quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.

Data sources:
PubMed, the Cochrane Library, EMBASE, CINAHL, PEDro, Guideline central, Guideline International Network and Agency for Healthcare Research and Quality (AHRQ) were used to search for relevant studies published between 1 January 2008 and 31 May 2022.

AGREE II was used to evaluate the included guidelines quality, SPSS 25.0 statistical software was used for data analysis, and the intra-group correlation coefficient value was calculated to verify the consistency between the raters. The two-way random effects model was used to calculate concordance scores, and each domain's total scores were calculated. Additionally, the median and interquartile range for domain and total scores were calculated.

Twenty-four guidelines recommending knee OA rehabilitation were included. Inter-rater consistency evaluation ranged from 0.62 to 0.90. The domains where the guideline's overall and rehabilitation parts scored highest and lowest were scope and purpose (domain 1) and applicability (domain 5), respectively. The highly recommended rehabilitation opinions included aerobic exercise programs (21/24), weight control (16/24), self-education and management (16/24), gait/walking aids (7/24), and tai chi (6/24). However, the orthopedic insole and hot/cold therapy roles remain controversial.

The clinical practice guidelines' overall quality for knee OA rehabilitation is good; however, the applicability is slightly poor. Therefore, we should improve the promoting factors and hindering factors, guideline application recommendations, tools, and resources when developing relevant guidelines.

Keywords: AGREE II; Knee osteoarthritis; clinical practice guidelines; quality assessment; rehabilitation.

PMID: 36540949 DOI: 10.1177/02692155221144892