Appraisal of quality and analysis of the similarities and differences between osteoarthritis Clinical Practice Guideline recommendations: A systematic review

Bimbi Gray; Alison Gibbs; Jocelyn L Bowden; Jillian P Eyles; Sandra Grace; Kim Bennell; Rinie Geenen; Sharon Kolasinski; Christian Barton; Philip G Conaghan; Timothy McAlindon; Olivier Bruyere; Quentin Géczy; David J Hunter

doi:10.1016/j.joca.2024.02.890

Appraisal of quality and analysis of the similarities and differences between osteoarthritis Clinical Practice Guideline recommendations: A systematic review

Osteoarthritis Cartilage. 2024 Mar 5:S1063-4584(24)00935-X. doi: 10.1016/j.joca.2024.02.890. Online ahead of print.

Authors

Affiliations

¹ Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. Electronic address: bimbi.gray@sydney.edu.au.
² La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia. Electronic address: a.gibbs@latrobe.edu.au.
³ Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. Electronic address: Jocelyn.bowden@sydney.edu.au.
⁴ Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. Electronic address: jillian.eyles@sydney.edu.au.
⁵ Faculty of Health, Southern Cross University, Lismore, NSW, Australia. Electronic address: Sandra.grace@scu.edu.au.
⁶ Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia, Level 7, Alan Gilbert Building, Carlton, VIC 3052, Australia.
⁷ Utrecht University, Department of Psychology, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands. Electronic address: R.Geenen@uu.nl.
⁸ Division of Rheumatology, University of Pennsylvania. Electronic address: sharon.kolasinski@pennmedicine.upenn.edu.
⁹ La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia. Electronic address: c.barton@latrobe.edu.au.
¹⁰ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom. Electronic address: p.conaghan@leeds.ac.uk.
¹¹ Tufts University School of Medicine and Tufts Medical Center, 800 Washington Street Boston, MA 02111, USA. Electronic address: tmcalindon@tuftsmedicalcenter.org.
¹² WHO Collaborating Center for Public Health aspects of musculo-skeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Belgium. Electronic address: olivier.bruyere@uliege.be.
¹³ Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. Electronic address: qgec6670@uni.sydney.edu.au.
¹⁴ Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, NSW, Australia. Electronic address: david.hunter@sydney.edu.au.

PMID: 38452880
DOI: 10.1016/j.joca.2024.02.890

Abstract

Objective: Clinical Practice Guidelines (CPGs) aim to support management of hip and knee osteoarthritis (OA), but recommendations are often conflicting and implementation is poor, contributing to evidence-to-practice gaps. This systematic review investigated the contextual and methodological factors contributing to conflicting recommendations for hip and knee OA.

Method: Our systematic review appraised CPGs for managing hip and knee OA in adults ≥18 years (PROSPERO CRD42021276635). We used AGREE-II and AGREE-REX to assess quality and extracted data on treatment gaps, conflicts, biases, and consensus. Heterogeneity of recommendations was determined using Weighted Fleiss Kappa (K). The relationship between (K) and AGREE-II/AGREE-REX scores was explored.

Results: We identified 25 CPGs across eight countries and four international organisations. The ACR, EULAR, NICE, OARSI and RACGP guidelines scored highest for overall AGREE-II quality (83%). The highest overall AGREE-REX scores were for BMJ Arthroscopy (80%), RACGP (78%) and NICE (76%). CPGs with the least agreement for pharmacological recommendations were ESCEO and NICE (-0.14), ACR (-0.08), and RACGP (-0.01). The highest agreements were between RACGP and NICE (0.53), RACGP and ACR (0.61), and NICE and ACR (0.91). Decreased internal validity determined by low-quality AGREE scores(<60%) in editorial independence were associated with less agreement for pharmacological recommendations.

Conclusion: There were associations between guideline quality and agreement scores. Future guideline development should be informed by robust evidence, editorial independence and methodological rigour to ensure a harmonisation of recommendations. End-users of CPGs must recognise the contextual factors associated with the development of OA CPGs and balance these factors with available evidence.

Keywords: Clinical practice guideline; Evidence-to-practice; Implementation; Osteoarthritis.

Publication types

Review