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Conley B, Bunzli S, Bullen J, O'Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PFM, Lin I. Core Recommendations for Osteoarthritis Care: A Systematic Review of Clinical Practice Guidelines. Arthritis Care Res (Hoboken) 2023; 75:1897-1907. [PMID: 36762545 PMCID: PMC10952362 DOI: 10.1002/acr.25101] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To evaluate the quality of clinical practice guidelines (CPGs) for interventions in management of osteoarthritis (OA) and to provide a synthesis of high-quality CPG recommendations. METHODS Five databases (OvidSP Medline, Cochrane, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, and the Physiotherapy Evidence Database [PEDro]) and 4 online guideline repositories were searched. CPGs for the management of OA were included if they were 1) written in English and published from January 2015 to February 2022, focused on adults age ≥18 years, and met the criteria of a CPG as defined by the Institute of Medicine; and 2) were rated as high quality on the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. CPGs for OA were excluded if they were available via institutional access only, only addressed recommendations for the system/organization of care and did not include interventional management recommendations, and/or included other arthritic conditions. RESULTS Of 20 eligible CPGs, 11 were appraised as high quality and included in the synthesis. Of interest were the hip, knee, hand, and glenohumeral joints and/or polyarticular OA. Consistent recommendations were that care should be patient centered and include exercise, education, and weight loss (where appropriate). Nonsteroidal antiinflammatory drugs and surgical interventions were recommended for disabling OA that had not improved with nonsurgical care. Hand orthoses should be recommended for patients with hand OA. CONCLUSION This synthesis of high-quality CPGs for OA management offers health care providers with clear, simple guidance of recommended OA care to improve patient outcomes.
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Affiliation(s)
- Brooke Conley
- The University of MelbourneMelbourneVictoriaAustralia
| | - Samantha Bunzli
- The University of Melbourne, Melbourne, Victoria, Australia, Griffith University, Nathan, Queensland, Australia, and Royal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | | | - Penny O'Brien
- The University of MelbourneMelbourneVictoriaAustralia
| | - Jennifer Persaud
- Arthritis and Osteoporosis Western Australia and Sir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | | | | | | | - Ivan Lin
- University of Western Australia and Geraldton Regional Aboriginal Medical ServiceGeraldtonWestern AustraliaAustralia
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Rizk E, Tajchman S, Fink E, Aryal DK, Iso T, Flores E, Brown AE, Chokshi SP, Desai SN, Dewan AK, Kazzaz SA, Guevara M, Nagaraj S, Robben CP, Vittone V, Swan JT. Quality indicators for osteoarthritis pain management in the primary care setting. BMC Musculoskelet Disord 2023; 24:538. [PMID: 37391737 DOI: 10.1186/s12891-023-06637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Development of valid and feasible quality indicators (QIs) is needed to track quality initiatives for osteoarthritis pain management in primary care settings. METHODS Literature search identified published guidelines that were reviewed for QI extraction. A panel of 14 experts was assembled, including primary care physicians, rheumatologists, orthopedic surgeons, pain specialists, and outcomes research pharmacists. A screening survey excluded QIs that cannot be reliably extracted from the electronic health record or that are irrelevant for osteoarthritis in primary care settings. A validity screening survey used a 9-point Likert scale to rate the validity of each QI based on predefined criteria. During expert panel discussions, stakeholders revised QI wording, added new QIs, and voted to include or exclude each QI. A priority survey used a 9-point Likert scale to prioritize the included QIs. RESULTS Literature search identified 520 references published from January 2015 to March 2021 and 4 additional guidelines from professional/governmental websites. The study included 41 guidelines. Extraction of 741 recommendations yielded 115 candidate QIs. Feasibility screening excluded 28 QIs. Validity screening and expert panel discussion excluded 73 QIs and added 1 QI. The final set of 15 prioritized QIs focused on pain management safety, education, weight-management, psychological wellbeing, optimizing first-line medications, referral, and imaging. CONCLUSION This multi-disciplinary expert panel established consensus on QIs for osteoarthritis pain management in primary care settings by combining scientific evidence with expert opinion. The resulting list of 15 prioritized, valid, and feasible QIs can be used to track quality initiatives for osteoarthritis pain management.
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Affiliation(s)
- Elsie Rizk
- Department of Pharmacy, Houston Methodist, Houston, TX, USA
- Department of Surgery, Houston Methodist, TX, Houston, USA
| | | | - Ezekiel Fink
- Department of Neurology, Houston Methodist, Houston, TX, USA
| | - Dipendra K Aryal
- Department of Pharmacy, Houston Methodist, Houston, TX, USA
- Department of Surgery, Houston Methodist, TX, Houston, USA
| | - Tomona Iso
- Department of Pharmacy, Houston Methodist, Houston, TX, USA
- Department of Surgery, Houston Methodist, TX, Houston, USA
| | - Eleazar Flores
- Houston Methodist Primary Care Group, Houston Methodist, Houston, TX, USA
| | - Anthony E Brown
- Houston Methodist Primary Care Group, Houston Methodist, Houston, TX, USA
| | - Sagar P Chokshi
- Department of Neurosurgery, Houston Methodist, Houston, TX, USA
| | | | - Ashvin K Dewan
- Department of Orthopedic Surgery, Houston Methodist, Houston, TX, USA
| | - Sarah A Kazzaz
- Houston Methodist Academic Medicine Associates - Rheumatology, Houston Methodist, Houston, TX, USA
| | - Myriam Guevara
- Houston Methodist Academic Medicine Associates - Rheumatology, Houston Methodist, Houston, TX, USA
| | - Sudha Nagaraj
- Houston Methodist Primary Care Group, Houston Methodist, Houston, TX, USA
| | | | - Veronica Vittone
- Houston Methodist Primary Care Group, Houston Methodist, Houston, TX, USA
| | - Joshua T Swan
- Department of Pharmacy, Houston Methodist, Houston, TX, USA.
- Department of Surgery, Houston Methodist, TX, Houston, USA.
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA.
- Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, SM1661, Houston, TX, 77030, USA.
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O'Brien V, Johnson J, Pisano K, Enke A. Dynamic stabilization of the painful thumb: A historical and evidence-informed synthesis. J Hand Ther 2022; 35:388-399. [PMID: 35985937 DOI: 10.1016/j.jht.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Expert opinion INTRODUCTION: Thumb carpometacarpal joint (CMC) osteoarthritis is a common condition seen in the hand therapy clinic. Prevalence is generally higher in females, and the percentage rises for post-menopausal females. Patients typically present with pain and functional difficulties. Conservative management is recommended before a surgical consult. Evidence is mounting that a dynamic stability modeled approach has a significant effect on pain and improving function. PURPOSE The purpose of this paper is two-fold: first, to present the history and development of a dynamic stabilization model for treatment of the patient with thumb CMC osteoarthritis (OA), and second, to provide expert clinical commentary and recommendations for the treatment of thumb CMC OA in light of the best available evidence. METHODS Expert clinical commentary is based on an extensive review of relevant literature. RESULTS The current literature and expert opinion supports an evidence-informed multimodal intervention: modalities, pain relief techniques, manual release, joint mobilizations as deemed necessary, neuromuscular re-education through proprioceptive exercises, and education in joint protection principles. CONCLUSION A rationale for a dynamic stabilization approach is presented. The unique anatomy of the thumb deserves finely tuned care based on high quality research. To advance our knowledge and clinical skills we must not become stagnant, but continue to generate high level evidence. The standard for future thumb CMC OA studies should be well-defined intervention parameters, consistent documentation, and the use of appropriate patient-rated outcome measures.
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Affiliation(s)
- Virginia O'Brien
- Department of Rehabilitation and Orthopedics, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
| | | | - Katie Pisano
- Hand and Upper Body Rehabilitation Center, Erie, PA, USA
| | - Ashley Enke
- M Health Fairview Hand Therapy, Minneapolis, MN, USA
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Duruöz MT, Erdem Gürsoy D, Tuncer T, Altan L, Ayhan F, Bal A, Bilgilisoy M, Cerrahoğlu L, Çapkın E, Çay HF, Çevik R, Durmaz B, Dülgeroğlu D, Gürer G, Gürsoy S, Hepgüler S, Hizmetli S, Kaçar C, Kaptanoğlu E, Kaya T, Ecesoy H, Alkan Melikoğlu M, Nas K, Nur H, Özçakır Ş, Sarıdoğan M, Sarıkaya S, Sezer İ, Sindel D, Şahin N, Şahin Ö, Faruk Şendur Ö, Taşçı Bozbaş G, Tıkız C, Uğurlu H. The clinical, functional, and radiological features of hand osteoarthritis: TLAR-osteoarthritis multi-center cohort study. Arch Rheumatol 2022; 37:375-382. [PMID: 36589604 PMCID: PMC9791555 DOI: 10.46497/archrheumatol.2022.9234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/24/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population. Patients and methods Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA. Results The DHI had significant correlations with VAS-pain (r=0.367, p<0.001), duration of pain (r=0.143, p=0.001) and bilateral handgrip strengths (r=-0.228, p=0.001; r=-0.303, p<0.001). Although DHI scores were similar between the groups in terms of the presence of hand deformity (p=0.125) or Heberden's nodes (p=0.640), the mean DHI scores were significantly higher in patients with Bouchard's nodes (p=0.015). The total number of nodes had no significant correlations with the VAS-pain and DHI score (p>0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p<0.001), duration of pain (p<0.001), and DHI (p<0.001) were significant. There were no significant differences between radiological hand OA grades according to the duration of the stiffness, grip strength, and BMI (p>0.05 for all). Conclusion In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.
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Affiliation(s)
- Mehmet Tuncay Duruöz
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Didem Erdem Gürsoy
- Department of Physical Medicine and Rehabilitation, Rheumatology Clinic, Prof. Dr. Cemil Taşcoğlu City Hospital, Istanbul, Turkey
| | - Tiraje Tuncer
- Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, Uludağ University School of Medicine, Bursa, Turkey
| | - Figen Ayhan
- Department of Physical Medicine and Rehabilitation, Atılım University School of Medicine, Ankara, Turkey
| | - Ajda Bal
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Meral Bilgilisoy
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey
| | - Lale Cerrahoğlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Erhan Çapkın
- Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Hasan Fatih Çay
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey
| | - Remzi Çevik
- Department of Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Berrin Durmaz
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, Izmir, Turkey
| | - Deniz Dülgeroğlu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Gülcan Gürer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Savaş Gürsoy
- Department of Physical Medicine and Rehabilitation, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Simin Hepgüler
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, Izmir, Turkey
| | - Sami Hizmetli
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Cahit Kaçar
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ece Kaptanoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Başkent University Zübeyde Hanım Application and Research Center, Izmir, Turkey
| | - Taciser Kaya
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Hilal Ecesoy
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Karamanoğlu Mehmetbey University School of Medicine, Karaman, Turkey
| | - Meltem Alkan Melikoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Kemal Nas
- Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Hakan Nur
- Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Şüheda Özçakır
- Department of Physical Medicine and Rehabilitation, Uludağ University School of Medicine, Bursa, Turkey
| | - Merih Sarıdoğan
- Department of Physical Medicine and Rehabilitation, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Selda Sarıkaya
- Department of Physical Medicine and Rehabilitation, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - İlhan Sezer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Dilşad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Nilay Şahin
- Department of Physical Medicine and Rehabilitation, Balıkesir University, Balıkesir, Turkey
| | - Özlem Şahin
- Department of Physical Medicine and Rehabilitation, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ömer Faruk Şendur
- Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Gülnur Taşçı Bozbaş
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Canan Tıkız
- Department of Physical Medicine and Rehabilitation, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Hatice Uğurlu
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University School of Medicine, Konya, Turkey
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