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A critical appraisal of guidelines for the management of knee osteoarthritis using Appraisal of Guidelines Research and Evaluation criteria

Stéphane Poitras1*, Jérôme Avouac2, Michel Rossignol1, Bernard Avouac2, Christine Cedraschi3, Margareta Nordin4, Chantal Rousseaux5, Sylvie Rozenberg6, Bernard Savarieau5, Philippe Thoumie7, Jean-Pierre Valat8, Éric Vignon9 and Pascal Hilliquin10

Author Affiliations

1 Département d'épidémiologie, biostatistiques et de santé au travail, Université McGill, Montréal, Canada

2 Service de rhumatologie, hôpital Henri Mondor, Créteil, France

3 Division of General Medical Rehabilitation, Geneva University Hospitals, Switzerland

4 Department of Orthopaedics, New York University, New York, USA

5 Agence Nukleus, Paris, France

6 Département de rhumatologie, hôpital Pitié-Salpetrière, Paris, France

7 Fédération de Médecine Physique et de Réadaptation, Hopital Rothschild APHP, Paris, France

8 Université François-Rabelais de Tours, Faculté de Médecine, France

9 Université Claude Bernard, Lyon, France

10 Service de Rhumatologie, Centre Hospitalier Sud Francilien, Corbeil Essonnes, France

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Arthritis Research & Therapy 2007, 9:R126  doi:10.1186/ar2339

Published: 6 December 2007


Clinical practice guidelines have been elaborated to summarize evidence related to the management of knee osteoarthritis and to facilitate uptake of evidence-based knowledge by clinicians. The objectives of the present review were summarizing the recommendations of existing guidelines on knee osteoarthritis, and assessing the quality of the guidelines using a standardized and validated instrument – the Appraisal of Guidelines Research and Evaluation (AGREE) tool. Internet medical literature databases from 2001 to 2006 were searched for guidelines, with six guidelines being identified. Thirteen clinician researchers participated in the review. Each reviewer was trained in the AGREE instrument. The guidelines were distributed to four groups of three or four reviewers, each group reviewing one guideline with the exception of one group that reviewed two guidelines. One independent evaluator reviewed all guidelines. All guidelines effectively addressed only a minority of AGREE domains. Clarity/presentation was effectively addressed in three out of six guidelines, scope/purpose and rigour of development in two guidelines, editorial independence in one guideline, and stakeholder involvement and applicability in none. The clinical management recommendation tended to be similar among guidelines, although interventions addressed varied. Acetaminophen was recommended for initial pain treatment, combined with exercise and education. Nonsteroidal anti-inflammatory drugs were recommended if acetaminophen failed to control pain, but cautiously because of gastrointestinal risks. Surgery was recommended in the presence of persistent pain and disability. Education and activity management interventions were superficially addressed in most guidelines. Guideline creators should use the AGREE criteria when developing guidelines. Innovative and effective methods of knowledge translation to health professionals are needed.