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Gao Y, Liu Z, Cao R, Feng Y, Tao L, Su C, Guan X, Fang R, Deng Y, Xiang W, Fei Y. Reporting form and content of research priorities identified in knee osteoarthritis clinical practice guidelines: a methodological literature analysis. BMJ Open 2024; 14:e076107. [PMID: 38604638 PMCID: PMC11015183 DOI: 10.1136/bmjopen-2023-076107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/21/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES Clinical practice guideline (CPG) developers conduct systematic summaries of research evidence, providing them great capacity and ability to identify research priorities. We systematically analysed the reporting form and content of research priorities in CPGs related to knee osteoarthritis (KOA) to provide a valuable reference for guideline developers and clinicians. DESIGN A methodological literature analysis was done and the characteristics of the reporting form and the content of the research priorities identified in KOA CPGs were summarised. DATA SOURCES Six databases (PubMed, Embase, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Wanfang and Chinese Biomedical Literature Database) were searched for CPGs published from 1 January 2017 to 4 December 2022. The official websites of 40 authoritative orthopaedic societies, rheumatology societies and guideline development organisations were additionally searched. ELIGIBILITY CRITERIA We included all KOA CPGs published in English or Chinese from 1 January 2017 that included at least one recommendation for KOA. We excluded duplicate publications, older versions of CPGs as well as guidance documents for guideline development. DATA EXTRACTION AND SYNTHESIS Reviewers worked in pairs and independently screened and extracted the data. Descriptive statistics were used, and absolute frequencies and proportions of related items were calculated. RESULTS 187 research priorities reported in 41 KOA CPGs were identified. 24 CPGs reported research priorities, of which 17 (41.5%) presented overall research priorities for the entire guideline rather than for specific recommendations. 110 (58.8%) research priorities were put forward due to lack of evidence. Meanwhile, more than 70% of the research priorities reflected the P (population) and I (intervention) structural elements, with 135 (72.2%) and 146 (78.1%), respectively. More than half of the research priorities (118, 63.8%) revolved around evaluating the efficacy of interventions. Research priorities primarily focused on physical activity (32, 17.3%), physical therapy (30, 16.2%), surgical therapy (27, 14.6%) and pharmacological treatment (26, 14.1%). CONCLUSIONS Research priorities reported in KOA CPGs mainly focused on evaluating non-pharmacological interventions. There exists considerable room for improvement for a comprehensive and standardised generation and reporting of research priorities in KOA CPGs.
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Affiliation(s)
- Yicheng Gao
- Beijing University of Chinese Medicine, Beijing, China
| | - Zhihan Liu
- Beijing University of Chinese Medicine, Beijing, China
| | - Rui Cao
- Beijing University of Chinese Medicine, Beijing, China
| | - Yuting Feng
- Beijing University of Chinese Medicine, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Chengyuan Su
- Beijing University of Chinese Medicine, Beijing, China
| | - Xinmiao Guan
- Beijing University of Chinese Medicine, Beijing, China
| | - Rui Fang
- Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yingjie Deng
- Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wenyuan Xiang
- Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yutong Fei
- Beijing University of Chinese Medicine, Beijing, China
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Waters P, Anderson R, Anderson JM, Scott J, Detweiler B, Streck S, Hartwell M, Torgerson T, Vassar M. Analysis of the Evidence Underpinning the American Academy of Orthopedic Surgeons Knee Osteoarthritis Clinical Practice Guidelines. Sports Health 2022; 15:11-25. [PMID: 35915571 PMCID: PMC9808825 DOI: 10.1177/19417381221112674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
CONTEXT Clinical practice guidelines (CPGs) are vital to establishing a standardized and evidence-based approach in medicine. These guidelines rely on the use of methodologically sound clinical trials, and the subsequent reporting of their methodology. OBJECTIVE To evaluate the completeness of randomized controlled trials (RCTs) underpinning CPGs published by the American Academy of Orthopedic Surgeons (AAOS) for management of osteoarthritis of the knee. DATA SOURCES We searched the most recent AAOS CPGs for surgical and nonsurgical management of osteoarthritis of the knee for RCTs. To estimate the necessary sample size, we performed a power analysis using OpenEpi 3.0 (openepi.com). STUDY SELECTION Two authors independently screened the reference sections of the included CPGs. Included studies met the definition of an RCT, were retrievable in the English language, and were cited in at least one of the included CPGs. STUDY DESIGN Meta-Analysis. LEVEL OF EVIDENCE Level 1a. DATA EXTRACTION We performed double-blind screening and extraction of RCTs included in the AAOS CPGs. We evaluated each RCT for adherence to the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist. A multiple regression analysis was conducted to assess CONSORT adherence against characteristics of included studies (ie, type of intervention, funding source, etc). RESULTS Our study included 179 RCTs. The overall adherence was 68.5% with significant differences between those published before and since the development of the 2010 CONSORT guidelines (P = 0.02). We found that RCTs receiving funding from industry/private sources as well as studies that included a conflict of interest statement showed more completeness than RCTs that reported receiving no funding (P < 0.01). CONCLUSION We found suboptimal CONSORT adherence for RCTs cited in AAOS CGPs for management of osteoarthritis of the knee. Therefore, the CPGs are likely supported by outdated evidence and lack of high-quality reporting. It is important that evidence used to guide clinical decision making be of the highest quality in order to optimize patient outcomes. In order for clinicians to confer the greatest benefits to their patients, CPGs should provide the totality of evidence and emphasize emerging high-quality RCTs to ensure up-to-date, evidence-based clinical decision-making.
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Affiliation(s)
- Philo Waters
- Philo Waters, BS, Oklahoma
State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK 74107
() (Twitter: @PWaters04)
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Bibens M, Vassar M, Wayant C. Use of a meta-research team to facilitate evidence-based medicine to the next generation. BMJ Evid Based Med 2019; 24:205-206. [PMID: 30282754 DOI: 10.1136/bmjebm-2018-111021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Michael Bibens
- Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Cole Wayant
- Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Norris GR, Checketts JX, Scott JT, Vassar M, Norris BL, Giannoudis PV. Prevalence of Deep Surgical Site Infection After Repair of Periarticular Knee Fractures: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e199951. [PMID: 31441940 PMCID: PMC6714463 DOI: 10.1001/jamanetworkopen.2019.9951] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Surgical management of periarticular knee fractures can be challenging, and adverse outcomes may be severe. Recent literature indicates that the rate of periarticular knee surgical site infection (SSI) may range from 2% to 88% depending on the fracture site. OBJECTIVE To examine the prevalence of deep SSI and the rate of septic arthritis after surgical repair of fractures around the knee. DATA SOURCES The electronic databases MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to July 1, 2018. STUDY SELECTION Eligible studies had to specifically report deep SSI rates and include fractures in the distal femur, patella, tibial plateau, or proximal tibia. Risk factors that were associated with increased the risk of deep SSI were also examined. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were extracted by multiple investigators. Comprehensive Meta-Analysis software was used for the pooling of data, using either random-effects or fixed-effects models, with respect to the degree of statistical heterogeneity present. Data analyses were conducted in October 2019. MAIN OUTCOMES AND MEASURES The primary outcome was overall prevalence of deep SSI after periarticular knee fracture repair. The secondary outcomes were the overall prevalence of septic arthritis, risk factors associated with deep SSI, and the most commonly cultured bacteria specimens found periarticular knee infections. RESULTS Of 6928 articles screened, 117 articles met inclusion criteria and were included in analysis. Among 11 432 patients included in analysis, 653 patients (5.7%) experienced deep SSIs, most commonly among patients with proximal tibia fractures (56 of 872 patients [6.4%]). Among studies that included information on septic arthritis, 38 of 1567 patients (2.4%) experienced septic arthritis. The 2 most commonly reported bacteria were methicillin-resistant Staphylococcus aureus, found in 67 SSIs, and methicillin-susceptible S aureus, found in 53 SSIs. Sixty-two studies (53.0%) in the sample received a Coleman Methodological Score of poor (<50 points). CONCLUSIONS AND RELEVANCE Deep SSIs occurred in nearly 6% of periarticular knee fracture repairs, and 2.4% of SSIs were associated with septic arthritis. Surgeons managing these injuries should be vigilant when wounds are not pristine. Efforts should be made to elevate the quality of research conducted not only in this subject but also in orthopedic surgery as a whole.
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Affiliation(s)
| | | | - Jared T. Scott
- Oklahoma State University Center for Health Sciences, Tulsa
- Department of Orthopedics, Oklahoma State University Center for Health Sciences, Tulsa
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Brent L. Norris
- Department of Orthopedics, Oklahoma State University Center for Health Sciences, Tulsa
- Orthopedic & Trauma Services of Oklahoma, Tulsa
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Primeau CA, Birmingham TB, Leitch KM, Appleton CT, Giffin JR. Degenerative Meniscal Tears and High Tibial Osteotomy: Do Current Treatment Algorithms Need to Be Realigned? Clin Sports Med 2019; 38:471-482. [PMID: 31079775 DOI: 10.1016/j.csm.2019.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Degenerative medial meniscal tears (DMMTs) are a common feature of early knee osteoarthritis (OA). Varus alignment is a strong risk factor for medial compartment knee OA and its progression. We propose that high tibial osteotomy (HTO) should be considered much earlier in the treatment algorithm for patients presenting with recurring medial knee pain, varus alignment, and DMMT, absent of radiographic OA. We provide rationale for investigating HTO as a disease-modifying intervention for secondary prevention in knee OA, and present case examples as low-level proof of principle. Finally, caveats and challenges are discussed along with proposed future research.
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Affiliation(s)
- Codie A Primeau
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, Room 1220, London, Ontario N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, London, Ontario N6G 1H1, Canada
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, Room 1220, London, Ontario N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, London, Ontario N6G 1H1, Canada
| | - Kristyn M Leitch
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, Room 1220, London, Ontario N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada
| | - C Thomas Appleton
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada; Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5C1, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, Room 1220, London, Ontario N6A 3K7, Canada; Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre, University Hospital B6-200, London, Ontario N6A 5B5, Canada; School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, London, Ontario N6G 1H1, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, University of Ontario, St. Joseph's Healthcare London, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada; Orthopaedic Surgery, University of Western Ontario, London, Ontario N6A 3K7, Canada.
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Said Ahmed MA, Saweeres ESB, Abdelkader NA, Abdelmajeed SF, Fares AR. Improved Pain and Function in Knee Osteoarthritis with Dexamethasone Phonophoresis: A Randomized Controlled Trial. Indian J Orthop 2019; 53:700-707. [PMID: 31673169 PMCID: PMC6804376 DOI: 10.4103/ortho.ijortho_639_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intraarticular corticosteroid injection is an adjunct to core treatments for relief of moderate-to-severe pain in osteoarthritis (OA) patients. This randomized controlled trial was conducted to determine the effect of dexamethasone phonophoresis (DxPh) on knee OA. PATIENTS AND METHODS Forty six female patients with knee OA were randomized into two equal groups. The study group received DxPh over the medial side of the knee, transcutaneous electrical nerve stimulation (TENS), and quadriceps strengthening exercises. Control group received ultrasound therapy and the same TENS and exercise program. Pain was assessed using the visual analog scale (VAS) and the pain subscale of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pre- and posttreatment. Functional mobility was assessed by the Timed Up and Go (TUG) test, total WOMAC, and the joint stiffness and physical function subscales of WOMAC. The minimal clinically identifiable difference was used to calculate treatment effect sizes of both modalities, which was compared to intraarticular steroid injections. RESULTS The VAS, TUG, and WOMAC scores improved with both modalities. Pain intensity improved by 50.6%-58.0% in the study group (VAS and pain subscale of WOMAC, respectively) compared to 17.8%-28.6% for the control group. Functional mobility showed a higher rate of improvement in the DxPh group compared to control (37.7 vs. 17.5% for TUG and 53.2 vs. 23.0 and 56.1 vs. 26.4% for the joint stiffness and physical function subscales of WOMAC, respectively). Posttreatment results revealed statistically and clinically significant improvement in pain intensity and functional mobility in the DxPh group. CONCLUSION DxPh resulted in a greater improvement in pain and function in patients with knee OA than therapeutic ultrasound combined with exercise and TENS. The effect size of phonophoresis was clinically significant and higher than that reported for intraarticular steroid injection from pooled data in the literature.
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Affiliation(s)
| | - Emad Samuel Boles Saweeres
- Department of Orthopaedic Surgery, El-Sahel Teaching Hospital, Cairo, Egypt,Address for correspondence: Prof. Emad Samuel Boles Saweeres, Department of Orthopaedic Surgery, El-Sahel Teaching Hospital, Cairo 11697, Egypt. E-mail:
| | - Nasr Awad Abdelkader
- Department of Musculoskeletal Disorders and Their Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Salwa Fadl Abdelmajeed
- Department of Musculoskeletal Disorders and Their Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ahmed Roshdy Fares
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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