Consistency of advice for the conservative management of knee osteoarthritis across international clinical practice guidelines

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Aims: Knee osteoarthritis (OA) is a leading cause of pain and disability, impacting quality of life. There are various conservative (non-surgical, non-pharmacological) management approaches suggested to support those with knee OA and multiple international clinical practice guidelines to inform patient care. This study contrasts the consistency of these management recommendations across the currently available guidelines. Methods: Systematic search of CINAHL, MEDLINE, Science Direct, and the Guideline International Network website applying PRISMA guidance. Clinical practice guidelines from representative bodies relating to the conservative management of knee OA were included. Quality assessment was completed using the International Centre for Allied Health Evidence (iCAHE) tool. Results: The search returned 750 records, from which 13 current clinical practice guidelines from national and international medical, surgical, and professional associations were identified. Quality of guideline construction was high. Recommendations for core knee OA management were broadly consistent; entailing exercise, self-management advice and education, and weight management; however, detail as to the proposed delivery of these interventions was lacking. Notable variation was evident between guidelines recommendation for all other interventions, such as manual therapy, bracing/orthotics and acupuncture, related to how the guideline groups interpreted generally low levels of evidence. Conclusion: There is broad consistency across clinical practice guidelines regarding core conservative management of knee OA which should direct and support patient care. Differences in evidence interpretation as to effect of alternative treatments result in different recommendations which may be confusing for patients, physiotherapists and medical personnel referring to these services.

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