Clinical practice guidelines for osteoarthritis
Sandra Grace | Professor , Faculty of Health , Southern Cross University
What are clinical practice guidelines ?
The National Health and Medical Research Council 1 has described clinical practice guidelines as ‘ evidence based statements that include recommendations intended to optimise patient care and assist health care practitioners to make decisions about appropriate health care for specific clinical circumstances ’. They are designed to help practitioners and their patients / clients make informed decisions about the most appropriate care . They are based on the best available evidence that can be used to inform practice , along with the patients ’/ clients ’ preferences for treatment and the practitioner ’ s own clinical judgement .
How are they developed ?
Clinical practice guidelines are developed by groups of researchers who conduct a systematic literature review , assess the quality of the evidence and then create recommendations for practice based on the results . 2 The strength of the evidence on which recommendations are based should be clearly stated . 3 Where possible , results from different studies are combined and the quality of the evidence is ranked . Recommendations can be strongly recommended , conditionally recommended , conditionally not recommended or strongly not recommended based on the strength of the available evidence . Guidelines need to be updated regularly as new research emerges . In natural medicine , there are many areas of practice in which little or no research has been conducted . Consequently , natural medicine practices are not highly represented in clinical practice guidelines and their potential contribution may not yet be realised .
How can they be used ?
‘ Guidelines are being designed to improve the quality of health care and decrease the use of unnecessary , ineffective or harmful interventions ’. 3 A good example of the benefits and costsaving is the recognition of unnecessary X-ray referrals for managing chronic non-specific low back pain . We ’ ve known for over a decade that X-rays for such back pain provide limited useful information for treatment choices . 4 Moreover , they were costly for patients .
Taking clinical practice guidelines into account when discussing treatment choices with patients / clients is likely to enhance the quality of care provided . By way of example , clinical practice guidelines for osteoarthritis are discussed below .
Clinical practice guidelines for osteoarthritis
Osteoarthritis affects approximately 3.6 million Australians ( 15 % of the population ), according to the Australian Bureau of Statistics 2017 – 18 National Health Survey ( NHS ). 5 It represented over half ( 62 %) of all arthritic conditions in 2017 – 18 in Australia . Several factors are known to contribute to the onset and progression of the condition . 6 These include : 7
• genetic factors
• female gender
• being overweight or obese
• previous history of joint injury
• repeated joint-loading
• joint misalignment
72 | vol28 | no2 | JATMS