Evaluating self-help and education descriptors as a physiotherapy rehabilitation intervention in knee osteoarthritis and its impact on clinical practice.

[摘要] ENGLISH SUMMARY : Background: The regular use of clinical practice guidelines (CPGs) has been promoted as a way of improving care, standardising clinical decisions and treatment. However, the intervention's reported in the randomised controlled clinical trials (RCTs) used in CPGs is typically not fully described and may lack description making it difficult to replicate in clinical practice. There was thus need to investigate ways in which the CPG-recommended interventions could be delineated into a more clinician-friendly format, so that it could be easier to replicate in practice and therefore ensure evidence-based practice. This study will form part of a larger project.Objective: To evaluate the descriptions of physiotherapy rehabilitation interventions of self-help and education for people with specifically knee osteoarthritis (OA) in CPGs and more recent RCTs, in terms of the detail provided, and how readily they could be replicated in clinical practice. It will act as a process to ascertain logistics of methods required to extract data for intervention descriptions and form part of a larger project investigating methods in which CPGs can be made more clinician friendly.Methodology: The most recent and the highest quality CPGs for community based rehabilitation for adults living with knee OA was accessed through data clearing houses. The CPGs were critically appraised using the iCACHE tool to ensure that the guideline is of the highest quality. The RCTs that were used to compile the systematic reviews on self-help and education in the CPGs for knee OA, was retrieved and evaluated. An updated search was conducted in Pubmed and PEDro computerised databases for the RCTs published after the CPGs release date. The quality of the RCTs was critically appraised by making use of the PEDro scale. A standard evaluation approach was then taken, using a recently-published checklist, the Template for Intervention Description and Replication Checklist (TIDieR) tool, to assess elements of rehabilitation interventions used. Results were summarised using pie charts, tables or in narrative form.Results: Two CPGs were retrieved and a total of nine RCTs trials included in this review. The results of the TIDieR revealed that certain aspects were adequately described, such as 'name of the intervention' (77.78%), 'intervention rationale for essential elements' (100%), 'description of the intervention procedures' (88.89%), 'mode of delivery of intervention' (100%) and 'details about the number; duration, intensity, and dose of intervention sessions' (88.89%). Other aspects however scored less adequately such as 'intervention materials and details about how to access them' (22.22%), 'details of intervention providers' (44.44%), 'location of intervention delivery and key infrastructure' (0%), 'details of any intervention tailoring' (11.11%), 'any intervention modifications throughout the study' (0%), and 'details of intervention fidelity assessment, monitoring, and level achieved' (11.11%).Conclusion: Despite the availability of evidence for the use of the self-help and education for knee OA in CPGs, there remains a lack of descriptions of the interventions within RCTs. Since the reproducibility of an intervention in a clinical setting forms a crucial part of adding value to research, the lack of description and difficulty in reproducing the interventions in clinical practice, is concerning. CPGs therefore fail to bridge the gap between best practice, patient choices and local context and strategies to address this gap need to be developed.

[发布机构] Stellenbosch University