treatment_based_QA.json

[{"Guideline specific question":"Is  Cognitive Behavioral Therapy with Exercise recommended for Other Treatment of Knee osteoarthritis.","Short_answer":"Cognitive Behavioral Therapy with Exercise is Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"Cognitive Behavioral Therapy with Exercise is Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with no comorbidities and for patients with gastrointestinal and cardiovascular comorbidities.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Education on weight loss recommended for treatment of osteoarthritis.","Short_answer":"Education on weight loss is Recommend for Knee osteoarthritis EducationTreatment and Hip osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is hip III ( Descriptive studies, such as comparative studies, correlation studies or case–control studies), Knee Ia (Meta-analysis of randomised controlled trials). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.","Full_answer":"Education on weight loss is Recommend for Knee osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is hip III ( Descriptive studies, such as comparative studies, correlation studies or case–control studies), Knee Ia (Meta-analysis of randomised controlled trials). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\n\n Education on weight loss should incorporate individualised strategies that are recognised to effect successful weight loss\nand maintenance*—for example: \na† regular self-monitoring, recording monthly weight\nb† regular support meetings to review\/discuss progress\nc† increase physical activity\nd† follow a structured meal plan that starts with breakfast\ne† reduce fat (especially saturated) intake; reduce sugar; limit salt; increase intake of fruit and vegetables (at least ‘5\nportions’ a day)\nf† limit portion size;\ng† addressing eating behaviours and triggers to eating (eg, stress)\nh† nutrition education\ni† relapse prediction and management (eg, with alternative coping strategies)\nThe recommendation is mainly supported by the literature in knee OA, as no evidence to support the effect of weight loss in patients with hip OA is available. However, being overweight or obese has been shown to be associated with hip OA (OR=1.11, 95% CI 1.07 to 1.16). In patients with knee OA, the effectiveness of weight-loss programmes on body weight, pain and\/or physical function was demonstrated in programmes delivered as weekly super vised sessions for a range of 8 weeks to 2 years. The effects on pain, function and weight loss from attending weight-loss programmes were small but significant (ES, 95%\nCI, pain 0.20, 0.00 to 0.39; physical function 0.23, 0.04 to 0.42; mean weight loss, 95% CI, 6.1 kg, 4.7 to 7.6).109 The interventions included strategies on how to reduce calorie intake by meal plans, reduce fat and sugar, reduce portion size, meal replacements, and comprised behavioural modifications, selfmonitoring, weight-loss goals and maintaining body weight in participants who had reached their goals and\/or exercises for some of them. Overall, the evidence from RCTs for the maintenance of achieved weight loss after the interventions have ended is absent in people with hip and knee OA. In general, in overweight or obese populations, healthy eating, limiting fat and salt intake, eating at least five portions of fruit and vegetables a day, being physically active for at least 30 min\/ day and elements such as self-monitoring, explicit weight-loss goals, and motivational interviewing have all been suggested to promote weight loss and that regular follow-up over 4 years helps in maintenance of the weight loss. Weight-loss programmes in older obese people that included explicit weight-loss goals showed mean changes in weight of −4.0 kg (95% CI −7.3 to −0.7), which was significantly more than pro grammes without explicit weight-loss goals (mean change, 95% CI, −1.3 kg, −2.9 to 0.3).65 To achieve a structured meal plan with a balanced combinations of low calorie and sufficient vitamin and mineral intake, meal replacement bars or powders can be an addition to healthy eating. Though not included in the literature review, it has been suggested that bariatric surgery should be part of comprehensive weight management in people with hip or knee OA who are morbidly obese, and could help reduce weight and joint pain.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"hip III \/Knee Ia"},{"Guideline specific question":"Is intra-articular corticosteroids (IACS) and intra-articular hyaluronan (IAHA) recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"intra-articular corticosteroids (IACS) and intra-articular hyaluronan (IAHA) is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"Intra-articular corticosteroids (IACS) and intra-articular hyaluronan (IAHA) is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\n\nThe use of intra-articular corticosteroids (IACS) and hyaluronan (IAHA) were conditionally recommended in individuals with knee OA in all groups. A Good Clinical Practice Statement applying to intra articular (IA) treatments for all comorbidity subgroups was added, noting that intra-articular corticosteroid (IACS) may provide short term pain relief, whereas Intra-articular hyaluronic acid (IAHA) may have beneficial effects on pain at and beyond 12 weeks of treatment and a more favorable long-term safety profile than repeated IACS.The recommendation is for patients with gastrointestinal comorbidities, cardiovascular comorbidities, frailty and wide spread pain\/depression.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional\/Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Acetaminophen recommended for Pharmacologic treatment of osteoarthritis.","Short_answer":"Acetaminophen is Recommend for Hand osteoarthritis Pharmacologic Treatment, Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment . The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Acetaminophen is Recommend for Hand osteoarthritis PharmacologicTreatment, Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment . The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nMembers of the Patient Panel noted that, for most individuals, acetaminophen is ineffective. For those with limited pharmacologic options due to intolerance of or contraindications to the use of NSAIDs, acetami nophen may be appropriate for short-term and episodic use. Regu lar monitoring for hepatotoxicity is required for patients who receive acetaminophen on a regular basis, particularly at the recommended maximum dosage of 3 gm daily in divided doses\nIn clinical trials, the effect sizes for acetaminophen are very small, suggesting that few of those treated experience important benefit, and meta-analysis has suggested that use of acetaminophen as monotherapy may be ineffective.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is Acupuncture (ie traditional, laser, electrical) recommended for Physical  Treatment of osteoarthritis.","Short_answer":"Acupuncture is Recommend for Hand osteoarthritis Physical Treatment, Knee osteoarthritis Physical Treatment and Hip osteoarthritis Physical Treatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nAcupuncture is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Acupuncture is Recommend for Hand osteoarthritis PhysicalTreatment,Knee osteoarthritis PhysicalTreatment and Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\n    In addition, the benefits of acupuncture result from the large contextual effect plus small differences in outcomes between “true” and “sham” acupuncture. The latter is of the same magnitude as the effect of full-dose acetami_x005f_x005f_x005f_x005f_x0002_nophen versus placebo. The greatest number of positive trials with the largest effect sizes have been carried out in knee OA. Positive trials and meta-analyses have also been published in a variety of other painful conditions and have indicated that acupuncture is effective for analgesia. While the “true” magnitude of effect is difficult to discern, the risk of harm is minor, resulting in the Voting Panel providing a conditional recommendation.\n    Although a large number of trials have addressed the use of acupuncture for OA, its efficacy remains a subject of controversy.\n\n    Acupuncture is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n    The available evidence was predominantly for knee osteoarthritis. This showed a lack of benefits of acupuncture and some evidence of harm. Economic evidence also showed that using acupuncture for osteoarthritis is not cost effective, so the committee did not recommend using acupuncture or dry needling. There was some evidence of clinical benefit and cost effectiveness for electroacupuncture but this was of very low quality because of small study sizes and inconsistency between studies. The evidence for electroacupuncture suggested it showed a benefit compared with sham acupuncture but not compared with acupuncture or no treatment. The committee considered that the inconsistent evidence could be the result of some people responding more to electroacupuncture than others. Because there is uncertainty about who might benefit from electroacupuncture, the committee made a recommendation for research on electroacupuncture for osteoarthritis.\nAcupuncture is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty)\n    A meta-analysis was performed using pain data from five high-quality studies (Chen 2013, Suarez-Almazor 2010, Mavrommatis 2012, Berman 2004, Hinman 2014) and two moderate-quality studies (Vas 2007, Berman 1999). Acupuncture treatments were either traditional (Chen 2013, Hinman 2014) or electro-acupuncture (Suarez-Almazor 2010, Mavrommatis 2012, Vas 2007, Berman 2004, Berman 1999). Control groups consisted of either no acupuncture (Hinman 2014), sham acupuncture (Mavrommatis 2012, Suarez-Almazor 2010, Vas 2007, Berman 2004), sham TENS (Chen 2013), or usual care (Berman 1999). The meta-analysis also accounted for the degree of blinding effectiveness of the studies. The results of the meta-analysis can be seen in Figure 11 in the appendix. The overall findings were in favor of acupuncture for reducing pain in subjects with knee osteoarthritis. There appeared to be no effect in two studies where blinding was effective. In studies where there was no blinding or the effects of blinding were unclear, there were greater effects favoring acupuncture. This prompted our decision to apply a limited strength of recommendation in favor of acupuncture for pain control.\n    A similar meta-analysis was performed using the same studies for measures of function. The results of this meta-analysis can be seen in Figure 12 in the appendix. The overall findings were in favor of acupuncture for improving measures of function in subjects with knee osteoarthritis. However, the effects of blinding effectiveness on the results were similar to that described above for pain. Again, this prompted our decision to apply a limited strength of recommendation in favor of acupuncture for improving function.\nSome investigators examined variations in the delivery of acupuncture treatment. Ju et al. examined high intensity vs. low intensity electro-acupuncture and found no difference between these approaches for pain but possibly better improvements in function favoring the high-intensity group (Ju 2015). Others found no meaningful differences between using 2-point, 4-point, or 6-point acupuncture approaches (Qi 2016, Taechaarpornkul 2009).\n    The Acupuncture recommendation has been downgraded two levels because of inconsistent evidence and a lack of internal consistency with recommendations of equal supporting evidence.acupuncture (ie traditional, laser, electrical) is Not Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n    Acupuncture may be administered by a variety of health professionals. It is traditionally applied via the insertion of acupuncture needles into acupuncture points, with or without mechanical or electrical stimulation. Laser acupuncture involves the application of low intensity laser light to acupuncture points, instead of needles. Acupuncture is usually provided as a course of treatment over multiple sessions spread over a number of weeks.\n    There is a statistically significant increase in the risk of adverse events with acupuncture, compared with sham in people with knee OA, although most were unrelated to acupuncture treatment (Appendix 5 of the Guideline for the management of knee and hip osteoarthritis: Technical document).\n\n    Acupuncture (ie traditional, laser, electrical) is Not Recommend for Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n    Acupuncture may be administered by a variety of health professionals. It is traditionally applied via the insertion of acupuncture needles into acupuncture points, with or without mechanical or electrical stimulation. Laser acupuncture involves the application of low intensity laser light to acupuncture points, instead of needles. Acupuncture is usually provided as a course of treatment over multiple sessions spread over a number of weeks.\n    There is a statistically significant increase in the risk of adverse events with acupuncture, compared with sham in people with knee OA, although most were unrelated to acupuncture treatment (Appendix 5 of the Guideline for the management of knee and hip osteoarthritis: Technical document).","RecommendationStatus":"Recommend\/Not recommended\/may be used","StrengthofRecommendation":"Conditional\/Not specified\/limited","CertaintyofEvidence":"Ia\/Not specified\/Low\/Very low"},{"Guideline specific question":"Is \"Advise people with osteoarthritis that joint pain may increase when they start therapeutic exercise\" recommended for Education Treatment of  osteoarthritis.","Short_answer":"\"Advise people with osteoarthritis that joint pain may increase when they start therapeutic exercise\" is recommended for  osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"\"Advise people with osteoarthritis that joint pain may increase when they start therapeutic exercise\" is recommended for  osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nExplain that: doing regular and consistent exercise, even though this may initially cause pain or discomfort, will be beneficial for their joints; ong-term adherence to an exercise plan increases its benefits by reducing pain and increasing functioning and quality of life. \nThe committee, acknowledging the importance of exercise, made further recommendations to support people to continue therapeutic exercise by \nemphasising its benefits while acknowledging that exercise may initially be difficult. They wanted to reassure people with osteoarthritis and healthcare professionals that exercise is not harmful to osteoarthritic joints, and that doing regular and consistent exercise over a long period of time can reduce pain and increase functioning and quality of life.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is \"Advise people with osteoarthritis where they can find further information\" recommended for Education Treatment of  osteoarthritis.","Short_answer":"\"Advise people with osteoarthritis where they can find further information\" is Recommended for  osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"\"Advise people with osteoarthritis where they can find further information\" is Recommended for  osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nAdvise patients to learn how it develops (including flares and progression over time), and information that challenges common misconceptions about the condition; specific types of exercise;  managing their symptoms ; how to access additional sources of information and support after consultations, such as peer-to-peer support and support groups; benefits and limitations of treatment.\n\nEvidence showed that generally people with osteoarthritis wanted more information about their condition. This included information about the causes, what their diagnosis means for the future and where to find more information on self-management. The committee based their recommendations on the evidence and their experience. They agreed that it is important to tell people that diagnosis is made clinically without imaging, that imaging rarely provides any extra information helpful for diagnosing or planning non-surgical treatment for osteoarthritis, and that it would only be used if there were suspicion of an alternative diagnosis or other complications. This would help reassure and dispel any belief that X-rays or other forms of imaging are needed to diagnose osteoarthritis. \n\nThe committee noted the importance of information that offers hope for the future and supports self-management strategies (for example, information that emphasises symptom-reducing behaviours, like therapeutic exercise). They agreed that explaining the core treatments for osteoarthritis would help people understand that pharmacological treatments are not a long-term solution. They also agreed that information about recognising flares and how to manage changes in pain would help the person better understand how their condition may vary over time and what they can do about it. The committee noted more evidence was needed on information about managing flares and information for different populations of people with osteoarthritis, and so made recommendations for research on what information people with osteoarthritis need. \n\nThe committee agreed that each person's experience of osteoarthritis differs and therefore tailoring the information to their needs, as described in NICE's guideline on patient experience in adult NHS services, is important. They also agreed that osteoarthritis is more common in older people who are likely to have other conditions. Therefore, the recommendations on delivering an approach to care that takes account of multimorbidity in NICE's guideline on multimorbidity are particularly relevant to people with osteoarthritis.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Anti-NGF recommended for Pharmacologic Treatment\n of  osteoarthritis.","Short_answer":"Anti-NGF is Not Recommend for Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Anti-NGF is Not Recommend for Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n\nNGF is a secretory soluble protein that binds to two different cell surface receptors – 75 kDa neurotrophin receptor (p75NTR) and high-affinity NGF-specific tyrosine kinase receptor (TrkA). It is critical for normal development of sympathetic and sensory neurons that are responsible for nociception and temperature sensation.110 A humanised monoclonal antibody, tanezumab, was developed specifically to inhibit NGF from binding to its receptors on pain-signalling neurons. Fulranumab is a fully humanised recombinant immunoglobulin G2 (IgG2) monoclonal antibody that specifically neutralises the biological actions of human NGF.\n\nBased on current evidence, the number of adverse events was not significantly different between treatment and placebo groups. Reported adverse events included arthralgia, headache, upper respiratory tract infection and abnormal peripheral sensation (eg paraesthesia, dysesthesia, hyperaesthesia, hypoesthesia). A meta-analysis of tanezumab safety suggested the use of tanezumab plus nonsteroidal anti-inflammatory drug (NSAID) treatment had a higher occurrence of serious adverse events than NSAID alone.111 A recent adjudication of joint-related adverse events in the tanezumab clinical program reported that the drug was not associated with an increased risk of osteonecrosis, but was associated with an increased risk of rapidly progressive OA, especially in people on higher doses of tanezumab, tanezumab plus NSAIDs, or pre-existing subchondral insufficiency fractures.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Moderate"},{"Guideline specific question":"Is Aquatic exercise\/Hydrotherapy recommended for Exercise\nTreatment of  osteoarthritis.","Short_answer":"Aquatic Exercise is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nAquatic exercise\/Hydrotherapy is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nAquatic exercise\/Hydrotherapy is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Aquatic Exercise is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with and without comorbidities.\nAquatic exercise, though it is supported by a modest evidence base and demonstrates robust benefits on pain and objective measures of function, received a conditional recommendation because of accessibility issues, financial burden, as well as issues with uptake. Aquatic exercise was not recommended for patients who suffered from frailty due to potential risk of accidental injury.\nAquatic exercise\/Hydrotherapy is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis \nThis will depend upon personal preference and the availability of local facilities\nAquatic exercise\/hydrotherapy are low impact exercise undertaken in water. Water also offers natural resistance, which can be used to strengthen muscles. It may be undertaken individually or in group classes located in community settings. In some settings, classes may be specific to those with arthritis and\/or musculoskeletal conditions.\nThere is a very low likelihood of serious adverse effects; most are minor and include temporary increased pain at the affected joint or pain at other sites.\n\nAquatic exercise\/Hydrotherapy is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis \nThis will depend upon personal preference and the availability of local facilities\nAquatic exercise\/hydrotherapy are low impact exercise undertaken in water. Water also offers natural resistance, which can be used to strengthen muscles. It may be undertaken individually or in group classes located in community settings. In some settings, classes may be specific to those with arthritis and\/or musculoskeletal conditions.\nThere is a very low likelihood of serious adverse effects; most are minor and include temporary increased pain at the affected joint or pain at other sites.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Not specified\/Low"},{"Guideline specific question":"Is Arthritis Education recommended for OtherTreatment of osteoarthritis.","Short_answer":"Arthritis Education is Recommend for Knee osteoarthritis OtherTreatment and  Hip osteoarthritis OtherTreatment. The strength of recommendation is Strong The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"Arthritis Education is Recommend for Knee osteoarthritis OtherTreatment and  Hip osteoarthritis OtherTreatment. The strength of recommendation is Strong The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with and without comorbidities.\nEducation about OA is considered a standard of care, despite a lack of RCT data addressing the topic. Clinicians are encouraged to continually provide their patients with necessary information about OA disease progression and self-care techniques and to promote hope, optimism, and a positive expec_x005f_x0002_tation of benefit from treatment. \nArthritis Education is Recommend for Hip osteoarthritis OtherTreatment. The strength of recommendation is Strong The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Arthroscopic lavage or debridement,\nArthroscopic partial meniscectomy,\nArthroscopy with lavage and\/or debridement recommended for \nSurgery Treatment of osteoarthritis.","Short_answer":"Arthroscopic lavage or debridement is Not recommended for  osteoarthritis SurgeryTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nArthroscopic partial meniscectomy is Recommend for knee osteoarthritis SurgeryTreatment. The strength of recommendation is Moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nArthroscopy with lavage and\/or debridement is Not Recommend for knee osteoarthritis SurgeryTreatment. The strength of recommendation is Moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Arthroscopic lavage or debridement is Not recommended for  osteoarthritis SurgeryTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nThere was no evidence showing that arthroscopic procedures reduce pain and improve physical function. Evidence also showed possible harms with arthroscopic procedures compared with sham procedures. Cost-effectiveness evidence showed that arthroscopic procedures were more costly than standard care. The committee agreed that arthroscopic procedures were not commonly used in clinical practice for osteoarthritis.\nArthroscopic partial meniscectomy is Recommend for knee osteoarthritis SurgeryTreatment. The strength of recommendation is Moderate The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty)\n\nThe three studies discussed below compare outcomes following arthroscopic partial meniscectomy with physical therapy and demonstrate that knee arthroscopy with partial meniscectomy is as effective as physical therapy. In PICO 5, this workgroup recommended supervised or unsupervised exercise as opposed to no exercise to improve pain and function in patients with knee osteoarthritis. Currently, there are no studies that compare outcomes (knee pain and function) following arthroscopic partial meniscectomy versus physical therapy alone in patients who have failed to improve with an initial course of physical therapy. It is important to clearly define the appropriate indications for arthroscopic partial meniscectomy in patients with knee OA. This procedure should be considered in patients with mild-to-moderate knee OA and an MRI-confirmed meniscal tear who have previously failed appropriate conservative treatment such as physical therapy, corticosteroid injections, and a course of non-steroidal anti-inflammatory medications.\n\nKatz et al (2013) conducted a multicenter, randomized, controlled trial of symptomatic patients over the age 45 or older with a meniscal tear and evidence of mild-to-moderate knee osteoarthritis to determine the efficacy of arthroscopic partial meniscectomy compared to standardized physical therapy in this patient population. Three hundred fifty-one patients were randomly assigned to surgery and postoperative physical therapy or to a standardized physical therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). The patients were evaluated at 6 and 12 months, and the primary outcome was the difference between the groups with respect to the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function score. The mean improvement in WOMAC score at 6 months was similar between the groups. At 6 months, 51 patients who were randomized to physical therapy alone (30%) had undergone surgery. The authors concluded that in their intention-to-treat analysis, there were no significant differences in functional improvement 6 months after randomization; however, 30% of patients in the physical therapy alone group underwent surgery. These patients were analyzed in their original group, based on the intention-to-treat analysis.\n\nVan de Graaf et al. (2018) performed a multicenter randomized clinical trial in the Netherlands to determine whether physical therapy is inferior to arthroscopic partial meniscectomy (APM) for improving patient-reported knee function in patients with meniscal tears. Three hundred twenty-one patients were randomly assigned to APM or a predefined physical therapy protocol. Patients were excluded if they had locking of the knee, prior knee surgery, instability caused by anterior or posterior cruciate ligament rupture, severe osteoarthritis (Kellgren Lawrence score of 4), and a BMI > 35 kg\/m2. Change in patient-reported knee function on the International Knee Documentation Committee Subscale Knee form (IKDC) over a 24-month period was used as the primary outcome. In the PT group, 47 patients (29%) had APM during the 24-month follow-up period. The authors noted a similar level of improvement in knee function between the APM and PT groups. They concluded that PT was noninferior to APM for improving patient-reported knee function over a 24-month follow-up period in patients with nonobstructive meniscal tears.\n\nIn 2007, Herrlin et al. performed a prospective randomized study to compare knee function and physical activity following arthroscopic partial meniscectomy followed by supervised exercise or supervised exercise alone in patients with non-traumatic medial meniscal tear. Ninety patients were evaluated using the Knee Injury and Osteoarthritis Outcomes Score (KOOS), the Lysholm Knee Scoring Scale, and Tegner Activity Scale and a Visual Analog Scale (VAS) for pain prior to the intervention and after 8 weeks of exercise and 6 months following intervention. The authors found that after the intervention, both groups reported decreased knee pain, improved knee function, and high satisfaction (p < 0.0001). They, therefore, concluded that arthroscopic partial meniscectomy was not superior to supervised exercise alone in terms of reduced knee pain, improved knee function, and improved quality of life.\nArthroscopy with lavage and\/or debridement is Not Recommend for knee osteoarthritis SurgeryTreatment. The strength of recommendation is Moderate The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty)\nArthroscopy with lavage and\/or debridement only for treating knee osteoarthritis is not recommended.\nThere were four studies that met the inclusion criteria for this recommendation. There was one high strength (Moseley et al 2002), two moderate strength (Kirkley et al. 2008, Kalunian et al. 2000), and one low quality (Saeed et al. 2015).\n\nKirkely et al. 2008 compared arthroscopic surgery which included lavage and debridement combined with physical therapy and medical treatment versus physical therapy and medical treatment alone. The outcome measures utilized were the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Short Form-36 (SF-36) Physical Component Summary score, McMaster– Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR), and the Arthritis Self-Efficacy Scale (ASES) and standard-gamble utility scores. Six patients assigned to surgery elected not to have the procedure; data from these patients were analyzed, according to the intention to- treat principle, with data from the surgery group. Out of all potential outcomes, only two were statistically significant in favor of surgery. In summary, this randomized controlled trial demonstrated no benefit of arthroscopic lavage and debridement compared to physical therapy and medical treatment for osteoarthritis of the knee.\n\nKalunian et al. 2000 compared arthroscopic lavage (3000ml) with placebo (250ml). The study was performed at 4 different institutes and included a large number of enrolled patients from one institution with intra-articular crystals in their knee. The arthroscopes used were less than usual caliber in size ranging from 1.7mm to 2.7mm. Outcome measures were WOMAC scores at 12 months. There were not any statistically significant differences in aggregate WOMAC scores between the two treatment groups. The study concludes that irrigation may be helpful in a small subset of patients, especially those with crystals.\n\nMosley et al. 2002 study is an RCT comparing arthroscopic debridement, arthroscopic lavage, versus placebo \/ sham surgery. The study provides strong evidence that knee arthroscopy with or without debridement is not better and appears to be equivalent to a placebo procedure in improving knee pain and self-reported function. However, the study raised questions regarding its limited sampling (mostly male veterans) as well as the number of potential study participants who declined randomization into a treatment group. They also used a non-validated Knee Specific Pain score. Also, patients with substantial malalignment (varus or valgus deformity) and those with advanced disease, who might have a poorer response to surgical intervention were included in the trial.\n\nSaeed et al. 2015 compared HA injections versus arthroscopic debridement in patients with OA in an RCT where only the pain component of the knee society score was utilized. In the short-term follow-up of 6 months, arthroscopy failed to show better pain outcome than injections.\n\nMost of the studies excluded patients with meniscal tear, loose body, or other mechanical derangement, with concomitant diagnosis of osteoarthritis of the knee. The present recommendation does not apply to such patients.","RecommendationStatus":"Not recommend\/Recommend","StrengthofRecommendation":"Not specified\/Moderate","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is assistive walking device (eg cane) recommended for Physical\nTreatment of osteoarthritis.","Short_answer":"Assistive walking device (eg cane) is Recommend for Knee osteoarthritis PhysicalTreatment and Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Assistive walking device (eg cane) is Recommend for Knee osteoarthritis PhysicalTreatment and Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nAssistive walking devices include devices such as canes (eg walking sticks), crutches and walkers. As appropriate to the needs to individual users, these can help walking ambulation by reducing lower limb loading, improving stability and assisting movement. They may also help reduce falls risk.\nThere are a few adverse events associated with this recommendation","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Low"},{"Guideline specific question":"Is Balance training recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Balance training is Recommend for Knee osteoarthritis ExerciseTreatment and Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Balance training is Recommend for Knee osteoarthritis ExerciseTreatment and Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nAlthough one might expect balance exercises to help reduce the risk of falls in patients with OA, RCTs to date have not addressed this outcome in this population, and the low quality of evidence addressing the use of balance exercises necessitates only a conditional recom_x005f_x0002_mendation for balance exercises.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"IIb"},{"Guideline specific question":"Is Biopsychosocial initial assessments recommended for \n Assessment of osteoarthritis.","Short_answer":"Biopsychosocial initial assessments is Recommend for Knee osteoarthritis Assessment and hip osteoarthritis Assessment. The strength of recommendation is Not specified. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.","Full_answer":"Biopsychosocial initial assessments is Recommend for Knee osteoarthritis Assessment and hip osteoarthritis Assessment. The strength of recommendation is Not specified. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\n In people with hip or knee OA, initial assessments should use a biopsychosocial approach including:\na physical status (including pain; fatigue; sleep quality; lower limb joint status (foot, knee, hip); mobility; strength; joint\nalignment; proprioception and posture; comorbidities; weight)\nb activities of daily living\nc participation (work\/education, leisure, social roles)\nd mood\ne health education needs, health beliefs and motivation to self-manage\nResearch data on how a comprehensive assessment of people with hip or knee OA should best be carried out are scarce. Since initial assessment will always be a part of the management in any person with hip or knee OA, controlled trials evaluating assessment will have difficulties in selecting the most appropriate comparator. One randomised, controlled\ntrial (RCT) comparing a comprehensive assessment and management approach with usual care showed no difference in pain or physical function.13 However, in that study, both approaches included initial assessments, but with different content and were executed by different professionals. The group considered a comprehensive initial assessment to be a prerequisite for the individualised management strategy described in recommendation 2. The recommendation on the initial assessment included the following elements: the person’s physical status, activities of daily living, participation, mood and health education needs, health beliefs and motivation to self-manage. In the absence of evidence from studies on the effectiveness of various forms of assessment, the group based the recommended content of the initial assessment on the main areas of disease consequences, including potentially inter acting personal and environmental factors described in the literature. Evaluation of cardiovascular disease, people’s expectations and self-efficacy were also discussed as important aspects in a biopsychosocial approach. Moreover, the group found that a comprehensive assessment, which is applicable to the initial consultation, should also be repeated during regular follow-up of the person.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"IIb"},{"Guideline specific question":"Is bisphosphonates recommended for Pharmacologic Treatment\n of  osteoarthritis.","Short_answer":"Bisphosphonates is Not Recommend for hand osteoarthritis PharmacologicTreatment, knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment . The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nBisphosphonates is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis","Full_answer":"Bisphosphonates is Not Recommend for hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\n\nThough a single small study of an oral bisphosphonate sug_x005f_x0002_gested a potential analgesic benefit in OA, the preponderance of data shows no improvement in pain or functional outcomes\nBisphosphonates is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\n\nThough a single small study of an oral bisphosphonate sug_x0002_gested a potential analgesic benefit in OA, the preponderance of data shows no improvement in pain or functional outcomes\nbisphosphonates is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis \n\nAnti-osteoporotic medications are predominantly used to reduce morbidity and mortality (mainly from fractures) associated with exogenous and endogenous osteoporotic change within bone. Bisphosphonates can inhibit bone resorption and, therefore, are the mainstream medications for osteoporosis. Osteoporosis may be concomitantly present in those with OA.\nBisphosphonates come with significant side effect profiles and restrictions on some day-to-day activities (eg dental procedures). Treatment with these drugs should be reserved for individuals who meet the Pharmaceutical Benefits Scheme (PBS) guidelines for treatment of their osteoporosis, but not for the management of OA.\n\nThough a single small study of an oral bisphosphonate sug_x0002_gested a potential analgesic benefit in OA, the preponderance of data shows no improvement in pain or functional outcomes\nBisphosphonates is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\n\nBisphosphonates is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis \n\nAnti-osteoporotic medications are predominantly used to reduce morbidity and mortality (mainly from fractures) associated with exogenous and endogenous osteoporotic change within bone. Bisphosphonates can inhibit bone resorption and, therefore, are the mainstream medications for osteoporosis. Osteoporosis may be concomitantly present in those with OA.\nBisphosphonates come with significant side effect profiles and restrictions on some day-to-day activities (eg dental procedures). Treatment with these drugs should be reserved for individuals who meet the Pharmaceutical Benefits Scheme (PBS) guidelines for treatment of their osteoporosis, but not for the management of OA.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional\/Strong","CertaintyofEvidence":"III\/Very low"},{"Guideline specific question":"Is Brace treatment recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Brace treatment is Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Brace treatment is Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nFour high, four moderate and two low-quality studies were included for review, following the application of exclusion criteria by committee (Brouwer 2006b; Kirkley 1999; Callaghan 2015; Van Raaij 2010; Thoumie 2018; Hjartarson 2018; Petersen 2018; Niazi 2014; Hungerford 2013; Yu 2016). Three prospective randomized controlled trials compared bracing to control groups for treatment of symptomatic OA of the knee joint and found statistically significant and clinically meaningful improvement in patient symptoms related to symptomatic OA of the knee (Callaghan 2015; Thoumie 2018; Brouwer 2006b). Kirkley et al compared outcomes between valgus offloading brace, neoprene sleeve, and non-brace control for symptomatic OA and Varus alignment. This study reported statistically significant improvement in disease-specific quality of life and function in both study groups (Kirkley 1999). The study by Brouwer et al., comparing valgus bracing to a non-braced control, and reported no significant difference in functional assessment, PRO or pain; however, clinically significant improvements were noted in walking distance (1.25km[0.15,2.35]) for the brace group. Subgroup analysis demonstrated a greater positive effect of bracing in patients with varus alignment and more severe symptoms. Callaghan et al examined the effects of bracing for patella-femoral OA and found significant improvement from baseline VAS and KOOS pain scores. Finally, Hjartarson et al examined outcomes of bracing vs. placebo by removing valgus tension straps from the control group brace. In their study, they reported statistically significant and clinically meaningful improvements in KOOS sub-scores: symptoms, ADL, sports and recreation, and quality of life. \n\nThe Braces recommendation has been downgraded one level because of heterogeneity.","RecommendationStatus":"Recommend","StrengthofRecommendation":"moderate","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is calcitonin recommended for Pharmacologic Treatment of  osteoarthritis.","Short_answer":"Calcitonin is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Calcitonin is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nCalcitonin is a natural peptide hormone produced by parafollicular cells (C-cells) in the thyroid gland. The protective activity of calcitonin on bone and cartilage has been demonstrated in many different OA models and preliminary clinical settings.106 Available as an injection or nasal spray since the 1970s to treat osteoporosis, calcitonin inhibits bone resorption by binding and activating to the calcitonin receptor on osteoclasts\nThere were markedly higher incidences of gastrointestinal disorders and hot flushes in the active treatment arms of the included studies. No other adverse events were markedly different between the two groups in either study.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is Cane recommended for Physical\nTreatment of osteoarthritis.","Short_answer":"Cane is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nCane is Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Cane is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nCane use is strongly recommended for patients with knee and\/or hip OA in whom disease in 1 or more joints is causing a sufficiently large impact on ambulation, joint stability, or pain to warrant use of an assistive device.\n\nCane is Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nCanes have been used since antiquity for lower extremity orthopaedic disorders. With that in mind, only a small number of modern studies have formally investigated use of a cane for knee osteoarthritis. Our literature review found one high-quality study (Jones 2012) showing support for use regarding moderate pain relief and another study (Van Ginckel 2019) of moderate quality showing no major improvement in pain.\n\nJones 2012 performed a comprehensive study of use of a cane for knee osteoarthritis. Their primary outcome was pain, but they also looked at function, general health, consumption of NSAIDs, and energy expenditure. 64 patients were selected out of a total of 323 patients nominated from a rheumatology clinic. The majority of possible patients (168 out of 323) refused to participate in the study. 32 patients were randomized to use of a cane for 60 days (EG, experimental group). The cane was cut to appropriate height, and they received instructions on its use. The 32 control patients (CG) were instructed to maintain a normal lifestyle and not to use auxiliary gait devices. At 30 and 60 days, the EG patients had less pain compared to controls. The greatest improvement was in the VAS (10 cm scale): EG averaging 3.84 cm and CG 5.95 cm at 60 days. The Lequesne scale (0-24) difference was only 2.53 (CG 15.09 and EG 12.56 at 60 days). At 60 days, the study group consumed fewer NSAIDs than control.\n\nVan Ginckel 2019 evaluated use of a cane in patients with medial compartment knee osteoarthritis and bone marrow lesions (BML) on MRI. The primary intent of their study was to identify an effect on the size of BML by using a cane. Out of 1989 potential patients (contacted by phone or online) 231 were considered eligible for radiographic screening and of those, only 79 showed arthritic changes on plain films and BML on MRI and chose to continue with the study. 40 patients were assigned to use a cane whenever walking for the next 12 weeks. 39 control patients were instructed to maintain their usual lifestyle without any gait aids. Only one patient in the control group was lost to follow up. After 3 months, there was no significant improvement in BML size. Secondary information was obtained relative to clinical characteristics. There was no significant difference between the two groups with regards to knee pain (WOMAC scale) or quality of life (AQoL 6-D scale) although there was improvement in global knee pain in the group using the cane.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong\/moderate","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Chondroitin recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Chondroitin is Not Recommend for hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nChondroitin is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nchondroitin is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nChondroitin is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nChondroitin is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nChondroitin is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Chondroitin is Not Recommend for hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nA single trial suggested analgesic efficacy of chondroitin sul_x005f_x0002_fate, without evidence of harm, in hand OA.\nChondroitin is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nChondroitin is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis \nChondroitin is a component of connective tissues and bone, which is believed to help draw water and nutrients into the cartilage, keeping it spongy and healthy. Chondroitin is available as chondroitin sulfate supplements, which are made from bovine (cow) or shark cartilage. The usual dose is 800–1200 mg daily as a tablet, capsule or powder\nPooled data from six trials with more than 1000 participants found that the risk of adverse events is comparable to placebo.\nChondroitin is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is limited The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty)\nChondroitin may be helpful in reducing pain and improving function for patients with mild to moderate knee osteoarthritis.\nThe majority of 8 high-quality trials (Fransen 2015, Clegg 2006, Uebelhart 2004, Reginster 2017, Morita 2018, Zegels 2013, Kahan 2009, Rondanelli 2019) and 6 moderate-quality trials (Mazieres 2007, Moller 2010, Rondanelli 2019, Bourgeois 1998, Mazieres 2001, Bucsi 1998) that met inclusion criteria showed either improvement or no change in patient outcomes for those with osteoarthritis of the knee when taking chondroitin. \nThis recommendation has been downgraded two levels because of inconsistency and the need for additional clarity of efficacy.\n\n\nChondroitin is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\nChondroitin is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis \nChondroitin is a component of connective tissues and bone, which is believed to help draw water and nutrients into the cartilage, keeping it spongy and healthy. Chondroitin is available as chondroitin sulfate supplements, which are made from bovine (cow) or shark cartilage. The usual dose is 800–1200 mg daily as a tablet, capsule or powder\nPooled data from six trials with more than 1000 participants found that the risk of adverse events is comparable to placebo.","RecommendationStatus":"Not Recommend\/may be used","StrengthofRecommendation":"Conditional\nStrong\nStrong\nConditional\nConditional\nlimited","CertaintyofEvidence":"Ib\/Very low\/Not specified"},{"Guideline specific question":"Is Cognitive behavioral therapy (CBT) recommended for Other Exercise Treatment of osteoarthritis.","Short_answer":"Cognitive behavioral therapy is Recommend for hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nCognitive behavioural therapy (CBT) is Recommend for Hip osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nCognitive behavioral therapy is Recommend for Hand osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nCognitive behavioral therapy is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nCognitive behavioural therapy (CBT) is Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Cognitive behavioral therapy is Recommend for hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nTrials have demonstrated improvement in pain, health-related quality of life, negative mood, fatigue, functional capacity, and disability in con_x005f_x0002_ditions other than OA. In OA, limited evidence suggests that CBT may reduce pain (21). Further research is needed to establish whether or not benefits in OA are related to alteration in mood, sleep, coping, or other factors that may co-occur with, result from, or be a part of the experience of OA.\nThere is a well-established body of literature (19,20) sup_x0002_porting the use of CBT in chronic pain conditions, and CBT may have relevance for the management of OA. T.\nCognitive behavioural therapy (CBT) is Recommend for Hip osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis .\nClinicians should consider whether CBT is appropriate, taking into account psychological comorbidities and personal preference. They should be cognisant of issues related to cost and access. It is recommended that CBT is combined with exercise to improve outcomes. CBT may be offered face-to-face or via online programs.\nCBT is a psychological intervention that aims to show people how their thinking affects their mood, to help them identify and challenge unhelpful thoughts, and to learn practical self-help strategies. It can be used to treat a range of problems that may be relevant for people with OA, including pain, depression, anxiety, insomnia and eating problems. The most commonly studied CBT for OA has been pain coping skills training, with or without partner support.\nLow likelihood of adverse effects\n\nCognitive behavioral therapy is Recommend for Hand osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\nTrials have demonstrated improvement in pain, health-related quality of life, negative mood, fatigue, functional capacity, and disability in con_x0002_ditions other than OA. In OA, limited evidence suggests that CBT may reduce pain. Further research is needed to establish whether or not benefits in OA are related to alteration in mood, sleep, coping, or other factors that may co-occur with, result from, or be a part of the experience of OA.\nThere is a well-established body of literature sup_x0002_porting the use of CBT in chronic pain conditions, and CBT may have relevance for the management of OA. T.\n\nCognitive behavioral therapy is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\nTrials have demonstrated improvement in pain, health-related quality of life, negative mood, fatigue, functional capacity, and disability in con_x0002_ditions other than OA. In OA, limited evidence suggests that CBT may reduce pain (21). Further research is needed to establish whether or not benefits in OA are related to alteration in mood, sleep, coping, or other factors that may co-occur with, result from, or be a part of the experience of OA.\nThere is a well-established body of literature (19,20) sup_x0002_porting the use of CBT in chronic pain conditions, and CBT may have relevance for the management of OA. T.\nCognitive behavioural therapy (CBT) is Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis .\nClinicians should consider whether CBT is appropriate, taking into account psychological comorbidities and personal preference. They should be cognisant of issues related to cost and access. It is recommended that CBT is combined with exercise to improve outcomes. CBT may be offered face-to-face or via online programs.\nCBT is a psychological intervention that aims to show people how their thinking affects their mood, to help them identify and challenge unhelpful thoughts, and to learn practical self-help strategies. It can be used to treat a range of problems that may be relevant for people with OA, including pain, depression, anxiety, insomnia and eating problems. The most commonly studied CBT for OA has been pain coping skills training, with or without partner support.\nLow likelihood of adverse effects","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Ia\/Low\/Very low"},{"Guideline specific question":"Is Colchicine recommended for Pharmacologic Treatment of  osteoarthritis.","Short_answer":"Colchicine is Not Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nColchicine is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. \nColchicine is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n\nColchicine is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nColchicine is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Colchicine is Not Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nTwo very small studies have suggested analgesic benefit of colchicine in OA, but the quality of the data was low. In addition, potential adverse effects, as well as drug interactions, may occur with use of colchicine.\n\nColchicine is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nTwo very small studies have suggested analgesic benefit of colchicine in OA, but the quality of the data was low. In addition, potential adverse effects, as well as drug interactions, may occur with use of colchicine.\nColchicine is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nColchicine is a medication most commonly used to treat gout. It is a toxic natural product and secondary metabolite, originally extracted from plants of the genus colchicum. The hypothesis of action of colchicine is that it can block inflammasome_x005f_x0002_mediated inflammatory and biochemical joint degradation. The therapeutic use of colchicine has extended beyond gouty arthritis and familial Mediterranean fever to OA, pericarditis and atherosclerosis.1\nThere was no significant adverse event in the included trials of colchicine. The most commonly reported adverse events encountered with colchicine were gastrointestinal adverse events (eg loose bowel movements, pain in the abdomen), which were usually mild.\n\nColchicine is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nTwo very small studies have suggested analgesic benefit of colchicine in OA, but the quality of the data was low. In addition, potential adverse effects, as well as drug interactions, may occur with use of colchicine.\nColchicine is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nColchicine is a medication most commonly used to treat gout. It is a toxic natural product and secondary metabolite, originally extracted from plants of the genus colchicum. The hypothesis of action of colchicine is that it can block inflammasome_x0002_mediated inflammatory and biochemical joint degradation. The therapeutic use of colchicine has extended beyond gouty arthritis and familial Mediterranean fever to OA, pericarditis and atherosclerosis.1\nThere was no significant adverse event in the included trials of colchicine. The most commonly reported adverse events encountered with colchicine were gastrointestinal adverse events (eg loose bowel movements, pain in the abdomen), which were usually mild.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Iib\/Very low"},{"Guideline specific question":"Is Combining therapeutic exercise with an education programme or behaviour change approaches in a structured treatment package recommended for Exercise Treatment of  osteoarthritis.","Short_answer":"Combining therapeutic exercise with an education programme or behaviour change approaches in a structured treatment package is Recommended for  osteoarthritis ExerciseTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Combining therapeutic exercise with an education programme or behaviour change approaches in a structured treatment package is Recommended for  osteoarthritis ExerciseTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nEvidence showed that treatment packages had a clinically important benefit on physical function compared with education or behaviour change interventions alone. They also had consistent beneficial changes in quality of life, pain and physical function compared with standard care. However, they showed no superiority to individual therapies (such as exercise, manual therapy and electrotherapy). The committee agreed that a person_x005f_x0002_centred approach is important. Additional education or behavioural change approaches may help some people achieve their goals, but others may not need this. Therefore, the committee recommended combining therapeutic exercise as part of a structured treatment package because this may be more suitable for some people and motivate them.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Comprehensive management plan recommended for Other\nTreatment of osteoarthritis.","Short_answer":"Comprehensive management plan is Recommend for Knee osteoarthritis OtherTreatment and hip osteoarthritis OtherTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.","Full_answer":"Comprehensive management plan is Recommend for Knee osteoarthritis OtherTreatment and  hip osteoarthritis OtherTreatment. The strength of recommendation is Not specified The certainty of evidence is Ib(At least one randomised controlled trial). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis\n All people with knee\/hip OA should receive an comprehensive management plan (a package of care) that includes the core non-pharmacological approaches, specifically: a information and education regarding OA\nb addressing maintenance and pacing of activity\nc addressing a regular individualised exercise regimen\nd addressing weight loss if overweight or obese\ne* reduction of adverse mechanical factors (eg, appropriate footwear)\nf* consideration of walking aids and assistive technology\nThis recommendation deals with the provision of an integrated package of care rather than single treatments alone or in succession. The group recommended five core interventions to be considered comprehensively in every patient with hip or knee OA. The recommendation specifically implies that a person with hip or knee OA should receive education about her\/his\ncondition (3a), and be managed accordingly (3b–e). With the exception of walking aids and assistive technology and dealing with adverse mechanical factors, the literature sup ports the delivery of combined interventions including information and education, exercise and\/or weight reduction. In people with hip and\/or knee OA the combination of patient education or self-management intervention plus exercise was found to have a significant effect on pain, but a less marked effect on function. In people with hip OA the effect of such combinations was mainly seen on function (0–100 point scale) at 3 and 6 months after intervention (mean\ndifference, 95% CI −7.5, −13.9 to −1.0; and −8.4, −15.1 to −1.7). In people with knee OA effects on pain and\/or function were seen in eight studies, whereas no effect was seen in four studies. The addition of advice from a dietician for overweight or obese patients to the combination of patient education or self-management intervention plus exercise was found to improve both pain and function in patients with hip or knee OA.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Ib"},{"Guideline specific question":"Is \"Consider referring people with hip, knee or shoulder osteoarthritis for joint replacement if:\n• their joint symptoms (such as pain, stiffness, reduced function or progressive joint deformity) are substantially impacting their quality of life and \n• non-surgical management (for example, therapeutic exercise, weight loss, pain relief) is ineffective or unsuitable.\nConsider referring people with hip, knee or shoulder osteoarthritis for joint replacement if:\n• their joint symptoms (such as pain, stiffness, reduced function or progressive joint deformity) are substantially impacting their quality of life and \n• non-surgical management (for example, therapeutic exercise, weight loss, pain relief) is ineffective or unsuitable.\nConsider referring people with hip, knee or shoulder osteoarthritis for joint replacement if:\n• their joint symptoms (such as pain, stiffness, reduced function or progressive joint deformity) are substantially impacting their quality of life and \n• non-surgical management (for example, therapeutic exercise, weight loss, pain relief) is ineffective or unsuitable\" recommended for Surgery\nTreatment of osteoarthritis.","Short_answer":"\"Consider referring people with hip, knee or shoulder osteoarthritis for joint replacement if:\n• their joint symptoms (such as pain, stiffness, reduced function or progressive joint deformity) are substantially impacting their quality of life and \n• non-surgical management (for example, therapeutic exercise, weight loss, pain relief) is ineffective or unsuitable\" is Recommended for knee osteoarthritis SurgeryTreatment. The strength of recommendation is Not specified The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"\"Consider referring people with hip, knee or shoulder osteoarthritis for joint replacement if:\n• their joint symptoms (such as pain, stiffness, reduced function or progressive joint deformity) are substantially impacting their quality of life and \n• non-surgical management (for example, therapeutic exercise, weight loss, pain relief) is ineffective or unsuitable\" is Recommended for knee osteoarthritis SurgeryTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nEvidence on referral criteria for joint replacement was limited. This evidence suggested\nthat non-response to analgesics may be associated with a need for joint replacement.\nLonger duration of symptoms did not appear to be associated with the need for joint\nreplacement, which may show that the symptom duration is less relevant than non-\nresponse to treatments. Evidence for the Oxford Hip and Knee scores and the Knee injury\nand Osteoarthritis Outcome score (KOOS) and Hip disability and Osteoarthritis Outcome\nScore (HOOS) summary score showed that these numerical scales alone were unlikely to determine whether someone should have surgery, so they were not recommended for use.\nThe committee agreed that the decision to refer someone for joint replacement should be\nbased on clinical assessment after trying all appropriate treatments for that person. These\nshould have been tried for a sufficient length of time to ensure they are not effective at\nreducing symptoms before referral happens. Given the absence of evidence, the\ncommittee made a recommendation for research on indicators for joint replacement in\npeople with osteoarthritis.\nEvidence on weight loss before surgery showed that, after hip or knee replacement, there\nwas no difference in outcomes for people in different body mass index (BMI) categories.\nPeople who were overweight or obese based on BMI did not have an increased mortality\nrate after surgery and had improved health-related quality of life and patient-reported\noutcome measures. For people who were underweight based on BMI, evidence showed an\nincreased mortality rate. However, the committee considered that this may be due to\ncomorbidities and that the effect may be exaggerated by the smaller number of\nunderweight participants in studies. Some studies combined the healthy weight group with\nthe underweight group, which made interpreting the evidence more difficult. The\ncommittee acknowledged that BMI can give a false impression of the risks and that other\nfactors need to be considered, such as comorbidities. The committee concluded that BMI,\nand other measurements of whether someone is overweight or obese, should not be a\nbarrier to joint replacement.\nSimilarly, the committee agreed that everyone should be treated equally, and people\nshould not be excluded from referral for joint replacement based on their age, sex or\ngender, if they smoke or any comorbidities. They agreed that there are few\ncontraindications to surgery and the surgeon would be best placed to assess and discuss\nsuitability of joint replacement on a case-by-case basis. The committee also\nrecommended that the varying risks of surgery in relation to a person's specific\ncircumstances should be explained.\n","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is COX-2 Inhibitors recommended for Pharmacologic Treatment\nof  osteoarthritis.","Short_answer":"COX-2 Inhibitors is Recommend for Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"COX-2 Inhibitors is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with gastrointestinal comorbidities.\nFor individuals with GI comorbidities, selective COX-2 inhibitors and non-selective NSAIDs in combination with a PPI were conditionally recommended due to their benefits on pain and functional outcomes, but more importantly, because they have a\nmore favorable upper GI safety profile than non-selective NSAIDs.\nCOX-2 Inhibitors is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with widespread pain\/depression.\nCOX-2 Inhibitors  is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis\nThe recommendation is for patients with no comobidities.\n\nCOX-2 Inhibitors is Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with gastrointestinal comorbidities.\nFor individuals with GI comorbidities, selective COX-2 inhibitors and non-selective NSAIDs in combination with a PPI were conditionally recommended due to their benefits on pain and functional outcomes, but more importantly, because they have a\nmore favorable upper GI safety profile than non-selective NSAIDs.\nCOX-2 Inhibitors is Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with no comorbidities.\nCOX-2 Inhibitors is Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis\nThe recommendation is for patients with wide spread pain\/depression","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional\/Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Denervation therapy recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Denervation therapy is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Denervation therapy is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nFor the denervation therapies, there are 2 high-quality studies (Radnovic et al 2017 and Mendes et al 2019) and 2 moderate-quality studies (McAlindon et al 2017 and El-Hakeim et al 2018) comparing denervation technique with placebo.\n\nOne high-quality study (Radnovic et al 2017) specifically evaluated the efficacy of cryoneurolysis in comparison to placebo control in patients with knee OA. It was found that the group receiving cryoneurolysis had improved total WOMAC, WOMAC stiffness, WOMAC pain, WOMAC physical function and in VAS pain compared to the placebo control group.\n\nAnother high-quality study (Mendes et al 2019) evaluated the efficacy of chemical ablation in comparison to placebo control in patients with knee OA. It was found that the group receiving chemical denervation had improved in WOMAC pain compared to the placebo control group. Another moderate-quality study (McAlindon et al 2017) comparing the efficacy of chemical ablation in comparison to placebo control in patients with knee OA found no major difference between the two groups.\n\nOne moderate-quality study (El-Hakeim et al 2018) specifically evaluated the efficacy of thermal ablation in comparison to placebo control in patients with knee OA. It was found that the group receiving thermal ablation had improved WOMAC total, WOMAC function, and VAS pain compared to the placebo control group.\n\nOne high-quality study (Davis et al) and one moderate-evidence study (Davis et al 2018) compared IA HA to thermal ablation in patients with knee OA. The first study (Davis et al 2018) showed worse Oxford Knee Score, Global Perceived Index, and Numeric Rating Scale in the HA group compared to the thermal ablation group, while the second study (Davis et al 2018) showed worse Oxford Knee Score, Change in Medication Use (mg) from Baseline, Knee pain-Numeric Rating scale, and Mean Reduction in average NRS score in the HA group compared to the thermal ablation.\n\nOne high-quality study (Gulec et al 2017) compared unipolar to bipolar radiofrequency ablation of the knee in patients with knee OA. In patients with OA, Bipolar intra-articular pulsed radiofrequency thermocoagulation may be used over Unipolar intra-articular pulsed radiofrequency thermocoagulation to improve patient pain.\n\nOne moderate-quality study (Sari et al 2018) compared IA steroids to thermal ablation of the knee in patients with knee OA. The study showed worse WOMAC total, WOMAC function, WOMAC stiffness, and worse VAS pain in the IA steroids group compared to the thermal ablation group.\n\nIn summary, our analysis demonstrates that denervation therapy may reduce pain and improve function in patients with symptomatic osteoarthritis of the knee.\n\nThe Denervation Therapy recommendation has been downgraded two levels because of inconsistent evidence and bias.","RecommendationStatus":"may be used","StrengthofRecommendation":"Limited","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is dextrose prolotherapy recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Dextrose prolotherapy is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Dextrose prolotherapy is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nHypertonic dextrose injection, also termed as prolotherapy, is an injection-based treatment used for a variety of painful chronic musculoskeletal pain conditions. The core practice principle of prolotherapy is injection of relatively small volumes (0.5–6 ml) of an irritant solution, usually hypertonic dextrose, at painful ligament and tendon attachments, and in adjacent joint spaces. The hypothesised mechanisms for pain relief include stimulation of local healing, reduction of joint instability through the strengthening of stretched or torn ligaments and stimulation of cellular proliferation.\nThe study reported self-limited bruises after dextrose (n = 3) and saline (n = 5) injections. This was an expected side effect and deemed to be of minimal clinical relevance because of its transient nature. No serious adverse events were reported; however, this may be because the study sample size is not large enough to detect uncommon adverse events.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Low"},{"Guideline specific question":"Is diacerein recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Diacerein is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Diacerein is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis \n\nDiacerein is purified compound with an anthraquinone structure that interferes with pro-inflammatory interleukin-1 (IL-1) and the secretion of metalloproteinases, without affecting the synthesis of prostaglandins. It is widely available on prescription in Europe, but not available in Australia. The dose used in the trials was 50 mg twice a day\nAdverse events were significantly increased after using diacerein, mainly diarrhoea (relative risk [RR]: 3.50; 95% confidence interval [CI]: 1.95, 6.27). There is an increase in rash, but the between-group difference was not significant.\n\n","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is doxycycline recommended for Pharmacologic Treatment of  osteoarthritis.","Short_answer":"Doxycycline is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Doxycycline is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n\nDoxycycline is a tetracycline-class antibiotic agent. Besides being an antimicrobial agent, it is a metalloproteinase inhibitor, and inhibits the collagenase that cleaves collagen type IX that is present in articular cartilage.\nAdverse events that occurred significantly more frequently in the doxycycline group than the placebo group were restricted to recognised side effects of doxycycline (ie monilial vaginitis, sun sensitivity, nonspecific gastrointestinal symptoms). However, only a small proportion of subjects reporting doxycycline-related side effects discontinued the study medication prematurely. Subjects in the active treatment group reported fewer urinary tract infections, and there was a trend toward fewer upper respiratory tract infections in the doxycycline group than the placebo group.\n\n","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Low\/Very low"},{"Guideline specific question":"Is Dry needling recommended for Physical\nTreatment of osteoarthritis.","Short_answer":"Dry needling is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nDry needling is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Dry needling is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nThe available evidence was predominantly for knee osteoarthritis. This showed a lack of benefits of acupuncture and some evidence of harm. Economic evidence also showed that using acupuncture for osteoarthritis is not cost effective, so the committee did not recommend using acupuncture or dry needling. There was some evidence of clinical benefit and cost effectiveness for electroacupuncture but this was of very low quality because of small study sizes and inconsistency between studies. The evidence for electroacupuncture suggested it showed a benefit compared with sham acupuncture but not compared with acupuncture or no treatment. The committee considered that the inconsistent evidence could be the result of some people responding more to electroacupuncture than others. Because there is uncertainty about who might benefit from electroacupuncture, the committee made a recommendation for research on electroacupuncture for osteoarthritis.\n\nDry needling is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nTwo high-quality studies examining the effectiveness of dry needling in combination with either exercise versus sham dry needling and exercise (Sanchez, 2019) or dry needling combined with manual therapy and exercise versus manual therapy and exercise alone (Dunning, 2018) were reviewed. Sanchez et al. 2019 found no difference in clinical outcomes of pain or function between treatment groups. In contrast, Dunning et al. found greater improvements in measures of pain and function in the group receiving dry needling. The inconsistency in the results of these studies has prompted the workgroup not to make a recommendation for or against dry needling at this time. Additional evidence will be required before a recommendation can be made.","RecommendationStatus":"Not recommend\/may be used","StrengthofRecommendation":"Not specified\/Limited","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Duloxetine recommended for Pharmacologic Treatment of  osteoarthritis.","Short_answer":"Duloxetine is Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nDuloxetine is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nDuloxetine is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nDuloxetine is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\n\nDuloxetine is Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nDuloxetine is Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Duloxetine is Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nIn considering all the ways in which OA may be affecting an individual patient, shared decision-making between the physician and patient may include consideration of any of these agents. Considering the utility of these agents in pain man_x005f_x0002_agement generally, their use may be an appropriate target of future investigations specific to OA. Evidence suggests that duloxetine has efficacy in the treatment of OA when used alone or in combi_x0002_nation with NSAIDs; however, there are issues regarding tolerabil_x0002_ity and side effects.\nWhile studied primarily in the knee, the effects of duloxetine may plausibly be expected to be similar for OA of the hip or hand. While a variety of centrally acting agents (e.g., pregabalin, gab_x0002_apentin, selective serotonin reuptake inhibitors, serotonin norepi_x0002_nephrine reuptake inhibitors, and tricyclic antidepressants) have been used in the management of chronic pain, only duloxetine has adequate evidence on which to base recommendations for use in OA.\n\nDuloxetine is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nIn considering all the ways in which OA may be affecting an individual patient, shared decision-making between the physician and patient may include consideration of any of these agents. Considering the utility of these agents in pain man_x0002_agement generally, their use may be an appropriate target of future investigations specific to OA. Evidence suggests that duloxetine has efficacy in the treatment of OA when used alone or in combi_x0002_nation with NSAIDs; however, there are issues regarding tolerabil_x0002_ity and side effects.\nWhile studied primarily in the knee, the effects of duloxetine may plausibly be expected to be similar for OA of the hip or hand. While a variety of centrally acting agents (e.g., pregabalin, gab_x0002_apentin, selective serotonin reuptake inhibitors, serotonin norepi_x0002_nephrine reuptake inhibitors, and tricyclic antidepressants) have been used in the management of chronic pain, only duloxetine has adequate evidence on which to base recommendations for use in OA.\nDuloxetine is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nThe imbalance of serotonin and norepinephrine systems within the central pain pathways have been implicated in the development and maintenance of central sensitisation, and associated with chronic pain in OA. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) with central nervous system activity. Its analgesic efficacy in central pain is putatively related to its influence on descending inhibitory pain pathways. Research has found it has a beneficial effect on pain associated with diabetic neuropathy, fibromyalgia, low back pain and OA\nAmong the participants in the three included RCTs, treatment with duloxetine was well tolerated, with the majority of adverse.\nDuloxetine is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis\nThe recommendation is for patients with wide spread pain\/depression.\n\nDuloxetine is Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nIn considering all the ways in which OA may be affecting an individual patient, shared decision-making between the physician and patient may include consideration of any of these agents. Considering the utility of these agents in pain man_x0002_agement generally, their use may be an appropriate target of future investigations specific to OA. Evidence suggests that duloxetine has efficacy in the treatment of OA when used alone or in combi_x005f_x005f_x0002_nation with NSAIDs; however, there are issues regarding tolerabil_x0002_ity and side effects.\nWhile studied primarily in the knee, the effects of duloxetine may plausibly be expected to be similar for OA of the hip or hand. While a variety of centrally acting agents (e.g., pregabalin, gab_x0002_apentin, selective serotonin reuptake inhibitors, serotonin norepi_x0002_nephrine reuptake inhibitors, and tricyclic antidepressants) have been used in the management of chronic pain, only duloxetine has adequate evidence on which to base recommendations for use in OA.\nDuloxetine is Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nThe imbalance of serotonin and norepinephrine systems within the central pain pathways have been implicated in the development and maintenance of central sensitisation, and associated with chronic pain in OA. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) with central nervous system activity. Its analgesic efficacy in central pain is putatively related to its influence on descending inhibitory pain pathways. Research has found it has a beneficial effect on pain associated with diabetic neuropathy, fibromyalgia, low back pain and OA\nAmong the participants in the three included RCTs, treatment with duloxetine was well tolerated, with the majority of adverse.\n\n","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"III\/Moderate\/Not specified"},{"Guideline specific question":"Is electrotherapy modalities of shockwave, interferential or laser\nrecommended for Physical\nTreatment of osteoarthritis.","Short_answer":"Electrotherapy modalities of shockwave, interferential or laser is Not Recommend for Knee osteoarthritis PhysicalTreatment or Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Electrotherapy modalities of shockwave, interferential or laser is Not Recommend for Knee osteoarthritis PhysicalTreatment or for Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n\nElectrotherapy modalities (eg shockwave, interferential electrical current, laser therapy) are purported to induce physiologically beneficial effects on body tissues at a cellular level, including: • promotion of cell growth and angiogenesis • minimising inflammatory processes • modulating pain through actions on the peripheral nervous system. Shockwave therapy is typically delivered by clinicians, while portable units are available for interferential and laser modalities\nThere is no evidence of harm across these modalities","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is Exercise recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Exercise is Recommend for Hand osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nExercise is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nExercise is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nExercise is Recommend for knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Exercise is Recommend for Hand osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nA substantial body of literature (see Evidence Report, Supplementary Appendix 2 [http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/acr.24131\/abstract]) supports a wide range of appropriate exercise options and sug_x005f_x005f_x005f_x005f_x0002_gests that the vast majority of OA patients can participate in, and benefit from with regard to pain and function, some form of exercise. Exercise recommendations to patients should focus on the patient’s preferences and access, both of which may be important barriers to participation. If a patient does not find a cer_x0002_tain form of exercise acceptable or cannot afford to participate or arrange transportation to participate, he or she is not likely to get any benefit from the suggestion to pursue that exercise.\nThough exercise is strongly recommended for all OA patients, there is considerably more evidence for the use of exercise in the treatment of knee and hip OA than for hand OA, and the vari_x0002_ety of exercise options studied is far greater. W.\n\nExercise is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nA substantial body of literature (see Evidence Report, Supplementary Appendix 2 [http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/acr.24131\/abstract]) supports a wide range of appropriate exercise options and sug_x0002_gests that the vast majority of OA patients can participate in, and benefit from with regard to pain and function, some form of exercise. Exercise recommendations to patients should focus on the patient’s preferences and access, both of which may be important barriers to participation. If a patient does not find a cer_x0002_tain form of exercise acceptable or cannot afford to participate or arrange transportation to participate, he or she is not likely to get any benefit from the suggestion to pursue that exercise.\nThough exercise is strongly recommended for all OA patients, there is considerably more evidence for the use of exercise in the treatment of knee and hip OA than for hand OA, and the vari_x0002_ety of exercise options studied is far greater. W.\nExercise is Recommend for knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nTen high-quality studies were reviewed that compared a supervised exercise program to a non-exercise control (e.g., no treatment, heat only, education, usual primary care). (Christensen 2015, Holsgaard-Larsen 2018, Oliveira 2012, Willamson 2007, de Rooij 2017, Imoto 2012, Topp 2002, Hu 2020, Kim 2013, Chen 2014) Seven of these studies found greater improvements in pain, function, or both pain and function over the non-exercise control group (Oliveira 2012, de Rooij 2017, Imoto 2012, Topp 2002, Hu 2020, Kim 2013, Chen 2014).\nOne high-quality study and four moderate-quality studies were reviewed that compared supervised exercise to a non-supervised exercise program (e.g., home program, internet-based program, exercise brochure). (McCarthy 2004, Allen 2018, Yilmaz 2019, Tunay 2010, Bennell 2014). Patients from both groups received benefit from the interventions but there were mixed results as to whether supervised exercise was superior to the non-supervised exercise programs. It appears that both supervised or non-supervised exercise programs can result in improved pain and function in people with knee osteoarthritis.\nFour high-quality studies and one moderate-quality study were reviewed that compared aquatic exercise to either usual primary care, education, or self-management. (Kuptniratsaikul 2019, Rewald 2020, Waller 2017, Munukka 2020, Dias 2017.) Three high-quality studies reported greater improvements in pain, function, or global ratings of improvement for the aquatic groups over the control groups. (Kuptniratsaikul 2019, Rewald 2020, Dias 2017) One high-quality study reported increased leisure time activity for the aquatic group compared to the control. (Waller 2017) One moderate-quality study compared aquatic exercise to land-based exercise. (Silva 2008) There was no difference in WOMAC pain and function scores reported between groups for this study, but the aquatic exercise group had less pain with walking compared to the land-based group. Although there may be some benefit from aquatic exercise, inconsistent results do not allow us to recommend aquatic exercise over land-based exercise at this time.\nSeveral studies examined clinical outcomes for different modes of exercise in patients with knee osteoarthritis. Ebnezar 2012 reported some improvement in anxiety measures when comparing yoga to non-yoga exercise. (Ebnezar 2012) Other studies compared weightbearing to non-weightbearing exercise (Bennell 2020, Jan 2009), high versus low resistance training (Jan 2008), isokinetic, isometric, and isotonic exercise (Huang 2005), and leg versus hip exercise (Lun 2015) and did not find substantial differences in the mode of exercise. It appears that exercise is beneficial, but the mode of exercise may not matter as much as engaging in any exercise program.\n\nExercise is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nA substantial body of literature (see Evidence Report, Supplementary Appendix 2 [http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/acr.24131\/abstract]) supports a wide range of appropriate exercise options and sug_x0002_gests that the vast majority of OA patients can participate in, and benefit from with regard to pain and function, some form of exercise. Exercise recommendations to patients should focus on the patient’s preferences and access, both of which may be important barriers to participation. If a patient does not find a cer_x0002_tain form of exercise acceptable or cannot afford to participate or arrange transportation to participate, he or she is not likely to get any benefit from the suggestion to pursue that exercise.\nThough exercise is strongly recommended for all OA patients, there is considerably more evidence for the use of exercise in the treatment of knee and hip OA than for hand OA, and the vari_x0002_ety of exercise options studied is far greater. W.\n","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Ia\/Not specified"},{"Guideline specific question":"Is Exercise education recommended for Education Treatment of  osteoarthritis.","Short_answer":"Exercise education  is Recommend for Knee osteoarthritis EducationTreatment and hip osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.","Full_answer":"Exercise education  is Recommend for Knee osteoarthritis EducationTreatment and hip osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\nThe mode of delivery of exercise education (eg, individual 1 : 1 sessions, group classes, etc) and use of pools or other facilities should be selected according both to the preference of the person with hip or knee OA and local availability. Important principles of all exercise include:\na† ‘small amounts often’ (pacing, as with other activities)\nb† linking exercise regimens to other daily activities (eg, just before morning shower or meals) so they become part of\nlifestyle rather than additional events\nc* starting with levels of exercise that are within the individual’s capability, but building up the ‘dose’ sensibly over several months\nThere is convincing evidence for the overall effectiveness of exercise on pain (ES, 95% CI: 0.40, 0.30 to 0.50) and function (ES, 95% CI: 0.37, 0.25 to 0.49) in people with knee OA,87 and to a lesser extent in people with hip OA (ES, 95% CI, pain 0.38, 0.08 to 0.68). Few studies have directly compared different exercise ‘dosage’ (frequency, intensity and duration) and progression approaches in people with OA.87 89 90 One RCT reported reduced pain from attending a progressive functional strengthening pro gramme compared with a non-progressive programme in people with knee OA,90 but two trials could not show any differences from attending various intensity levels of aerobic or resistance-exercise programmes.89 91 Hence, the optimal exercise ‘dosage’ and rate of progression remain uncertain. In patients with knee OA different delivery modes (individual, group-based or home programmes) have all been shown to effectively reduce pain (individual, ES, 95% CI 0.55, 0.29 to 0.81; group-based, ES, 95% CI 0.37, 0.24 to 0.51; and, home, ES, 95% CI 0.28, 0.16 to 0.39) and improve function (individual, ES, 95% CI 0.52, 0.19 to 0.86; group-based, ES, 95% CI 0.35, 0.19 to 0.50; and, home, ES, 95% CI 0.28, 0.17 to 0.38) compared with education, telephone calls, waiting list, relaxation, ultrasound, hot-packs or no treatment. In patients with hip and\/or knee OA, water-based exercise was found to significantly reduce pain (ES, 95% CI 0.19, 0.04 to 0.35) and improve function (ES, 95% CI 0.26, 0.11 to 0.42) compared with education, telephone calls or no intervention. Home-based exercise was found to be as effective as water based exercise in one small RCT in people with hip OA. Water-based exercise can include swimming and\/or different types of exercise programmes. Since the different modes of delivery are equally effective, the person’s preference, findings of the initial assessment and local availability should determine the choice of mode of delivery in clinical practice. The literature suggests that pacing of activity and\/or integrating physical activity into daily living as part of a comprehensive exercise regimen is more effective in people with hip or knee OA or with knee pain than usual care or written information, but not compared with standardised exercise or a pharmacy review. This recommendation suggests the need for an increase in the intensity and\/or duration of exercise over time. This is based on the literature, where most strength training exercise programmes evaluated in people with knee OA included dynamic exercises with progression over time. Moreover, in one study comparing progressive and non progressive approaches in people with knee OA, the former was found to reduce pain more effectively. General recommendations for dosage and progression of exercise in older people and people with chronic disease are aerobic moderate-intensity training for at least 30 min\/day or up to 60 min for greater benefit, and progressive strength training involving the major muscle groups at least 2 days\/week at a level of moderate to vigorous intensity (60–80% of one repetition maximum) for 8–12 repetitions.96 97 These recommendations emphasise that in people with chronic disease who do not reach the recommended level, they should be as physically active as their abilities and condition allow.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is Exercise tailored to patient's need recommended for Exercise Treatment of  osteoarthritis.","Short_answer":"Exercise tailored to patient's need is Recommended for  osteoarthritis ExerciseTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Exercise tailored to patient's need is Recommended for  osteoarthritis ExerciseTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nThe evidence showed that exercise has a clinically important benefit for people with osteoarthritis, as well as general health benefits and a superior safety profile compared with other common treatments, such as analgesia. In particular, the committee highlighted the importance of therapeutic exercise to help manage and reduce symptoms and improve or maintain physical functioning over the long term. The committee also agreed that shared decision making is important when deciding the form of exercise delivery and type of exercise, as well as considering personal preference and service availability. For most benefit, they recommended this be tailored to the needs of the person, such as joint-site-specific exercises.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is \"Explain to patients what osteoarthritis is\" recommended for Education Treatment of  osteoarthritis. ","Short_answer":"\"Explain to patients what osteoarthritis is\" is Recommended for  osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"\"Explain to patients what osteoarthritis is\" is Recommended for  osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nOsteoarthrits is diagnosed clinically and usually does not need imaging to confirm the diagnosis and management should be guided by symptoms and physical function and the core treatments for the condition are therapeutic exercise and weight management (if appropriate), along with information and support. \nEvidence showed that generally people with osteoarthritis wanted more information about their condition. This included information about the causes, what their diagnosis means for the future and where to find more information on self-management. The committee based their recommendations on the evidence and their experience. They agreed that it is important to tell people that diagnosis is made clinically without imaging, that imaging rarely provides any extra information helpful for diagnosing or planning non-surgical treatment for osteoarthritis, and that it would only be used if there were suspicion of an alternative diagnosis or other complications. This would help reassure and dispel any belief that X-rays or other forms of imaging are needed to diagnose osteoarthritis. \nThe committee noted the importance of information that offers hope for the future and supports self-management strategies (for example, information that emphasises symptom-reducing behaviours, like therapeutic exercise). They agreed that explaining the core treatments for osteoarthritis would help people understand that pharmacological treatments are not a long-term solution. They also agreed that information about recognising flares and how to manage changes in pain would help the person better understand how their condition may vary over time and what they can do about it. The committee noted more evidence was needed on information about managing flares and information for different populations of people with osteoarthritis, and so made recommendations for research on what information people with osteoarthritis need. \nThe committee agreed that each person's experience of osteoarthritis differs and therefore tailoring the information to their needs, as described in NICE's guideline on patient experience in adult NHS services, is important. They also agreed that osteoarthritis is more common in older people who are likely to have other conditions. Therefore, the recommendations on delivering an approach to care that takes account of multimorbidity in NICE's guideline on multimorbidity are particularly relevant to people with osteoarthritis.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Extracorporeal shockwave therapy recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Extracorporeal shockwave therapy is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Extracorporeal shockwave therapy is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nA meta-analysis was performed using pain data from three high-quality studies (Zhong 2019, Ediz 2018, and Uysal 2020) in which Extracorporeal Shockwave Therapy (ESWT) was compared to sham ESWT in subjects with knee osteoarthritis. The results of the meta-analysis can be seen in Figure 19 in the appendix. The overall findings were in favor of receiving ESWT for reducing pain in subjects with knee osteoarthritis. In addition, four high-quality studies reported greater improvements in function scores in subjects receiving ESWT compared to the sham group at 4 to 12 weeks but not at 1-year follow-up. (Zhao 2013, Ediz 2018, Zhong 2019, Uysal 2020). \n\nThe Extracorporeal Shockwave Therapy recommendation has been downgraded two levels because of inconsistent evidence and a lack of internal consistency with recommendations of equal supporting evidence.","RecommendationStatus":"may be used","StrengthofRecommendation":"limited","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is FGF recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"FGF is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"FGF is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n\nSprifermin is a recombinant and truncated version of human FGF-18 that binds to, and specifically activates, FGF receptor-3 in cartilage in order to promote chondrocyte proliferation and cartilage matrix production.\nAccording to the findings in two recent trials, the overall proportion of participants experiencing at least one treatment_x005f_x0002_emergent adverse event (TEAE) was not increased in the sprifermin group, compared with the placebo group (Appendix 5 of the Guideline for the management of knee and hip osteoarthritis: Technical document). Incidence, severity and nature of reported TEAEs raised no local or systemic safety concerns for doses up to 300 μg.1","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is Fish Oil recommended for Pharmacologic Treatment of  osteoarthritis.","Short_answer":"Fish Oil is Not Recommend for Hand osteoarthritis PharmacologicTreatment, knee osteoarthritis PharmacologicTreatment or hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\n.","Full_answer":"Fish Oil is Not Recommend for Hand osteoarthritis PharmacologicTreatment, knee osteoarthritis PharmacologicTreatment or hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nFish oil is the most commonly used dietary supplement in the US\nDespite its popularity, only 1 published trial has addressed its potential role in OA. This study failed to show efficacy of a higher dose of fish oil over a lower dose","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"IIb"},{"Guideline specific question":"Is \"For those who are overweight (BMI ≥25 kg\/m2) or obese (BMI ≥30 kg\/m2), a minimum weight loss target of 5–7.5% of body weight\"recommended for Other Treatment of osteoarthritis.","Short_answer":"\"For those who are overweight (BMI ≥25 kg\/m2) or obese (BMI ≥30 kg\/m2), a minimum weight loss target of 5–7.5% of body weight\" is Recommend for Hip osteoarthritis OtherTreatment and Knee osteoarthritis OtherTreatment. The strength of recommendation is Strong. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"\"For those who are overweight (BMI ≥25 kg\/m2) or obese (BMI ≥30 kg\/m2), a minimum weight loss target of 5–7.5% of body weight\" is Recommend for Hip osteoarthritis OtherTreatment and Knee osteoarthritis OtherTreatment. The strength of recommendation is Strong. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nIt is beneficial to achieve a greater amount of weight loss given that a relationship exists between weight loss and symptomatic benefits. Weight loss should be combined with exercise for greater benefits. For people of healthy body weight, education about the importance of maintaining healthy body weight is essential\nWeight loss is usually achieved through a combination of dietary modification and exercise, and in extreme cases, bariatric surgery\nThere are low risk of harms associated with this recommendation. However, there are currently no clearly defined BMI thresholds for older adults (aged >65 years). There is evidence to suggest that the cut-offs should be higher for older adults.84 The need for weight loss in older adults should be considered on an individual basis. If weight loss is appropriate, care should be taken to ensure maintenance of lean body mass and bone density, especially when it is accompanied with high intensity resistance and\/or impact loading training.85 People should be monitored for bone health if needed and strengthening exercise included as part of the treatment program.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is Free-floating (un-fixed) interpositional devices  recommended for Physical Treatment of osteoarthritis.","Short_answer":"Free-floating (un-fixed) interpositional devices  is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Free-floating (un-fixed) interpositional devices  is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nFree-floating (un-fixed) interpositional devices should not be used in patients with symptomatic medial compartment osteoarthritis of the knee.\nOne study met inclusion criteria, and no additional studies were available for review since the prior edition OAK CPG was published. The single study was a case series and retrospective review of outcomes in patients receiving the surgical intervention for isolated medial compartment OA. The study indicated high reoperation rates in the patients who were followed, with 32% of patients being revised to total knee arthroplasty during the study period. Regarding pain and functional improvement, the study reported no statistical difference in preoperative and postoperative Knee Society Scores. Given the lack of evidence to support use, the AAOS workgroup modified the grade of this recommendation to consensus, because of the high revision rates in this study, and the potential harm associated with surgical intervention (anesthesia risks, VTE, infection, and reoperation).","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Limited","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Gait Aids recommended for Physical Treatment of osteoarthritis.","Short_answer":"Gait Aids is Recommend for Knee osteoarthritis PhysicalTreatment and Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"Gait Aids is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with and without comorbidities.\n\nGait Aids is Recommend for Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditiona.l The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with widespread pain\/depression.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is gastroprotective treatment (such as a proton pump inhibitor) while taking NSAIDs recommended for Pharmacological Treatment of  osteoarthritis.","Short_answer":"Gastroprotective treatment (such as a proton pump inhibitor) while taking NSAIDs is Recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Gastroprotective treatment (such as a proton pump inhibitor) while taking NSAIDs is Recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nOral NSAIDs were found to be cost effective and evidence showed they slightly reduced pain and increased physical function. The committee acknowledged the Medicines and Healthcare products Regulatory Agency (MHRA) safety warnings on NSAIDs for cardiovascular safety, renal safety and gastrointestinal risk. They agreed that NSAIDs, as well as other pharmacological treatments for osteoarthritis, should be used for as short a time as possible and that the potential harms for gastrointestinal, cardiovascular, liver and kidney adverse events should be carefully considered when prescribing. Evidence showed that adding gastroprotection can reduce gastrointestinal bleeding or perforation. However, this was associated with an increase in cardiovascular adverse events compared with oral NSAIDs alone. The committee agreed that this may be unrelated to the addition of gastroprotection and that randomised controlled trial evidence alone may not be the best source for safety evidence, because the population size and length of follow-up are usually limited. Therefore, they also used their clinical experience and guidance from other organisations, including the MHRA. Based on this, the committee agreed that use of gastroprotection should be offered with NSAIDs.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Ginger extract recommended for Pharmacological Treatment of osteoarthritis.","Short_answer":"Ginger extract is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Ginger extract is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nGinger extract may be helpful in reducing pain and improving function for patients with mild to moderate knee osteoarthritis.\nOne high-quality study (Zakeri 2011) and one moderate-quality study (Altman 2001) that met inclusion criteria showed that ginger extract may be used to improve pain in patients with osteoarthritis of the knee. However, there was no significant difference in function between ginger extract and control.\n\nThis recommendation has been downgraded two levels because of inconsistency and the need for additional clarity of efficacy.","RecommendationStatus":"may be used","StrengthofRecommendation":"limited","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Glucosamine recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Glucosamine is Not Recommend for hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nGlucosamine is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nGlucosamine is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nGlucosamine is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nGlucosamine is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nGlucosamine is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis \n\nGlucosamine is Not recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Glucosamine is Not Recommend for hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nPatients also often perceive that different glucosamine formulas are associated with different degrees of efficacy and seek advice on brands and manufactur_x005f_x005f_x0002_ers. The potential toxicity of glucosamine is low, though some patients exposed to glucosamine may show elevations in serum glucose levels.\nPharmaceutical-grade preparations of glucosamine are available and have been studied in multiple trials. However, discrepancies in efficacy reported in studies that were industry sponsored as opposed to publicly funded have raised serious concerns about publication bias (34,35). In addition, there is a lack of a clear biologic understanding of how efficacy would vary with the type of salt studied. The data that were deemed to have the lowest risk of bias fail to show any important benefits over placebo. These recommendations represent a change from the prior conditional recommendation against the use of glu_x0002_cosamine. The weight of the evidence indicates a lack of efficacy and large placebo effects. Nonetheless, glucosamine remains among the most commonly used dietary supplements in the US (31), and clinicians should be aware that many patients per_x0002_ceive that glucosamine is efficacious.\n\nGlucosamine is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nPatients also often perceive that different glucosamine formulas are associated with different degrees of efficacy and seek advice on brands and manufactur_x0002_ers. The potential toxicity of Glucosamine is low, though some patients exposed to glucosamine may show elevations in serum glucose levels\nPharmaceutical-grade preparations of glucosamine are available and have been studied in multiple trials. However, discrepancies in efficacy reported in studies that were industry sponsored as opposed to publicly funded have raised serious concerns about publication bias (34,35). In addition, there is a lack of a clear biologic understanding of how efficacy would vary with the type of salt studied. The data that were deemed to have the lowest risk of bias fail to show any important benefits over placebo. These recommendations represent a change from the prior conditional recommendation against the use of glu_x0002_cosamine. The weight of the evidence indicates a lack of efficacy and large placebo effects. Nonetheless, glucosamine remains among the most commonly used dietary supplements in the US (31), and clinicians should be aware that many patients per_x0002_ceive that glucosamine is efficacious.\nGlucosamine is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nGlucosamine is a naturally produced sugar by the body, and one of the building blocks of cartilage. It comes in two forms – glucosamine sulfate and hydrochloride, and the usual dose is 1500 mg daily. Glucosamine supplements are usually made from crab, lobster or shrimp shells, although some supplements are made from a plant form of glucosamine. These are available as tablets or liquid, and often in combination with chondroitin\nOverall, there was a low risk of adverse effects reported in the trials. Shellfish allergy and interactions with warfarin and diabetes are of concern, and trials are likely to have excluded participants with those conditions more carefully than usual practice.\nGlucosamine is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nGlucosamine may be helpful in reducing pain and improving function for patients with mild to moderate knee osteoarthritis.\nThe majority of 6 high-quality trials (Reginster 2001, Cibere 2004, McAlindon 2004, Clegg 2006, Herrero-Beaumont 2007, Fransen 2015), the majority of 6 moderate-quality trials (Noack 1994, Houpt 1999, Rindone 2000, Pavelka 2002, Giordano 2009, and Shahine 2014), and 1 low-quality study that met inclusion criteria showed either improvement or no change in patient outcomes for those with osteoarthritis of the knee when taking glucosamine versus control. \nThis recommendation has been downgraded two levels because of inconsistency and the need for additional clarity of efficacy.\n\nGlucosamine is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nPatients also often perceive that different glucosamine formulas are associated with different degrees of efficacy and seek advice on brands and manufactur_x0002_ers. The potential toxicity of Glucosamine is low, though some patients exposed to glucosamine may show elevations in serum glucose levels\nPharmaceutical-grade preparations of glucosamine are available and have been studied in multiple trials. However, discrepancies in efficacy reported in studies that were industry sponsored as opposed to publicly funded have raised serious concerns about publication bias (34,35). In addition, there is a lack of a clear biologic understanding of how efficacy would vary with the type of salt studied. The data that were deemed to have the lowest risk of bias fail to show any important benefits over placebo. These recommendations represent a change from the prior conditional recommendation against the use of glu_x0002_cosamine. The weight of the evidence indicates a lack of efficacy and large placebo effects. Nonetheless, glucosamine remains among the most commonly used dietary supplements in the US (31), and clinicians should be aware that many patients per_x0002_ceive that glucosamine is efficacious.\nGlucosamine is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nGlucosamine is a naturally produced sugar by the body, and one of the building blocks of cartilage. It comes in two forms – glucosamine sulfate and hydrochloride, and the usual dose is 1500 mg daily. Glucosamine supplements are usually made from crab, lobster or shrimp shells, although some supplements are made from a plant form of glucosamine. These are available as tablets or liquid, and often in combination with chondroitin\nOverall, there was a low risk of adverse effects reported in the trials. Shellfish allergy and interactions with warfarin and diabetes are of concern, and trials are likely to have excluded participants with those conditions more carefully than usual practice.\n\nGlucosamine is Not recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nEvidence on glucosamine was inconsistent and the largest benefits were shown by smaller studies that were of lower quality. Because glucosamine is not used in current practice and  there is no strong evidence of benefit the committee recommended against its use for  people with osteoarthritis.","RecommendationStatus":"Not Recommend\/may be used","StrengthofRecommendation":"Strong\/Conditional\/Not specified\/limited","CertaintyofEvidence":"Ia\/Very low\/Low\/Not specified"},{"Guideline specific question":"Is glucosamine and chondroitin in compound for recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Glucosamine and chondroitin in compound form is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Glucosamine and chondroitin in compound form is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nGlucosamine and chondroitin are often marketed in a combination at the same doses as individual components. There does not appear to be any beneficial drug–drug synergistic interaction.\nAs with the individual components, the reported rates of adverse events were similar to placebo","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is Hand Orthosis recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Hand Orthosis is Recommend for Hand osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Hand Orthosis is Recommend for Hand osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nA variety of mechanical supports are available, including digital orthoses, ring splints, and rigid or neoprene orthoses, some of which are intended for specifically affected joints (e.g., first CMC joint, individual digits, wrist) and some of which sup_x005f_x005f_x005f_x005f_x0002_port the entire hand.\nData are insufficient to recommend one type of orthosis over another for use in the hand.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"III"},{"Guideline specific question":"Is High tibial osteotomy recommended for Surgery Treatment of  osteoarthritis.","Short_answer":"High tibial osteotomy is may be used for knee osteoarthritis SurgeryTreatment. The strength of recommendation is Limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"High tibial osteotomy is may be used for knee osteoarthritis SurgeryTreatment. The strength of recommendation is Limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nHigh tibial osteotomy may be considered to improve pain and function in properly indicated patients with unicompartmental knee osteoarthritis.\n\nHigh tibial osteotomy (HTO) has been used for pain relief of medial compartment knee osteoarthritis. Realigning the varus knee provides mechanical decompression of the medial compartment. An osteotomy line is created in the proximal tibial, and either a wedge defect is created by opening the medial cortex and held open with a wedge or plate and screw hardware, or a lateral wedge is removed and secured commonly with staples or wires. In the Nerhus 2017 study, patients continued to show improvement 6 and 12 months post-operatively. Historical studies have reported pain reduction with survival rates approximately 70% at 10 years (“survival” usually interpreted with endpoint conversion to replacement) (van Outeren cites Brouwer 2014 and Niinimaki 2012).\n\nMany studies available for review by the workgroup compared various techniques of osteotomy in randomized studies. Ogawa 2019 found osteotomy distal to the tibial tubercle to be superior to proximal osteotomy for an opening wedge procedure with regard to patellofemoral pain. Arthroscopic evaluation of the knee joint at the time of osteotomy and second look at the time of hardware removal showed less patellar and trochlear degeneration with the distal osteotomy group.\n\nNerhus 2017 saw no significant functional difference between surgical patients randomized to either opening or closing wedge, with all showing improvement.\n\nDuivenvoorden 2014 reported improved HSS scores from 71 to 81 at 6 years post-op. VAS scores improved from 6.1 baseline to a statistically significant difference at follow up of 4.0 in the opening wedge patients and 3.2 with the closing wedge (albeit no statistical difference between the groups). It should be noted that patients lost to follow up started with a VAS score of 6.6, thus tempering the analysis of late results.\n\nBrouwer 2006 performed a prospective randomized trial comparing closing wedge and opening wedge techniques. Closing wedge was secured with two surgical staples and opening wedge with a Puddu plate. After one year, VAS score had improved from 6.1 to 3.6.\n\nVan Outeren 2017 is perhaps the closest attempt to a large randomized control trial between surgery and non-operative management. However, this is still not a highest quality randomized control trial. The researchers gathered two different groups of patients at two different hospitals. The first group underwent randomization to valgus bracing versus usual care. The second group was randomized to HTO with either an opening wedge or closing wedge osteotomy. The groups were matched for baseline characteristics. They found HTO more effective in pain reduction compared to non-operative methods. VAS changed from baseline 6.2 in the surgery group to 3.8 post-op. The control group improved from 6.4 to 5.0. Function was improved only in comparison of surgical patients to usual care treatment.\n\nThe Wu 2017 study evaluated people with bilateral OA with pain around the medial part of the knee. The more degenerative knee got proximal tibial osteotomy, and the other knee got usual non-operative care. The study authors included a table of individual patient data, which allowed a model that controlled for differences in baseline knee society function scores between the knees to be run. With this model, the odds ratio of achieving satisfactory knee society function scores (defined as score >= 80) with osteotomy vs. non-operative treatment was 7.51 (CI 1.094, 51.6).\n\nThe Tibial Osteotomy recommendation has been downgraded one level because of inconsistent evidence.","RecommendationStatus":"may be used","StrengthofRecommendation":"Limited","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Hydroxychloroquine recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Hydroxychloroquine is Not Recommend for hand osteoarthritis PharmacologicTreatment, knee osteoarthritis PharmacologicTreatment or  hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Hydroxychloroquine is Not Recommend for hand osteoarthritis PharmacologicTreatment, knee osteoarthritis PharmacologicTreatment or  hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nWell-designed RCTs of hydroxychloroquine, conducted in the subset of patients with erosive hand OA, have demonstrated no efficacy.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is IACS recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"IACS is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"IACS is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with no comobidities.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is IL-1 inhibitors recommended for Pharmacologic Treatment of  osteoarthritis.","Short_answer":"IL-1 inhibitors is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"IL-1 inhibitors is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n\nThis is a group of agents that block the activity of a pro-inflammatory cytokine, IL-1, which is believed to play a role in inducing cartilage matrix degradation through the up-regulation of proteolytic enzymes.108 The most common IL-1 inhibitors are: • IL-1 receptor antagonist – anakinra • soluble decoy receptor – rilonacept • neutralising monoclonal anti-IL-1β antibody – canakinumab. In addition, a monoclonal antibody directed against the IL-1 receptor, AMG-108 and a neutralising anti-IL-1α or IL-1β antibody, ABT-981 are currently in clinical trials.\nThe percentage of participants reporting adverse events was similar between the placebo and anakinra groups (Appendix 5 of the Guideline for the management of knee and hip osteoarthritis: Technical document). The most common adverse event was arthralgia (10%), with similar rates between anakinra 150 mg and placebo groups, but a lower rate for the anakinra 50 mg group (3%). Headache (10% versus 1%), upper respiratory tract infection (8% versus 1%), back pain (8% versus 3%) and extremity pain (6% versus 0%) occurred more often in the anakinra 150 mg group than in the placebo group. Infections were reported in 10% of participants, more frequently for the anakinra 150 mg group, compared with the anakinra 50 mg or the placebo group.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Low"},{"Guideline specific question":"Is IL-1 Receptor Antagonists recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"IL-1 Receptor Antagonists is Not Recommend for hand osteoarthritis PharmacologicTreatment,  knee osteoarthritis PharmacologicTreatment or hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"IL-1 Receptor Antagonists is Not Recommend for hand osteoarthritis PharmacologicTreatment,  knee osteoarthritis PharmacologicTreatment or hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nInitial observations addressing the use of anti–nerve growth factor (anti-NGF) agents suggest that significant analgesic benefits may occur but that incompletely explained important safety issues may arise. A small subset of patients treated with these agents had rapid joint destruction leading to early joint replacement. The FDA temporarily halted clinical trials of anti-NGF as a result, but trials have since resumed, with ongoing collection of longer-term efficacy and safety data. As none of these agents were approved for use by the FDA and the longer-term data were not available at the time of the literature review and Voting Panel meeting, we are unable to make recommendations regarding the use of anti-NGF therapy.\nTumor necrosis factor inhibitors and interleukin-1 receptor antagonists have been studied in trials using both subcutaneous and intraarticular routes of administration. Efficacy has not been demonstrated, including in erosive hand OA. Therefore, given their known risks of toxicity, we strongly recommended against their use for any form of OA.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Ib"},{"Guideline specific question":"Is Imaging recommended for Imaging Diagnosis of  osteoarthritis.","Short_answer":"Imaging is Not recommended for  osteoarthritis ImagingDiagnosis. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Imaging is Not recommended for  osteoarthritis ImagingDiagnosis. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nThe recommendation is for patients 45 or over and；have activity-related joint pain and；have either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.\nThere was no evidence showing that imaging is beneficial for diagnosing osteoarthritis. The committee agreed that imaging adds little value and that osteoarthritis can be diagnosed by taking a thorough history and doing an examination. The committee agreed that imaging can be useful if atypical features are present that could suggest an alternative or additional diagnosis, such as other inflammatory forms of arthritis (for example, rheumatoid arthritis) and malignancy.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Individualised treatment recommended for Other Treatment of osteoarthritis.","Short_answer":"Individualised treatment is Recommend for Knee osteoarthritis OtherTreatment and hip osteoarthritis OtherTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.","Full_answer":"Individualised treatment is Recommend for Knee osteoarthritis OtherTreatment and hip osteoarthritis OtherTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\n Treatment of hip and\/or knee OA should be individualised according to the wishes and expectations of the individual, localisation of OA, risk factors (such as age, sex, comorbidity, obesity and adverse mechanical factors), presence of inflammation, severity of structural change, level of pain and restriction of daily activities, societal participation and quality of life\nThe task force agreed unanimously that the overarching principle for treatment of a person with hip or knee OA should be individualised, which is in line with previous guidelines. Individualised treatment does not imply that every treatment should be individually provided, it means rather that treatment is personalised, or tailored. RCTs on individualised on pharmacological management are scant. The available studies showed reduced pain (mean difference, 95% CI (0–20 pointscale): −1.19, −2.1 to −0.3 and −1.10, −1.84 to −0.19; and (0–100 scale): −17.0, −23.6 to −10.4) and improved physical function (mean difference, 95% CI (0–68 point scale): 3.65, 1.0 to 6.3 and 3.33, 0.78 to 5.88) compared with usual care,24–26 but not compared with group-based rehabilitation or information on healthy lifestyle. Follow-ups at 9, 18 or 30 months showed no effect on pain. As the data underpinning this recommendation are limited the factors to be considered for the tailoring of management\nwere mainly based on prognostic factors shown in the literature. An important and modifiable risk factor for knee OA is weight, implying individualised targeting at weight reduction in people who are overweight or obese. Moreover, individualised treatment being the standard of care in OA and chronic disease in general was considered to imply informed, shared decision-making, taking into account the person’s wishes and preferences. The group noted that with the conduct of an RCT to study the impact of individualisation, the patient’s view cannot be wholly taken into account and that some element of individualisation will always be incorporated in any treatment. To better understand individualised treatment, the group found that future research should focus on factors that affect outcome—that is, moderators, not individualisation as such.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Ib"},{"Guideline specific question":"Is Information and education recommended for Education\nTreatment of osteoarthritis.","Short_answer":"Information and education is Recommend for Knee osteoarthritis EducationTreatment and hip osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.","Full_answer":"Information and education is Recommend for Knee osteoarthritis EducationTreatment and hip osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\n To be effective, information and education for the person with hip or knee OA should:\na* be individualised according to the person’s illness perceptions and educational capability\nb* be included in every aspect of management\nc† specifically address the nature of OA (a repair process triggered by a range of insults), its causes (especially those\npertaining to the individual), its consequences and prognosis\nd† be reinforced and developed at subsequent clinical encounters;\ne† be supported by written and\/or other types of information (eg, DVD, website, group meeting) selected by the individual\nf† include partners or carers of the individual, if appropriate\n It is grounded in the general recognition that appropriate information and education are indispensable in prompting adequate self-management in chronic diseases. The recommendation is underpinned by the majority of studies on education interventions provided to patients with hip and\/or knee OA. In general, small, but statistically significant effect sizes on pain (0.06, 95% CI 0.02 to 0.10) and physical function (0.06, 95% CI 0.02 to 0.10) have been reported from attending education or self-management programmes.6 66 Lower costs of community-based care and medication up to 12 months has been achieved from attending a combined self-management and exercise programme, and a reduced number of medical consultations from attending self management programmes in patients with hip and\/or knee OA have been reported. The literature review included trials that compared education or self-management programmes with usual care, attention controls or no intervention. These trials described one or several elements from 5c to f (table 2) in their interventions.69–85 The literature did not support the additional value of spouse-assisted coping skills training,79 and no trials were found for individualisation according to illness perception and educational capability, or for inclusion of education in every aspect of management. The group, however, considered the inclusion of spouses in the intervention to be a question of individualisation and appropriate in some cases. One systematic review found that, in people with OA, effective self management interventions followed a protocol, included elements of cognitive behavioural theory or social cognitive theory and were led by trained health professionals. These elements are not specifically dealt with in the recommendation, yet they were supported by the group.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is Insoles, braces, tape, splints or supports recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Insoles, braces, tape, splints or supports is Recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Insoles, braces, tape, splints or supports is Recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nThe committee concluded that there was not enough evidence to support the routine use of insoles, braces, tape, splints or supports. They also noted that there is a potential risk that some of these devices could cause significant adverse events, such as blistering and other pressure damage. The committee acknowledged that research on devices has challenges, such as appropriate sham devices for comparisons.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is interferential therapy  recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Interferential therapy  is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Interferential therapy  is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nAlthough there were many studies on electrotherapy, the findings were inconsistent and mostly showed little benefit. The committee acknowledged that most studies were small, with fewer than 100 participants, and that evidence from direct comparisons of electrotherapy with other interventions was uncertain. The committee agreed there is not enough evidence to recommend electrotherapy for people with osteoarthritis.Extracorporeal shockwave therapy showed some evidence of benefit compared with a sham intervention. However, this evidence was uncertain because of the small trial sizes and challenges in using appropriate sham techniques. The committee agreed that further research using an appropriate sham with more than 53 participants in each study arm is needed and made a recommendation for research on extracorporeal shockwave therapy.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Intra-Articular Botulinum Toxin recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Intra-Articular Botulinum Toxin is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Intra-Articular Botulinum Toxin is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nThe small number of trials of intraarticular botulinum toxin treatment in knee or hip OA suggest a lack of efficacy.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"III"},{"Guideline specific question":"Is Intra-Articular Hyaluronic Acid recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Intra-Articular Hyaluronic Acid is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nIntra-Articular Hyaluronic Acid is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nIntra-Articular Hyaluronic Acid is Not Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nIntra-Articular Hyaluronic Acid is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Intra-Articular Hyaluronic Acid is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with and without comorbidities.\nThe use of intra-articular corticosteroids (IACS) and hyaluronan (IAHA) were conditionally recommended in individuals with knee OA in all groups. A Good Clinical Practice Statement applying to intra_x005f_x005f_x005f_x005f_x0002_articular (IA) treatments for all comorbidity subgroups was added, noting that intra-articular corticosteroid (IACS) may provide short term pain relief, whereas Intra-articular hyaluronic acid (IAHA) may have beneficial effects on pain at and beyond 12 weeks of\ntreatment and a more favorable long-term safety profile than\nrepeated IACS.\nIntra-Articular Hyaluronic Acid is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nIn clinical practice, the choice to use hyaluronic acid injections in the knee OA patient who has had an inadequate response to nonpharmacologic therapies, topical and oral NSAIDs, and intraarticular steroids may be viewed more favorably than offering no intervention, particularly given the impact of the contextual effects of intraarticular hyaluronic acid injections\nn prior systematic reviews, apparent benefits of hyaluronic acid injections in OA have been reported. These reviews have not, however, taken into account the risk of bias of the individual pri_x0002_mary studies. Our review showed that benefit was restricted to the studies with higher risk of bias: when limited to trials with low risk of bias, meta-analysis has shown that the effect size of hyal_x0002_uronic acid injections compared to saline injections approaches zero (37). The finding that best evidence fails to establish a benefit, and that harm may be associated with these injections, motivated the recommendation against use of this treatment.\n\nIntra-Articular Hyaluronic Acid is Not Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nn prior systematic reviews, apparent benefits of hyaluronic acid injections in OA have been reported. These reviews have not, however, taken into account the risk of bias of the individual pri_x0002_mary studies. Our review showed that benefit was restricted to the studies with higher risk of bias: when limited to trials with low risk of bias, meta-analysis has shown that the effect size of hyal_x0002_uronic acid injections compared to saline injections approaches zero (37). The finding that best evidence fails to establish a benefit, and that harm may be associated with these injections, motivated the recommendation against use of this treatment.\n\nIntra-Articular Hyaluronic Acid is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\nIn contrast, the evidence of lack of benefit is of higher quality with respect to hyaluronic acid injection in the hip. We therefore strongly recommend against hyaluronic acid injec_x0002_tions in hip OA\nn prior systematic reviews, apparent benefits of hyaluronic acid injections in OA have been reported. These reviews have not, however, taken into account the risk of bias of the individual pri_x0002_mary studies. Our review showed that benefit was restricted to the studies with higher risk of bias: when limited to trials with low risk of bias, meta-analysis has shown that the effect size of hyal_x0002_uronic acid injections compared to saline injections approaches zero (37). The finding that best evidence fails to establish a benefit, and that harm may be associated with these injections, motivated the recommendation against use of this treatment.","RecommendationStatus":"Not recommend\/Recommend","StrengthofRecommendation":"Conditional\/Strong","CertaintyofEvidence":"Not specified\/Ia"},{"Guideline specific question":"Is Intra-articular treatment recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Intra-articular treatment is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"Intra-articular treatment is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with and without comorbidities.\nThe use of intra-articular corticosteroids (IACS) and hyaluronan (IAHA) were conditionally recommended in individuals with knee OA in all groups. A Good Clinical Practice Statement applying to intra_x005f_x005f_x005f_x005f_x0002_articular (IA) treatments for all comorbidity subgroups was added, noting that intra-articular corticosteroid (IACS) may provide short term pain relief, whereas Intra-articular hyaluronic acid (IAHA) may have beneficial effects on pain at and beyond 12 weeks of\ntreatment and a more favorable long-term safety profile than\nrepeated IACS.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Iontophoresis recommended for Physical Treatment of osteoarthritis.","Short_answer":"Iontophoresis is Not Recommend for hand osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Iontophoresis is Not Recommend for hand osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nThere are no published RCTs evaluating iontophoresis for OA in any anatomic location.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"III"},{"Guideline specific question":"Is kinesio taping recommended for Other Physical Treatment of osteoarthritis.","Short_answer":"Kinesio taping is Not Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nKinesio taping is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nKinesio taping is Not Recommend for Hip osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n\nKinesio taping is Recommend for Hand osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Kinesio taping is Not Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nDifferent forms of taping are available, generally as a self-management strategy. Patellar taping uses rigid tape that aims to create a mechanical realignment of the patella in the trochlear groove in order to reduce pain and improve function. Kinesio taping uses non-rigid tape that is applied in various configurations; it is purported to offer support and stability to muscles and joints, and to stimulate somatosensory receptors.\nThe side effects are minor, and include skin irritation from the tape.\nKinesio taping is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\nKinesiotaping permits range of motion of the joint to which it is applied, in contrast to a brace, which maintains the joint in a fixed position. P\nPublished studies have examined various products and methods of application, and blinding with regard to use is not possible, thereby limiting the quality of the evidence.\n\nKinesio taping is Not Recommend for Hip osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nDifferent forms of taping are available, generally as a self-management strategy. Patellar taping uses rigid tape that aims to create a mechanical realignment of the patella in the trochlear groove in order to reduce pain and improve function. Kinesio taping uses non-rigid tape that is applied in various configurations; it is purported to offer support and stability to muscles and joints, and to stimulate somatosensory receptors.\nThe side effects are minor, and include skin irritation from the tape\n\nKinesio taping is Recommend for Hand osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nKinesiotaping permits range of motion of the joint to which it is applied, in contrast to a brace, which maintains the joint in a fixed position. P\nPublished studies have examined various products and methods of application, and blinding with regard to use is not possible, thereby limiting the quality of the evidence.","RecommendationStatus":"Not Recommend\/Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low\/Ia"},{"Guideline specific question":"Is \"Land-based exercise is recommendated to improve pain and function, regardless of their age, structural disease severity, functional status or pain levels in the treatment of osteoarthritis\"\nrecommended for Exercise Treatment of osteoarthritis.","Short_answer":"\"Land-based exercise is recommendated to improve pain and function, regardless of their age, structural disease severity, functional status or pain levels in the treatment of osteoarthritis\" is Recommend for Knee osteoarthritis ExerciseTreatment and  Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"\"Land-based exercise is recommendated to improve pain and function, regardless of their age, structural disease severity, functional status or pain levels in the treatment of osteoarthritis\" is Recommend for Knee osteoarthritis ExerciseTreatment and  Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nClinicians should prescribe an individualised exercise program, taking into account the person’s preference, capability, and the availability of resources and local facilities. Realistic goals should be set. Dosage should be progressed with full consideration \ngiven to the frequency, duration and intensity of exercise \nsessions, number of sessions, and the period over which \nsessions should occur.\nThis recommendation is specific to exercise performed on land for people with knee OA, including muscle strengthening, stretching\/range of motion, aerobic conditioning, neuromuscular\/balance, cycling, Tai Chi and yoga. Exercise dosage can vary in frequency, intensity and duration. Additionally, the exercise can involve expensive, specialised equipment, or no equipment at all; it can be delivered in a group setting or individually, either in-person or remotely via telephone or videoconference.\nThere is a very low likelihood of serious adverse effects; most are minor and include temporary increased pain at the affected joint or pain at other sites.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Low\/Moderate"},{"Guideline specific question":"Is laser therapy  recommended for Physical Treatment of  osteoarthritis.","Short_answer":"laser therapy  is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"laser therapy  is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nAlthough there were many studies on electrotherapy, the findings were inconsistent and mostly showed little benefit. The committee acknowledged that most studies were small, with fewer than 100 participants, and that evidence from direct comparisons of electrotherapy with other interventions was uncertain. The committee agreed there is not enough evidence to recommend electrotherapy for people with osteoarthritis.Extracorporeal shockwave therapy showed some evidence of benefit compared with a sham intervention. However, this evidence was uncertain because of the small trial sizes and challenges in using appropriate sham techniques. The committee agreed that further research using an appropriate sham with more than 54 participants in each study arm is needed and made a recommendation for research on extracorporeal shockwave therapy.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Lateral wedged insoles recommended for Other Physical Treatment of osteoarthritis.","Short_answer":"Lateral wedged insoles is Not Recommend for Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nLateral wedged insoles is Not Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nLateral wedge insoles is Not Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nLateral wedge insoles is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Lateral wedged insoles is Not Recommend for Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nThe currently available literature does not demonstrate clear efficacy of lateral or medial wedged insoles.\n\nLateral wedged insoles is Not Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\nThe currently available literature does not demonstrate clear efficacy of lateral or medial wedged insoles.\nLateral wedge insoles is Not Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nLateral wedge insoles are higher on the lateral side (and may include a subtalar strapping component), shifting weight toward the lateral tibiofemoral compartment, and are applicable for those with medial compartment tibiofemoral OA and varus deformity. Shock-absorbing insoles are made of a material that aims to absorb impact loading during walking. Arch supports are insoles designed to support and realign the foot.\nThere is a low likelihood of adverse effects.\nLateral wedge insoles is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nAlthough lateral heel wedges had historical support for their use in knee arthritis, contemporary studies have not shown a reliable improvement in pain relief, and no contemporary studies have shown sufficient functional improvement for patients suffering from knee arthritis to recommend using lateral wedge insoles. Lateral heel wedges can be prepared as an insert for the heel alone, or included in the heel of an independent arch support (i.e. lateral heel wedge arch support of LWAS) or built into the shoe itself (as was used by Hinman et al 2016). In the arthritic knee, medial compartment compression forces are commonly increased, especially in the knee with varus tibiofemoral alignment. The knee adduction moment can be calculated by gait analysis. The lateral wedge is thought to change the knee adduction moment thus relieving medial compartment pressure, hence relieving arthritic pain.\nOur literature review screening culled several papers for analysis. Baker and Goggins 2007 was a high-quality study finding no important differences between insole and wedged insole. 90 patients were randomized to one treatment for 6 weeks followed by a 4-week washout period and then the opposite treatment. There were no major differences in pain during either phase of the study. More musculoskeletal symptoms and more blisters occurred with neutral insoles. No patient falls were attributed to the treatment alternatives.\nFelson and Parke 2019 prescreened patients to eliminate those with patellofemoral OA and biomechanical non-responders. Lateral wedge insoles reduced knee pain, but the effect of treatment was small and was considered likely of clinical significance in only a minority of patients. 21 of 83 of patients did not show sufficient biomechanical correction. Only 28% of patients in the active phase of treatment had minimally important improvement whereas 22% of patients wearing neutral insoles reached the same level of improvement. 2 patients stopped treatment while wearing lateral wedge insoles (calf pain at night and increased knee pain) and 2 stopped while wearing neutral insoles (toe blister and increased knee pain). They also looked at volume of arthritic bone marrow lesions (BML) found by MRI and saw no significant difference in BML change between study and control groups.\nIn Bennell 2011, 89 patients with mild to moderate knee arthritis completed follow up with lateral insoles worn daily for 12 months. 90 patients completed follow up as the control group wearing neutral insoles. Pain relief after 12 months showed no significant difference between the groups.\nIn Hsieh 2016, 90 patients with Kellgren-Lawrence Grade 2 or higher radiographic changes were randomized to either a rigid insole with lateral wedge arch support (LWAS) or a soft insole with lateral wedge. Dropout rate was 20% with rigid and 15.6% with soft insoles over the 3-month long study. They concluded that patients using the soft insole LWAS had improved pain and function. However, their primary data suggests better walking time and speed going up and down stairs with rigid LWAS.\nFurthermore, pain was improved with soft LWAS only at the 3-month mark. Authors suggested longer-term follow-up for soft insoles.\nHinman 2016 evaluated an unloading shoe with stiff lateral midsole and 5-degree lateral wedge insole in comparison to a standard walking shoe. 164 patients were enrolled with 96% retention during the 6 months study. 83 patients received the unloading shoes and the control shoes. 14 of 83 stopped wearing the unloading shoes for various reasons and 8 of 81 stopped wearing the control shoes. 160 completed primary outcome measures at 6 months. There was no significant difference between groups with regard to pain or function, although both groups did show improvement.\n20% of participants with the study shoes reported ankle and foot pain whereas 9% of control shoe participants did so. There was no difference in the reason to discontinue treatment (unloading shoe 4% versus 2% control). Other reported adverse events were back pain, hip pain, knee pain, knee stiffness\/swelling, and shin\/calf pain. 2 of 83 experimental group patients reported an increase in knee pain with the unloading shoe and 2 of 81 control patients reported that the conventional shoe did not relieve knee pain.\nToda 2004 followed 84 knee female arthritis patients were followed for one month wearing either a hard rubber insole or urethane insole secured to the foot with a subtalar strap used for ankle sprains. 12 mm lateral wedge was manufactured for both. 17 of the 42 rubber insole patients had complications (foot pain in 8; popliteal pain in 6; low back pain in 3) versus 8 of the 42 using urethane insoles (popliteal pain in 4; foot pain in 3; low back pain in 1). All patients improved by the Lequesne Index with the urethane group achieving statistically significant improvement.\nNiazi 2014 was a comparison of off-loading knee brace versus lateral wedge insole. 120 patients with both radiographic medial compartment arthritis and gene varum were randomized to either knee brace or lateral wedge insole. Pain improvement with the knee brace group was statistically significant compared to the lateral wedge insole, but clinically minor (VAS 3.97 in the study group compared to 4.53 in controls).\nIn Hatef 2013, 118 of 150 patients completed the 2-month long study (101 women and 17 men). Half were given LWAS, and the control group wore neutral insoles. Patient compliance was much worse in the LWAS group. They noted statistically significant decline in knee pain and EKFS in women in the LWAS, but not men. Overall, there was improvement in the LWAS group. There was a much higher non-compliance rate in the LWAS than with the neutral insoles with 29 of 57 patients stopping use of the insoles by weeks 5 to 6 of an 8-week study.\nWe identified one potential study within our literature which addressed the question of special shoe versus a conventional shoe. Nigg 2006 evaluated a training shoe which purports to convert a flat hard surface into “natural uneven ground”, thus prompting increased muscle activity in the lower extremity. The control shoe was a standard walking shoe. 58 patients were enrolled in the study group and 67 in the control group. Both groups had one patient drop out (cumbersome shoes in the study group and increased knee pain with the control shoe). Pain with walking was improved at 12 weeks in both groups, without between groups difference. The study shoe showed increased pain relief at 3, 6, and 12 weeks. The control shoe showed increased pain relief at 3 and 12 weeks. They also reported improved balance from baseline in the study shoe at 12 weeks, which was not statistically significant.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional\/Strong","CertaintyofEvidence":"Ia\/Very low\/Not specified"},{"Guideline specific question":"Is Medial wedged insoles recommended for Physical Treatment of osteoarthritis.","Short_answer":"Medial wedged insoles is Not Recommend for Hip osteoarthritis PhysicalTreatment or Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Medial wedged insoles is Not Recommend for Hip osteoarthritis PhysicalTreatment or Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nThe currently available literature does not demonstrate clear efficacy of lateral or medial wedged insoles.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is Lifestyle changes if needed recommended for Other Treatment of osteoarthritis.","Short_answer":"Lifestyle changes if needed is Recommend for Knee osteoarthritis OtherTreatment and  hip osteoarthritis OtherTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.","Full_answer":"Lifestyle changes if needed is Recommend for Knee osteoarthritis OtherTreatment and  hip osteoarthritis OtherTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\nWhen lifestyle changes are recommended, people with hip or knee OA should receive an individually tailored programme, including long-term and short-term goals, intervention or action plans, and regular evaluation and follow-up with possibilities for adjustment of the programme\n It is known that behavioural changes are difficult to achieve\nand maintain, and the effect of advice and counselling by healthcare providers is disappointing.56 The literature search for this recommendation was limited to lifestyle changes considered most relevant for hip and knee OA—that is, exercise and weight loss. The common feature in the trials supporting this recommendation was to teach and encourage behavioural change strategies through goal setting of physical activity and weight changes, action plans to maintain changes and regular follow-up over at least 1 year to re-evaluate and discuss goals and action plans. Reports examining the effectiveness of specific elements to be included in interventions aiming to change behaviour are scarce. The literature suggests that the following factors improve adherence to exercise or physical activity: individual exercise, graded activity, individualisation according to the person’s exercise goals, feedback on progress made towards the goals, iterative problem solving with emphasis on skills that will improve adherence, reinforcements of maintaining exercise such as additional motivational programmes, exercise plans and log books, written information and audiotape or videotape, and booster sessions. In addition, some studies found an effect on pain or function59 from lifestyle interventions that integrate such elements. A systematic review including a mixed population of people with OA and\/or rheumatoid arthritis found effect sizes of 0.21 (95% CI 0.08 to 0.34) for pain and 0.69 (95% CI 0.49 to 0.88) for increased physical activity from lifestyle interventions aiming at increasing physical activity.64 Over 40% of the included lifestyle interventions prompted problem solving, self-monitoring, goal setting and\nregular feedback. For people with knee OA or knee pain, improvements were seen in pain, function and weight loss from diet interventions that included individual weight-loss goals, problem solving on how to reach these goals and follow-up visits to re-evaluate and discuss goals in combination with exercise. In obese patients, weight-loss programmes with explicit weight-loss goals showed a higher mean change in weight than pro grammes without explicit goals. This indicates that the elements in recommendation 4 are important for the change and long-term maintenance of behaviour. The group discussed the importance of regular follow-up that includes feedback on the progress towards explicit goals and extends over a long time to achieve long-term effects of a healthy lifestyle.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Ib"},{"Guideline specific question":"Is local cold application (eg ice packs) recommended for Physical\nTreatment of osteoarthritis.","Short_answer":"Local cold application (eg ice packs) is Not Recommend for Knee osteoarthritis PhysicalTreatment or Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Local cold application (eg ice packs) is Not Recommend for Knee osteoarthritis PhysicalTreatment or Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nCold therapy is the local application of cold via techniques (eg ice packs). It aims to reduce swelling, muscle spasm and pain\nWhile no adverse events have been identified in trials of cold therapy in people with knee OA, there is emerging clinical evidence that individuals with symptomatic knee OA may experience cold hyperalgesia,86,87 suggesting therapeutic use of cold may be unhelpful.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is local heat therapy (eg hot packs) as a self-management home strategy recommended for Other Treatment of osteoarthritis.","Short_answer":"Local heat therapy (eg hot packs) as a self-management home strategy is Recommend for Knee osteoarthritis OtherTreatment and Hip osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Local heat therapy (eg hot packs) as a self-management home strategy is Recommend for Knee osteoarthritis OtherTreatment and Hip osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nSuperficial heat can be applied via the use of hot packs or hot water bottles. Heat therapy is purported to relieve muscle tension and soreness, and improve blood flow.\nThere are no adverse effects reported. However, individuals should be warned about the risks of burns and heat therapy may not be suitable in those with compromised sensation.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is manual therapy recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Manual therapy is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nManual therapy is Recommended for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nManual therapy is Not Recommend for hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nManual therapy is Recommended for hip osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nManual therapy is Recommended for shoulder osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Manual therapy is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nManual therapy techniques may include manual lymphatic drainage, manual traction, massage, mobilization\/manipulation, and passive range of motion and are always used in conjunction with exercise\n A limited number of studies have addressed manual ther apy added to exercise versus exercise alone in hip and knee OA. \nAlthough manual therapy can be of benefit for certain conditions, such as chronic low back pain, limited data in OA show little addi tional benefit over exercise alone for managing OA symptoms.\nManual therapy is Recommended for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nalongside therapeutic exercise. Not enough evidence to support its use alone for managing osteoarthritis\nThe committee acknowledged recent evidence that showed some clinical benefits of manual therapy for hip and knee osteoarthritis, with no evidence being identified for other joint sites. However, the benefits were stronger if manual therapy was combined with exercise. Clinical and economic evidence showed that exercise alone was more effective than both manual therapy alone and the combination of manual therapy and exercise. So, the committee concluded that manual therapy should only be considered alongside therapeutic exercise. Most studies provided therapy for less than 3 months and on average for 7 weeks. The committee agreed that the duration of manual therapy would be similar, but would vary according to the person's needs. They agreed that further research was needed, in particular evidence from well-powered, high-quality studies with adequate blinding and on other osteoarthritis-affected joints.\n\n\nManual therapy is Not Recommend for hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative\n studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nManual therapy techniques may include manual lymphatic drainage, manual traction, massage, mobilization\/manipulation, and passive range of motion and are always used in conjunction with exercise\nA limited number of studies have addressed manual ther apy added to exercise versus exercise alone in hip and knee OA. \nAlthough manual therapy can be of benefit for certain conditions, such as chronic low back pain, limited data in OA show little addi tional benefit over exercise alone for managing OA symptoms.\nManual therapy is Recommended for hip osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nalongside therapeutic exercise. Not enough evidence to support its use alone for managing osteoarthritis\nThe committee acknowledged recent evidence that showed some clinical benefits of manual therapy for hip and knee osteoarthritis, with no evidence being identified for other joint sites. However, the benefits were stronger if manual therapy was combined with exercise. Clinical and economic evidence showed that exercise alone was more effective than both manual therapy alone and the combination of manual therapy and exercise. So, the committee concluded that manual therapy should only be considered alongside therapeutic exercise. Most studies provided therapy for less than 3 months and on average for 7 weeks. The committee agreed that the duration of manual therapy would be similar, but would vary according to the person's needs. They agreed that further research was needed, in particular evidence from well-powered, high-quality studies with adequate blinding and on other osteoarthritis-affected joints.\n\nManual therapy is Recommended for shoulder osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nalongside therapeutic exercise. Not enough evidence to support its use alone for managing osteoarthritis\nThe committee acknowledged recent evidence that showed some clinical benefits of manual therapy for hip and knee osteoarthritis, with no evidence being identified for other joint sites. However, the benefits were stronger if manual therapy was combined with exercise. Clinical and economic evidence showed that exercise alone was more effective than both manual therapy alone and the combination of manual therapy and exercise. So, the committee concluded that manual therapy should only be considered alongside therapeutic exercise. Most studies provided therapy for less than 3 months and on average for 7 weeks. The committee agreed that the duration of manual therapy would be similar, but would vary according to the person's needs. They agreed that further research was needed, in particular evidence from well-powered, high-quality studies with adequate blinding and on other osteoarthritis-affected joints.","RecommendationStatus":"Not Recommend\/Recommend","StrengthofRecommendation":"Conditional\/Not specified","CertaintyofEvidence":"III\/Not specified"},{"Guideline specific question":"Is Manual therapy in addition to an exercise program recommended for Physical Treatment of osteoarthritis.","Short_answer":"Manual therapy in addition to an exercise program is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Manual therapy in addition to an exercise program is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nManual therapy consists of maneuvers applied with manual force from the treating therapist to the patient’s body to improve joint mobility and\/or relieve pain. The techniques may generally consist of manually applied joint mobilization techniques, manually applied joint range of motion and\/or muscle stretching, and soft tissue massage. One high-quality study (Fitzgerald 2016) and one moderate-quality study (Deyle 2000) were reviewed that examined manual therapy combined with exercise compared to exercise alone (Fitzgerald 2016) or non-therapeutic ultrasound (placebo physical therapy) in subjects with knee osteoarthritis (Deyle 2000). Fitzgerald, et al, reported that both groups yielded significant improvements in clinical outcomes from baseline, but the manual therapy group had greater improvements in the WOMAC total score and were more likely to meet the OMERACT-OARSI Responder Criteria at the 9-week follow-up (Fitzgerald 2016). While both groups demonstrated sustained improvements in clinical outcomes at 1 year, there was no difference between groups on any measures at this timepoint. Deyle et al. reported similar findings with the manual therapy and exercise group demonstrating greater improvements at 8 weeks but no significant differences between groups at 1 year (Deyle 2000).\n\nThe Manual Therapy recommendation has been downgraded one level because of inconsistent evidence and lack of internal consistency with recommendations of equal supporting evidence.","RecommendationStatus":"may be used","StrengthofRecommendation":"limited","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is massage therapy recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Massage therapy is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nMassage therapy is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nMassage therapy is Not Recommend for hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nMassage therapy is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Massage therapy is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nMassage therapy encompasses a number of techniques aimed at affecting muscle and other soft tissue\nPatient participants on the Patient and Voting Panels noted that some studies have shown positive outcomes and minimal risk and felt strongly that massage therapy was beneficial for symptom management.\nMassage therapy is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nThis should be considered only as an adjunctive treatment to enable engagement with active management strategies, and only for short term, cognisant of issues related to cost and access.\n\nMassage therapy is Not Recommend for hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nMassage therapy is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nThis should be considered only as an adjunctive treatment to enable engagement with active management strategies, and only for short term, cognisant of issues related to cost and access.","RecommendationStatus":"Not Recommend\/Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Ib\/Low"},{"Guideline specific question":"Is Methotrexate recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Methotrexate is Not Recommend for hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nMethotrexate is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nMethotrexate is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nMethotrexate is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nMethotrexate is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Methotrexate is Not Recommend for hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nWell-designed RCTs of methotrexate, conducted in the subset of patients with erosive hand OA, have demonstrated no efficacy.\n\nMethotrexate is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nMethotrexate is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nMethotrexate is a chemotherapy agent and immune system suppressant, which is commonly used to treat cancer and autoimmune diseases (eg rheumatoid arthritis, psoriasis). For treating inflammatory arthritis, multiple mechanisms appear to be involved, including the inhibition of: • enzymes involved in purine metabolism, leading to accumulation of adenosine • T-cell activation and suppression of intercellular adhesion molecule expression by T-cells • methyltransferase activity, leading to deactivation of enzyme activity relevant to immune system function\nThe side effects of methotrexate can include gastrointestinal side effects, haematological abnormalities and elevated liver transaminases. Side effects resulting in discontinuation of the drug vary in frequency from 15% to 17%, but have been shown to reduce to 4% in the second year of treatment.\n\nMethotrexate is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nMethotrexate is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nMethotrexate is a chemotherapy agent and immune system suppressant, which is commonly used to treat cancer and autoimmune diseases (eg rheumatoid arthritis, psoriasis). For treating inflammatory arthritis, multiple mechanisms appear to be involved, including the inhibition of: • enzymes involved in purine metabolism, leading to accumulation of adenosine • T-cell activation and suppression of intercellular adhesion molecule expression by T-cells • methyltransferase activity, leading to deactivation of enzyme activity relevant to immune system function\nThe side effects of methotrexate can include gastrointestinal side effects, haematological abnormalities and elevated liver transaminases. Side effects resulting in discontinuation of the drug vary in frequency from 15% to 17%, but have been shown to reduce to 4% in the second year of treatment","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional\/Strong","CertaintyofEvidence":"Ia\/Low"},{"Guideline specific question":"Is Mind-body Exercise recommended for Exercise\nTreatment of osteoarthritis.","Short_answer":"Mind-body Exercise is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"Mind-body Exercise is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with and without comorbidities.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is modified shoes recommended for Physical Treatment of osteoarthritis.","Short_answer":"Modified shoes is Not Recommend for knee osteoarthritis PhysicalTreatment or  hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Modified shoes is Not Recommend for knee osteoarthritis PhysicalTreatment or  hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nModifications to shoes can be intended to alter the bio_x005f_x005f_x0002_mechanics of the lower extremities and the gait. While optimal footwear is likely to be of considerable importance for those with knee and\/or hip OA, the available studies do not define the best type of footwear to improve specific outcomes for knee or hip OA.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"III"},{"Guideline specific question":"Is Neuromuscular electrical stimulation (NMES) recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Neuromuscular electrical stimulation (NMES) is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Neuromuscular electrical stimulation (NMES) is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nAlthough there were many studies on electrotherapy, the findings were inconsistent and mostly showed little benefit. The committee acknowledged that most studies were small, with fewer than 100 participants, and that evidence from direct comparisons of electrotherapy with other interventions was uncertain. The committee agreed there is not enough evidence to recommend electrotherapy for people with osteoarthritis.Extracorporeal shockwave therapy showed some evidence of benefit compared with a sham intervention. However, this evidence was uncertain because of the small trial sizes and challenges in using appropriate sham techniques. The committee agreed that further research using an appropriate sham with more than 56 participants in each study arm is needed and made a recommendation for research on extracorporeal shockwave therapy.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Neuromuscular training in combination with traditional exercise recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Neuromuscular training in combination with traditional exercise is Recommend for knee osteoarthritis ExerciseTreatment. The strength of recommendation is moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Neuromuscular training in combination with traditional exercise is Recommend for knee osteoarthritis ExerciseTreatment. The strength of recommendation is moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nThree high-quality studies (Fitzgerald 2011, Gomiero 2018, Apparao 2017) and two moderate-quality studies (Bennell 2014 and Diracoglu 2005) comparing neuromuscular training combined with traditional strength and joint mobility exercise programs to strength and joint mobility exercise alone were reviewed. There were no differences in knee pain reported between groups in any of the studies. There were mixed results on function measures with two studies reporting greater improvements in self-reported function (Apparao 2017, Diracoglu 2005) and two studies reporting greater improvements in walking speed (Bennell 2014, Diracoglu 2005) for the neuromuscular training group. \n\nThe Neuromuscular training recommendation has been downgraded one level because of inconsistent evidence.","RecommendationStatus":"Recommend","StrengthofRecommendation":"moderate","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Non-selective NSAID and PPI recommended for Treatment of  osteoarthritis.","Short_answer":"Non-selective NSAID and PPI is Recommend for Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"Non-selective NSAID and PPI is Recommend for Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with gastrointestinal comorbidities.\nFor individuals with GI comorbidities, selective COX-2 inhibitors and non-selective NSAIDs in combination with a PPI were conditionally recommended due to their benefits on pain and functional outcomes, but more importantly, because they have a\nmore favorable upper GI safety profile than non-selective NSAIDs.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional\/Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Non-selective NSAIDs recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Non-selective NSAIDs is Recommend for Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"Non-selective NSAIDs is Recommend for Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with widespread pain\/depression.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional\/Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Non-Tramadol Opioids recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Non-Tramadol Opioids is Not Recommend for Hand osteoarthritis PharmacologicTreatment, knee osteoarthritis PharmacologicTreatment and hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Non-Tramadol Opioids is Not Recommend for Hand osteoarthritis PharmacologicTreatment, knee osteoarthritis PharmacologicTreatment and hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nAs noted above, evidence suggests very modest benefits of long-term opioid therapy and a high risk of toxicity and depen_x005f_x005f_x0002_dence. Use of the lowest possible doses for the shortest possible length of time is prudent, particularly since a recent systematic review and meta-analysis suggests that less pain relief occurs dur_x0002_ing longer trials in the treatment of non-cancer chronic pain.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is Electrotherapy treatments recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Electrotherapy treatments is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Electrotherapy treatments is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nAlthough there were many studies on electrotherapy, the findings were inconsistent and mostly showed little benefit. The committee acknowledged that most studies were small, with fewer than 100 participants, and that evidence from direct comparisons of electrotherapy with other interventions was uncertain. The committee agreed there is not enough evidence to recommend electrotherapy for people with osteoarthritis.Extracorporeal shockwave therapy showed some evidence of benefit compared with a sham intervention. However, this evidence was uncertain because of the small trial sizes and challenges in using appropriate sham techniques. The committee agreed that further research using an appropriate sham with more than 50 participants in each study arm is needed and made a recommendation for research on extracorporeal shockwave therapy.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is omega-3 fatty acids recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Omega-3 fatty acids is Not Recommend for Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Omega-3 fatty acids is Not Recommend for Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nOmega-3 polyunsaturated fatty acids are mainly produced by marine organisms (eg oil from whole fish, seal, mussels). This is widely available, and the usage is generally varied by region and disease (usual dose is 1–2 g\/day)\nSide effects are usually minor and uncommon","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is Oral acetaminophen  recommended for Pharmacological Treatment of osteoarthritis.","Short_answer":"Oral acetaminophen  is Recommend for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Oral acetaminophen  is Recommend for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nOral acetaminophen is recommended to improve pain and function in the treatment of knee osteoarthritis when not contraindicated.\nAmong the 4 high-quality and 3 moderate quality studies that met the inclusion criteria, oral acetaminophen consistently improved pain and function compared to controls in the treatment of osteoarthritis of the knee (Herrero-Beaumont 2007; Doherty 2011; Reed 2018; Prior 2014; Micelli 2004; Pincus 2004; Altman 2007). The meta-analysis of oral acetaminophen compared to controls demonstrated a meaningful reduction in pain and improved function with no evidence of confounding heterogeneity. Overall, acetaminophen is considered a safe medication with no evidence of significantly increased adverse events among the included studies. However, the United States FDA has a black-box warning for acetaminophen secondary to concern of overdose leading to hepatotoxicity or death. When oral acetaminophen was compared to NSAIDs, the use of oral NSAIDs provided a significant reduction in pain and improved function. As a result, providers may consider using oral NSAIDs instead of acetaminophen when a contraindication to oral NSAIDs does not exist in the patient.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Oral narcotics, including tramadol recommended for Pharmacological Treatment of osteoarthritis.","Short_answer":"Oral narcotics, including tramadol is Not Recommend for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Oral narcotics, including tramadol is Not Recommend for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nOral narcotics, including tramadol, result in a significant increase of adverse events and are not effective at improving pain or function for treatment of osteoarthritis of the knee.\nAmong the 5 high-quality and 2 moderate quality studies that met the inclusion criteria, oral narcotic medications are not an effective treatment to reduce pain and improve function in osteoarthritis of the knee (Serrie 2017; Afilalo 2010; Mayorga 2016; Fishman 2007; Fleischmann 2001; Burch 2007; Babul 2004). In fact, the use of narcotics to treat osteoarthritis of the knee is consistently associated with a significantly high risk of adverse events. Due to the lack of efficacy and increase of adverse event, we would recommend against the use of narcotics for the treatment of osteoarthritis of the knee. Given the effective and relatively safe alternatives of oral NSAIDs and acetaminophen, oral narcotics should be avoided when the provider is considering the recommendation of an oral medication.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Oral nonsteroidal antiinflammatory drugs recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Oral nonsteroidal antiinflammatory drugs is Recommend for Hand osteoarthritis PharmacologicTreatment, Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Oral nonsteroidal antiinflammatory drugs is Recommend for Hand osteoarthritis PharmacologicTreatment, Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nOral NSAIDs are the initial oral medication of choice in the treatment of OA, regardless of anatomic location, and are recommended over all other available oral medications.\nA large number of trials have established their short-term efficacy.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is oral NSAIDs recommended for Pharmacological Treatment of  osteoarthritis.","Short_answer":"Oral NSAIDs is Recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nOral NSAIDs is Recommend for Knee osteoarthritis PharmacologicTreatment and  Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n\nOral NSAIDs is Recommend for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Oral NSAIDs is Recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nOral NSAIDs were found to be cost effective and evidence showed they slightly reduced pain and increased physical function. The committee acknowledged the Medicines and Healthcare products Regulatory Agency (MHRA) safety warnings on NSAIDs for cardiovascular safety, renal safety and gastrointestinal risk. They agreed that NSAIDs, as well as other pharmacological treatments for osteoarthritis, should be used for as short a time as possible and that the potential harms for gastrointestinal, cardiovascular, liver and kidney adverse events should be carefully considered when prescribing. Evidence showed that adding gastroprotection can reduce gastrointestinal bleeding or perforation. However, this was associated with an increase in cardiovascular adverse events compared with oral NSAIDs alone. The committee agreed that this may be unrelated to the addition of gastroprotection and that randomised controlled trial evidence alone may not be the best source for safety evidence, because the population size and length of follow-up are usually limited. Therefore, they also used their clinical experience and guidance from other organisations, including the MHRA. Based on this, the committee agreed that use of gastroprotection should be offered with NSAIDs.\n\nOral NSAIDs is Recommend for Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nIt might be reasonable to trial oral NSAIDs at the lowest effective dose for a short period, then discontinue use if not effective. Clinicians also need to inform individuals about, monitor and capture adverse events, especially gastrointestinal, renal and cardiovascular, which may be associated with use of NSAIDs.\nNSAIDs are anti-inflammatory and analgesic agents commonly used for OA. NSAIDs are effective anti-inflammatory and analgesic drugs by virtue of their ability to inhibit biosynthesis of PGs at the level of the COX. It is thought that inhibiting COX-2 leads to the anti-inflammatory, analgesic and antipyretic effects, and those NSAIDs also inhibiting COX-1 may cause gastrointestinal bleeding and ulcers in large doses\nThe potential harms of NSAIDs are well recognised, and include gastrointestinal, renal and cardiovascular adverse effects. Older persons, who are at higher risk for OA, may also be at higher risk of adverse effects from NSAIDs, so this class of medication should be used with caution. Formal estimation of cardiovascular risk may be worthwhile using a validated tool (eg www.cvdcheck.org.au). In individuals at low absolute risk of harms, a judicious trial of NSAIDs may be considered, aiming for the lowest effective dose. Co-prescription of a proton-pump inhibitor (PPI) or the use of a COX-2 inhibitor should be considered in people at risk of gastrointestinal adverse effects. The balance of benefits and risks may vary between NSAIDs and between individuals; however, no particular drug is likely to be superior to others, nor is any NSAID free from the potential for harm.\n\n\n\noral NSAIDs is Recommend for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nOral NSAIDs are recommended to improve pain and function in the treatment of knee osteoarthritis when not contraindicated.\nAmong the 34 high-quality, 23 moderate-quality, and 1 low-quality studies that met the inclusion criteria, non-selective and selective cyclooxygenase-2 (COX-2) oral nonsteroidal anti-inflammatory drugs (NSAIDs) consistently improved pain and function compared to controls in the treatment of osteoarthritis of the knee (Reginster 2017; Lee 2017; Gordo 2017; Strand 2017; Essex 2014; Kongtharvonskul 2016; Altman 2015; Gibofsky 2014; Ishijima 2014; Conaghan 2013; Essex 2012; Singh 2012; Elsaman 2016; Schnitzer 2011; Kivitz 2004; Fleischmann 1997; Lee 1986; Davies 1999; Sandelin 1997; Puopolo 2007; Gibofsky 2003; Bensen 1999; Kivits 2002; Clegg 2006; Sangdee 2002; Sheldon 2005; Tannenbaum 2004; Lehmann 2005; Rother 2007; Simon 2009; Svensson 2006; Schnitzer 2010; Doherty 2011; McKenna 2001 (a); Paul 2009; Bolten 2015; Essex 2015; Ekman 2014; Ohtori 2013; Selvan 2012; Pavelka 2007; Ehrich 1999; Lee 1985; Dwicandra 2018; Asmus 2014; Smugar 2006; Bingham 2007; Altman 1998; Schnitzer 1999; Birbara 2006; Williams 2001; Miceli 2004; Mckenna 2001 (b); Pincus 2004; Lohmander 2005; Schnitzer 2005b; Williams 2000; Fleischmann 2006). Although meta-analysis of non-selective oral NSAIDs compared to controls demonstrated a meaningful reduction in pain, the results need to be interpreted with caution due to the relatively high degree of heterogeneity. The meta-analysis of non-selective oral NSAIDs compared to controls demonstrated a meaningful improvement in function with an acceptable degree of heterogeneity. In terms of selective COX-2 oral NSAIDs, the meta-analysis of celecoxib, the only available selective COX-2 oral NSAID on the United States market, demonstrated a meaningful reduction in pain and improved function with an acceptable degree of heterogeneity. The comparison of non-selective and selective COX-2 oral NSAIDs shows no significant difference in the effectiveness between the types of oral NSAIDs . Although NSAIDs effectively reduce pain and improve function in the treatment of osteoarthritis of the knee, providers should consider patient comorbidities, the type of NSAID administered, dose, and duration of administration. In fact, the United States Food and Drug Administration (FDA) has a black-box warning for NSAIDs citing an increased risk of serious cardiovascular thrombotic events and serious gastrointestinal events. Therefore, we recommend the lowest effective dose for the shortest duration possible for the patient. Although selective COX-2 oral NSAIDs were developed to reduce gastrointestinal adverse events compared to non-selective oral NSAIDs, meta-analysis did not reveal a significant reduction in gastrointestinal adverse events.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional\/Not specified","CertaintyofEvidence":"Not specified\/Moderate\/Not specified"},{"Guideline specific question":"Is Oral opioids recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Oral opioids is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Oral opioids is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nOpioids, including morphine, are substances derived from opium. Opioids act on binding opioid receptors, which are principally found in the central and peripheral nervous system, and gastrointestinal tract. Medically, opioids are conceived as powerful pain-relieving substances, and have been shown to be effective for acute pain\nCommon harmful effects may occur in the short-term (eg gastrointestinal disturbance, cognitive dysfunction), leading to a discontinuation of the drug in a significant proportion of individuals. The risk of additional adverse effects may accumulate with long-term use, including dependence, adverse effects on bone health, endocrine and immune function, and possible potentiation of chronic pain mechanisms. Deliberate misuse of opioids is an uncommon but serious risk associated with opioid prescription. Opioid use is associated with a risk of both non-fatal and fatal overdose. Observational data in those using opioids for chronic non-cancer pain suggest a risk of death from opioid-related causes as high as one in 550 individuals.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Low\/Very low"},{"Guideline specific question":"Is Paraffin recommended for Physical Treatment of osteoarthritis.","Short_answer":"Paraffin is Recommend for Hand osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Paraffin is Recommend for Hand osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nParaffin, an additional method of heat therapy for the hands, is conditionally recommended for patients with hand OA.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Patellofemoral knee braces recommended for Physical Treatment of osteoarthritis.","Short_answer":"Patellofemoral knee braces is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Patellofemoral knee braces is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nPatient Voting Panel members strongly emphasized the importance of coordination of care between primary care providers, specialists, and providers of braces.\nThe recommendation is conditional due to the variability in results across published trials and the difficulty some patients will have in tolerating the inconvenience and burden of these braces.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is Patient education programs recommended for Education Treatment of knee osteoarthritis.","Short_answer":"Patient education programs is Recommend for knee osteoarthritis EducationTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Patient education programs is Recommend for knee osteoarthritis EducationTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nSix high-quality studies (Saffari 2018, Somers 2012, Cagnin 2019, Gilbert 2018, Baker 2019, Berman 2004) thirteen moderate quality study (Brosseau 2012, Allen 2010, O’Brien 2018, Allen 2010, Bennell 2017, Marra 2012, Rezende 2017, Sandeghi 2019, Rodriguez da Silva 2017, Rini 2015, Moseng 2020, Chen 2020, Ravaud 2009) and two limited quality studies compared patient education and control. These studies reported more significant improvements in pain compared to the control groups.\n\nPatient education programs in studies overlap with self-management programs. Patient education programs vary from patient handout, 2+ hour DVD, one-day education to multiple sessions over a month (Saffari 2018, Cagnin 2019, Brosseau 2012, O’Brien 2018, Rezende 2017, Rodriguez da Silva 2017, Rini 2015). Many studies are challenging to evaluate the effects of education because they involve exercise classes and other proven interventions (Marra 2012, Ravaud 2009). Self-management programs train people in several elements of self-management for osteoarthritis (1148), including medication compliance, pain management, and pain coping strategies, joint protection strategies (1149) during physical activity, exercise advice, problem-solving approaches, and stress management techniques. Patient education programs may not be as labor-intensive, and further work is needed to identify the amount of education needed to improve patient-related outcome measures, like pain.\n\nPrograms that focused on education are two high quality (Saffari 2018, Cagnin 2019) and four moderate quality (Brosseau 2012, O’Brien 2018, Rodriguez da Silva 2017, Rini 2015). Saffari used seven (7) group sessions over one month and provided a CD-ROM and booklet describing preventive lifestyle procedures and the importance of treatment adherence (Saffari 2018). They found improvement in SF-12 and pain scores. Cagnin used an educational session with a physical therapist who demonstrated how recommended exercises should be performed and how patients can manage their pain. They demonstrated improvement in KOOS pain scores (Cagnin 2019). Brousseau looked at education (educational pamphlet) vs. walking and education vs. walking and behavioral intervention (Brouseau 2012). There was a non-clinically significant improvement in pain in the education-only group at 12 months compared to walking and behavioral intervention. O’Brien used weight loss education, where trained telephone interviewers provided brief advice and education about the benefits of weight loss and physical activity for knee osteoarthritis immediately after randomization [O’Brien 2018]. The intervention group provided an evidence-based public health non-disease-specific telephone-based coaching service funded by the local Australian state government to support adults in making sustained lifestyle improvements, including diet, physical activity, and achieving a healthy weight and, where appropriate, access smoking cessation services. They did not find an added benefit from the coaching service over the brief telephone education in pain nor WOMAC scores. Rini compared an internet-based app (PainCoach) [http:\/\/tri.ad\/projects-2\/] to usual care and found a non-clinically significant reduction in VAS pain scores (Rini 2015). Rodriguez da Silva used a single day (Saturday, from 8 a.m. to 5 p.m.), which included seven lectures of 30 min by each professional team, and 60-min workshops by the physical education, physical therapy, and occupational therapy professionals, approaching the importance of their area in knee OA treatment\/management. The study did not report pain scores but did note an increase in mobility with improvements in the get-up and go test. The two high-quality and four moderate-quality studies showed improved pain scores from the education given during educational sessions. Most studies (15 of the 21) incorporate education with other interventions; therefore, it is impossible to isolate the effects of education in these other 15 studies.\n\nOne high quality (Gilbert 2018) and three moderate quality (Rezende 2017, Chen 202, Ravaud 2009) used the transtheoretical model (TTM) and motivational interviewing to improve osteoarthritis treatment adherence. These studies showed improvement in WOMAC pain scores. TTM has been used successfully in other conditions that benefit from lifestyle changes [PMID: 24500864].","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Patient-initiated follow-up recommended for Follow-up Treatment of osteoarthritis.","Short_answer":"Patient-initiated follow-up is Recommended for  osteoarthritis Follow-upTreatment. The strength of recommendation is Moderate. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Patient-initiated follow-up is Recommended for  osteoarthritis Follow-upTreatment. The strength of recommendation is Moderate. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nThere was no evidence on follow-up for people with osteoarthritis. Therefore, the committee based their recommendations on their expert opinion. In current practice, follow-up is mainly symptom-led or people with osteoarthritis raise the condition as a concern during follow-up consultations for other conditions. The committee agreed that symptom-led follow-up is likely to be appropriate for most people with osteoarthritis. This is because they may be able to self-manage their condition effectively after getting information and guidance on management strategies. However, the committee also acknowledged that follow-up should focus on the person's needs, so there are some situations in which planned follow-up may be necessary. The committee noted that agreeing a specific time for people to seek additional help if the management is not improving their symptoms is important. They also agreed that it was important to manage osteoarthritis and other conditions the person may have holistically. Because there was no evidence in this area the committee also made a recommendation for research on the effectiveness of patient-initiated compared with routine follow-up.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Moderate","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Percutaneous Electrical Nerve Stimulation recommended for Physical Treatment of osteoarthritis.","Short_answer":"Percutaneous Electrical Nerve Stimulation is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Percutaneous Electrical Nerve Stimulation is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nOne high-quality study was reviewed that examined the use of Percutaneous Electrical Nerve Stimulation (PENS) combined with a Cox-2 inhibitor to sham PENS combined with a Cox-2 inhibitor in subjects with knee osteoarthritis. (He 2019) The results indicated greater improvements in pain and function measures in subjects receiving PENS compared to sham PENS. \n\nThis recommendation has been downgraded one level because of feasibility issues.","RecommendationStatus":"may be used","StrengthofRecommendation":"limited","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is \"pharmacological treatments alongside non-pharmacological treatments and to support therapeutic exercise；at the lowest effective dose for the shortest possible time\" recommended for Pharmacological Treatment of  osteoarthritis.","Short_answer":"\"Pharmacological treatments alongside non-pharmacological treatments and to support therapeutic exercise；at the lowest effective dose for the shortest possible time\" is Recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"\"Pharmacological treatments alongside non-pharmacological treatments and to support therapeutic exercise；at the lowest effective dose for the shortest possible time\" is Recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nThe committee agreed that pharmacological treatments may be useful for reducing symptoms and supporting people to start other more effective treatments, such as therapeutic exercise. However, they noted that the risks of pharmacological treatments should be understood and that treatments should not be overused or used when they are not needed. The committee agreed that it was difficult to define treatment strengths and durations that would be generalisable to everyone. This is because people with osteoarthritis can have a variety of comorbidities and factors that might influence treatment. Therefore, the committee emphasised that treatments should use the lowest effective dose for the shortest possible time. Topical non-steroidal anti-inflammatory drugs (NSAIDs) were clinically effective in reducing pain for people with knee osteoarthritis and generally the most cost-effective medicine for osteoarthritis. They were also associated with minimal adverse events.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Planned follow-up for people with osteoarthritis recommended for Follow-up Treatment of  osteoarthritis.","Short_answer":"Planned follow-up for people with osteoarthritis is Recommended for  osteoarthritis Follow-upTreatment. The strength of recommendation is Moderate. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Planned follow-up for people with osteoarthritis is Recommended for  osteoarthritis Follow-upTreatment. The strength of recommendation is Moderate. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nTreatments or interventions that need monitoring;their ability to seek help for themselves;their occupation and activities;the severity of their symptoms or functional limitations\nThere was no evidence on follow-up for people with osteoarthritis. Therefore, the committee based their recommendations on their expert opinion. In current practice, follow-up is mainly symptom-led or people with osteoarthritis raise the condition as a concern during follow-up consultations for other conditions. The committee agreed that symptom-led follow-up is likely to be appropriate for most people with osteoarthritis. This is because they may be able to self-manage their condition effectively after getting information and guidance on management strategies. However, the committee also acknowledged that follow-up should focus on the person's needs, so there are some situations in which planned follow-up may be necessary. The committee noted that agreeing a specific time for people to seek additional help if the management is not improving their symptoms is important. They also agreed that it was important to manage osteoarthritis and other conditions the person may have holistically. Because there was no evidence in this area the committee also made a recommendation for research on the effectiveness of patient-initiated compared with routine follow-up.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Moderate","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Platelet rich plasma(PRP) recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Platelet rich plasma(PRP) is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nPlatelet rich plasma (PRP) is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nPlatelet rich plasma(PRP) is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Platelet rich plasma(PRP) is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nthere is concern regarding the heterogeneity and lack of standardization in available preparations of platelet-rich plasma, as well as techniques used, making it difficult to identify exactly what is being injected.\nPlatelet rich plasma (PRP) is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nThere were two high (Rayegani; 2014, Gormeli; 2017) and one moderate (Akan; 2018) study with 30 people per group comparing PRP vs. control. There were mixed results in the studies for pain and function. A meta-analysis was not performed due to heterogeneity. Two studies (Akan; 2018, Gormeli; 2017) looked at PRP in severe OA with mixed results. Two studies (Rayegani; 2014, Gormeli; 2017) looked at change in all stages of OA at a six-month timeframe. The studies had mixed results. One study (Gormeli; 2017) looked at Kellgren-Lawrence 1-3 stage OA with improvement in IKDC and EQ-VAS. Therefore, due to the heterogeneity of results and the difference in early and late stage OA results, we downgraded the recommendation to Limited from Strong. We feel these recommendations may change with future research on the use of PRP in different levels of severity of OA.\nThe number of PRP injections had mixed results with the studies with three PRP injections (Akan; 2018, Gormeli; 2017) having positive results outcomes for pain and function. Studies with one and two PRP injections had mixed results, with the positive being less likely clinically significant changes in pain and function. Further research should be done to determine the number of PRP injections for treatment of KOA. Currently, three IA-PRP injections appear to have more favorable results.\nAdverse events from PRP injections have been investigated in one high-quality study (Huang; 2018) reported adverse events for PRP vs. control. They reported hypertension and proteinuria were treatment-related side-effects. These met Common Toxicity Criteria grade ≥3. This raises questions on the safety of PRP, which needs further evaluation. Therefore, the strength of recommendation was downgraded to Limited.\nWhen evaluating the effectiveness of PRP vs HA, there were eight high-quality studies (Sanchez; 2012, Vaquerizo; 2013, Filardo; 2015, Gormeli; 2017, Cole; 2017, Buendia-Lopez; 2018, Di Martino; 2019, Yaradilmis; 2020) and six (6) medium-quality studies (Spakova; 2012, Raeissadat; 2015, Lana; 2016, Duymus; 2017, Raeissadat; 2017, Ahmad; 2018) and one low-quality study (Sanchez; 2008) that investigated IA-PRP vs. IA-HA. Four studies were included in a meta-analysis of Total WOMAC results at the 9- OR 12-months mark. This analysis showed a clinically significant difference for IA-PRP over IA-HA. The results between IA-PRP vs IA-HA diverged after 6 months. Most studies showed similar results between IA-PRP and IA-HA at six months, except one (Yaradilimis 2020) where the LR-PRP total WOMAC was better at all time points than the IA HA. Both the patients in the IA HA and IA PRP improved in total WOMAC at six months. Patients in the IA-PRP-arms maintained improvement after 6 months at the 9- OR 12-months mark for total WOMAC vs. IA-HA which started to have a worsening score. The standard is to inject IA-HA every six months in patients with painful KOA. The preparation of the PRP (LR-PRP vs LP-PRP) was noted to be different with the LR-PRP had higher MID values than LP-PRP vs. IA-HA. The research highlights the prolonged effect of IA-PRP over IA-HA, though both appear to be equivalent at 6 months.\nPatient-related outcome measures (OARSI-OMERACT responders, percentage of subjects meeting a percentage reduction in VAS Pain OR WOMAC Pain scores) (Sanchez; 2008, Sanchez; 2012, Vaquerizo; 2013, Buendia-Lopez; 2018) more often favored IA-PRP at both the six-month and 12-month time frame. Further research is needed using standardized PROMs to investigate the effectiveness of IA-PRP to determine if more patients will benefit from IA-PRP at six months over IA-HA.\nAdverse events were higher in the PRP group than IA HA, both local soreness and injection pain (two studies (Spakova; 2012, Yaradilmis; 2020)) and one study (Huang; 2018) reported systemic events (proteinuria and hypertension). One study (Vaquerizo; 2013) did not find a difference in comparing any adverse event, and one study (Raeissadat; 2017) did not see a difference for minor injection-site adverse events. Therefore, there appears to be more studies finding IA-PRP to have more adverse events vs. IA-HA, more research is needed to determine if the adverse events outweigh the benefit of IA-PRP over IA-HA at 9 and 12 months. This is another reason for the downgrade in evidence from Strong to Limited.\nComparisons between IA-PRP and IA-CS, there were three high (Joshi Juber; 2017, Khan; 2018, Nabi; 2018) and one moderate quality study (Huang; 2019). One study (Joshi Juber; 2017) was KL IV end-stage OA and did not find a difference. One study (Khan; 2018) was repeat injections every other month (0, 2, 4 months) with follow up at six months in KL II OAK with no difference. One study (Nabi; 2018) used patients with KL II-III given three injections one month apart showed improvement at three months (one month after the last injection) and six months (4 months after the final injection). One study (Huang; 2019) did three PRP injections every three weeks on KL I-II OAK showed improvement in pain and function at six months (4 months after last injection) and 12 months (10 months after last injection). Therefore, the IA-PRP given in three injections evaluated at 4 months post last injection is more likely to show benefit in KL II and III stages of KOA. More research is needed to evaluate long-term benefits of IA-PRP vs IA-CS over a two- or five-year period to determine if IA-PRP is cartilage sparing vs IA-CS concern for possible cartilage damage over time.\nPRP is defined in LR-PRP and LP-PRP. There may be a difference in the effectiveness in knee osteoarthritis between these two preparations. Currently, there is limited data from one direct comparison (Yaradilimis; 2020) and our meta-analysis (Figure 45) of IA-PRP and IA-HA that would demonstrate that intra-articular LR-PRP vs. LP-PRP for KOA is more likely to demonstrate a benefit at 9 and 12 months. The number of studies is limited, therefore determining the better choice between LR-PRP vs. LP-PRP is still inconclusive, but at this time appears to favor LR-PRP.\nThe Platelet-Rich Plasma recommendation has been downgraded two levels because of inconsistent evidence.\n\nPlatelet rich plasma(PRP) is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nthere is concern regarding the heterogeneity and lack of standardization in available preparations of platelet-rich plasma, as well as techniques used, making it difficult to identify exactly what is being injected.","RecommendationStatus":"Not Recommend\/may be used","StrengthofRecommendation":"Strong\/Limited","CertaintyofEvidence":"III\/Not specified"},{"Guideline specific question":"Is Prolotherapy recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Prolotherapy is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Prolotherapy is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nA limited number of trials involving a small number of partici_x005f_x005f_x005f_x0002_pants have shown small effect sizes of prolotherapy in knee or hip OA. However, injection schedules, injection sites, and compara_x0002_tors have varied substantially between trials.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"III"},{"Guideline specific question":"Is Provide accesible information tailor to their individual needs  recommended for Education Treatment of  osteoarthritis.","Short_answer":"Provide accesible information tailor to their individual needs  is Recommended for  osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Provide accesible information tailor to their individual needs  is Recommended for  osteoarthritis EducationTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nEvidence showed that generally people with osteoarthritis wanted more information about their condition. This included information about the causes, what their diagnosis means for the future and where to find more information on self-management. The committee based their recommendations on the evidence and their experience. They agreed that it is important to tell people that diagnosis is made clinically without imaging, that imaging rarely provides any extra information helpful for diagnosing or planning non-surgical treatment for osteoarthritis, and that it would only be used if there were suspicion of an alternative diagnosis or other complications. This would help reassure and dispel any belief that X-rays or other forms of imaging are needed to diagnose osteoarthritis. \nThe committee noted the importance of information that offers hope for the future and supports self-management strategies (for example, information that emphasises symptom-reducing behaviours, like therapeutic exercise). They agreed that explaining the core treatments for osteoarthritis would help people understand that pharmacological treatments are not a long-term solution. They also agreed that information about recognising flares and how to manage changes in pain would help the person better understand how their condition may vary over time and what they can do about it. The committee noted more evidence was needed on information about managing flares and information for different populations of people with osteoarthritis, and so made recommendations for research on what information people with osteoarthritis need. \nThe committee agreed that each person's experience of osteoarthritis differs and therefore tailoring the information to their needs, as described in NICE's guideline on patient experience in adult NHS services, is important. They also agreed that osteoarthritis is more common in older people who are likely to have other conditions. Therefore, the recommendations on delivering an approach to care that takes account of multimorbidity in NICE's guideline on multimorbidity are particularly relevant to people with osteoarthritis.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Pulsed Electromagnetic Field Therapy recommended for Physical Treatment of osteoarthritis.","Short_answer":"Pulsed Electromagnetic Field Therapy is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Pulsed Electromagnetic Field Therapy is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nOne high-quality study was reviewed that examined the use of a wearable Pulsed Electromagnetic Field (PEMF) device for pain management in subjects with knee osteoarthritis. (Bagnato 2016) Subjects were randomized to either the PEMF group or a sham PEMF group. PEMF was applied 12 hours per day for a period of 4 weeks. The results indicated greater improvement in WOMAC pain and VAS pain scores for subjects receiving PEMF over sham PEMF. There was no difference between groups on WOMAC function scores. \n\nThe Percutaneous Electrical Nerve Stimulation\/Pulsed Electromagnetic Field Therapy recommendation has been downgraded one level because of feasibility issues.","RecommendationStatus":"may be used","StrengthofRecommendation":"limited","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is pulsed short-wave therapy recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Pulsed short-wave therapy is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Pulsed short-wave therapy is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nAlthough there were many studies on electrotherapy, the findings were inconsistent and mostly showed little benefit. The committee acknowledged that most studies were small, with fewer than 100 participants, and that evidence from direct comparisons of electrotherapy with other interventions was uncertain. The committee agreed there is not enough evidence to recommend electrotherapy for people with osteoarthritis.Extracorporeal shockwave therapy showed some evidence of benefit compared with a sham intervention. However, this evidence was uncertain because of the small trial sizes and challenges in using appropriate sham techniques. The committee agreed that further research using an appropriate sham with more than 55 participants in each study arm is needed and made a recommendation for research on extracorporeal shockwave therapy.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is pulsed vibration therapy recommended for Physical Treatment of osteoarthritis.","Short_answer":"Pulsed vibration therapy is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Pulsed vibration therapy is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nFew trials have addressed pulsed vibration therapy, and in the absence of adequate data, we conditionally recommend against its use","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"IIb"},{"Guideline specific question":"Is Radiofrequency ablation recommended for Physical Treatment of osteoarthritis.","Short_answer":"Radiofrequency ablation is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Radiofrequency ablation is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nA number of studies have demonstrated potential analgesic benefits with various ablation techniques but, because of the het_x005f_x005f_x005f_x005f_x0002_erogeneity of techniques and controls used and lack of long-term safety data, this recommendation is conditional.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is realigning patellofemoral braces recommended for Other Treatment of osteoarthritis.","Short_answer":"Realigning patellofemoral braces is Not Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Realigning patellofemoral braces is Not Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nPatellofemoral braces aim to realign patellar position for those with patellofemoral OA.\nThere is a low likelihood of adverse effects, which can include skin irritation","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is Regular individualised (daily) exercise regimen recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Regular individualised (daily) exercise regimen is Recommend for Knee osteoarthritis ExerciseTreatment and hip osteoarthritis ExerciseTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.","Full_answer":"Regular individualised (daily) exercise regimen is Recommend for Knee osteoarthritis ExerciseTreatment and hip osteoarthritis ExerciseTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\nPeople with hip and\/or knee OA should be taught a regular individualised (daily) exercise regimen that includes:\na strengthening (sustained isometric) exercise for both legs, including the quadriceps and proximal hip girdle muscles\n(irrespective of site or number of large joints affected)\nb aerobic activity and exercise\nc adjunctive range of movement\/stretching exercises\n* Although initial instruction is required, the aim is for people with hip or knee OA to learn to undertake these regularly on their own in their own environment\nBefore considering the evidence for specific exercises in hip and knee OA, it should be noted that although exercise has been shown to reduce pain in patients with hip OA, overall there is a lack of information to support treatment effects of exercise in hip OA. The LOE for the recommendation of different types of exercise in people with hip OA therefore could not be graded. For knee OA, however, high-quality research evidence has reported that exercise reduces pain and improves physical function. Results for the effect of exercise on quality of life are inconsistent. Research about strengthening exercises in knee OA shows that both specific quadriceps strengthening exercises or strength training for the lower limb reduce pain effectively (ES, 95% CI 0.29, 0.06 to 0.51 and 0.53, 0.27 to 0.79, respectively) and improve physical function (ES, 95% CI 0.24, 0.06 to 0.42 and 0.58, 0.27 to 0.88, respectively). The literature on strength training in people with knee OA in most cases describes dynamic exercises, whereas research on isometric exercises is sparse.95 Hip strengthening exercises have been poorly evaluated in people with hip OA. However, in people with medial tibiofemoral knee OA, hip strengthening exercises reduced knee pain and improved physical function. Aerobic training (walking) is effective in reducing pain (ES, 95% CI 0.48, 0.13 to 0.43) and improving physical function (ES, 95% CI 0.35, 0.11 to 0.58) in patients with knee OA. The evidence for mixed exercise programmes, including strengthening, aerobic and flexibility components, in patients with knee OA is conflicting. One type of exercise has not been shown to be better than another (strength, aerobic or mixed exercises). The group reached consensus that mixed programmes should be recommended. However, it was noted that with mixed pro grammes the minimal requirements to improve or maintain muscle strength, aerobic capacity and\/or joint range of motion need to be met, as some reports suggest that mixed pro grammes may be less effective than focused programmes. This recommendation states that initial instruction is required, but that in the longer term the person should integrate exercise into daily life. This part of the recommendation is substantiated by studies showing that the number of super vised sessions influences outcome in people with knee OA. Twelve or more directly supervised sessions have been shown to be more effective than a smaller number on pain (ES 0.46, 95% CI 0.32 to 0.60 vs ES 0.28, 95% CI 0.16 to 0.40, p=0.03) and physical function (ES 0.45, 95% CI 0.29 to 0.62 vs ES 0.23, 95% CI 0.09 to 0.37, p=0.02). In addition, it was noted that research evidence is growing for tai chi and yoga. Though not included in the literature review, tai chi has been found to be effective for the reduction of pain in patients with hip or knee OA, with ES ranging from 0.28 to 1.67.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is Routine hyaluronic acid intra-articular injection recommended for Pharmacological Treatment of osteoarthritis.","Short_answer":"Routine hyaluronic acid intra-articular injection is Not Recommend for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Routine hyaluronic acid intra-articular injection is Not Recommend for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nTwenty-eight studies (17 high-strength (Chevalier 2010, Petterson 2018, Maheu 2019, Neustadt 2005, Baltzer 2009, Lundsgaard 2008, Altman 2004, Huang 2011, van der Weergen 2015, Altman 2009, Day 2004, Jorgensen 2010, Henrotin 2017, Henderson 1994, Hangody 2018, Saccomanno 2016, Altman 1998) and 11 moderate-strength (Jubb 2003, Navarro-Sarabia 2011, Farr 2019, Kahan 2003, Kahan 2003, Karlsson 2002, Hermans 2019, Huskisson 1999, Heybeli 2008, Petrella 2006, Takamura 2018, Wobig 1998)) assessed intraarticular hyaluronic acid (HA) injections when compared to controls. A comparison of patients from these studies and from studies validating the MCIDs were used to judge clinical significance. Results revealed that patients were demographically comparable for WOMAC and VAS pain as well as WOMAC function based on age, baseline pain scores, BMI, weight, and gender. Meta-analysis in meaningfully important difference (MID) units showed that the effect was less than 0.5 MID units, indicating a low likelihood that an appreciable number of patients achieved clinically important benefits after intraarticular HA injection (Guyatt et al.). When we differentiated high- versus low-molecular weight viscosupplementation (three high, two moderate and two low quality studies), our analyses demonstrated no significant differences among different viscosupplementation formulations. Crosslinking features of the viscosupplemtation product was assessed in two high quality studies. In patients with OA, there was no difference between cross-linked and non-cross-linked HA.\n\nSome studies demonstrated a statistical benefit with the use of HA but could not reach the significance for a minimally clinical meaningful difference, leading to the conclusion that viscosupplementation can represent a viable option for some patients that failed other treatments when appropriately indicated. The number needed to treat to see a tangible benefit from HA was 17 patients. Furthermore, this difference was most evident at 6 weeks and 3 months. Most of the studies that exist in the literature evaluate low to moderate arthritic knees (Kellgren Lawrence of I-III) with worse results in patients with severely affected knees (KL IV).\n\nThe 2013 edition of this guideline strongly recommended against the use of viscosupplementation. In contrast to this updated version, the 2021 version found that statistically significant improvements were associated with high-molecular cross-linked hyaluronic acid but when compared to mid-range molecular weight, statistical significance was not maintained. This newer analysis did not demonstrate clinically relevant differences when compared to controls. However, as previous research reported benefits in their use, the group felt that a specific subset of patients might benefit from its use.\n\nThe Hyaluronic Acid recommendation was downgraded one level due to a lack of generalized results.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Moderate","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Routine imaging in follow up recommended for Imaging Assessment of  osteoarthritis.","Short_answer":"Routine imaging in follow up is Not recommended for  osteoarthritis ImagingAssessment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Routine imaging in follow up is Not recommended for  osteoarthritis ImagingAssessment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nThere was no evidence on using imaging to manage osteoarthritis. Therefore, the committee used their expertise to inform the recommendation. They acknowledged that imaging was important for confirming the severity of structural joint changes when planning or considering surgery. But it was unclear who should do this imaging because some surgeons may only accept a referral for surgery if they are provided with imaging results, whereas others may prefer to do their own imaging after referral. However, in most cases, imaging should not be needed for managing osteoarthritis because it does not guide how the condition will respond to treatment. The committee made recommendations for research on using imaging to inform non-surgical and pre-surgical management of osteoarthritis.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Routine intra-articular hyaluronan injections recommended for Pharmacological Treatment of  osteoarthritis.","Short_answer":"Routine intra-articular hyaluronan injections is Not recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Routine intra-articular hyaluronan injections is Not recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nThere was no evidence showing that hyaluronan injections improved quality of life or physical function, or reduced pain, in people with knee or hip osteoarthritis. Evidence showed a potential harm for hip osteoarthritis. Limited evidence for other osteoarthritis-affected joints showed inconsistent benefits and some potential harms. Based on their expert opinion, the committee agreed that these results were generalisable to other forms of osteoarthritis and that hyaluronan injections should not be offered. Evidence showed that corticosteroid injections had inconsistent benefits on improving quality of life and physical function for people with hip osteoarthritis, and reducing pain for people with knee osteoarthritis. There was no evidence showing long-term benefit beyond 3 months. Given the potential benefits and committee expert opinion, they agreed that intra-articular corticosteroids could be considered for people with osteoarthritis if other treatments have not worked, provided the person was made aware that the injection would only provide short-term relief (2 to 10 weeks). The committee agreed that when used, corticosteroid injections should only be used to supplement and support people to participate in therapeutic exercise where possible. Based on their expert opinion, the committee agreed that this evidence was generalisable to other osteoarthritis-affected joints.\nThe committee acknowledged that there was a lack of consistent evidence on corticosteroids (especially for non-knee joint sites), so they made a recommendation for research on intra-articular corticosteroids. There was some evidence from very small studies that showed a potential benefit of stem cell injections. The committee noted that this is an experimental treatment and agreed that it should not be used outside research. They made a recommendation for research on intra-articular stem cell injections.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is routine paracetamol recommended for Pharmacological Treatment of  osteoarthritis.","Short_answer":"Routine paracetamol is Not recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Routine paracetamol is Not recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nThey are only used infrequently for short-term pain relief;all other pharmacological treatments are contraindicated, not tolerated or ineffective.\nEvidence showed that opioids also have the potential for harm, including gastrointestinal and central nervous system adverse events. The committee acknowledged further potential harms such as physical dependence, opioid-induced hyperalgesia and tolerance. Cost-effectiveness evidence showed that buprenorphine, a transdermal opioid, was generally more cost effective than oral strong opioids (such as morphine, oxycodone and tramadol). This evidence was from people having buprenorphine who had not had opioids before, but this was generally not the case for people having oral strong opioids. All people had already tried a type of analgesia such as NSAIDs or paracetamol. However, the committee acknowledged the MHRA safety warning on opioids and recommendations in NICE's guideline on medicines associated with dependence or withdrawal symptoms, which advises against the use of modified-release opioids. Therefore, the committee recommended against the use of strong opioids. Evidence from 1 small study of weak opioids showed a clinically important benefit in reducing pain. The committee agreed that there was not enough evidence of benefit and on potential risks. Although paracetamol has a low potential to cause adverse events, evidence showed that it has no additional benefit in reducing osteoarthritis pain and improving quality of life and physical function compared with placebo. However, the committee discussed that some people cannot use NSAIDS. Therefore, they recommended against the routine use of paracetamol but noted some circumstances where it may be used. Evidence on glucosamine was inconsistent and the largest benefits were shown by smaller studies that were of lower quality. Because glucosamine is not used in current practice and there is no strong evidence of benefit the committee recommended against its use for people with osteoarthritis. The committee determined that there was not enough evidence to make recommendations on antiepileptics, antidepressants, rubefacients and topical local anaesthetics. The committee made recommendations for research on antiepileptics, antidepressants, weak oral opioids and topical local anaesthetics for osteoarthritis.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is routine weak opioids recommended for Pharmacological Treatment of  osteoarthritis.","Short_answer":"Routine weak opioids is Not recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Routine weak opioids is Not recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nThey are only used infrequently for short-term pain relief;all other pharmacological treatments are contraindicated, not tolerated or ineffective.\nEvidence showed that opioids also have the potential for harm, including gastrointestinal and central nervous system adverse events. The committee acknowledged further potential harms such as physical dependence, opioid-induced hyperalgesia and tolerance. Cost-effectiveness evidence showed that buprenorphine, a transdermal opioid, was generally more cost effective than oral strong opioids (such as morphine, oxycodone and tramadol). This evidence was from people having buprenorphine who had not had opioids before, but this was generally not the case for people having oral strong opioids. All people had already tried a type of analgesia such as NSAIDs or paracetamol. However, the committee acknowledged the MHRA safety warning on opioids and recommendations in NICE's guideline on medicines associated with dependence or withdrawal symptoms, which advises against the use of modified-release opioids. Therefore, the committee recommended against the use of strong opioids. Evidence from 1 small study of weak opioids showed a clinically important benefit in reducing pain. The committee agreed that there was not enough evidence of benefit and on potential risks. Although paracetamol has a low potential to cause adverse events, evidence showed that it has no additional benefit in reducing osteoarthritis pain and improving quality of life and physical function compared with placebo. However, the committee discussed that some people cannot use NSAIDS. Therefore, they recommended against the routine use of paracetamol but noted some circumstances where it may be used. Evidence on glucosamine was inconsistent and the largest benefits were shown by smaller studies that were of lower quality. Because glucosamine is not used in current practice and there is no strong evidence of benefit the committee recommended against its use for people with osteoarthritis. The committee determined that there was not enough evidence to make recommendations on antiepileptics, antidepressants, rubefacients and topical local anaesthetics. The committee made recommendations for research on antiepileptics, antidepressants, weak oral opioids and topical local anaesthetics for osteoarthritis.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Sefl-management programs recommended for Other\nEducation Exercise Treatment of osteoarthritis.","Short_answer":"Sefl-management programs is Recommend for Hip osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nSefl-management programs is Recommend for hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nSefl-management programs is Recommend for knee osteoarthritis EducationTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nSefl-management programs is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nSefl-management programs is Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\n\nSefl-management programs is Recommend for Hand osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Sefl-management programs is Recommend for Hip osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with gastrointestinal comorbidities.\nSefl-management programs is Recommend for hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nThese programs use a multidisciplinary group–based format combining sessions on skill-building (goal-setting, problem-solving, positive thinking), education about the disease and about medication effects and side effects, joint protection measures, and fitness and exercise goals and approaches. Health educators, National Commission for Certification Services–certified fitness instructors, nurses, physical therapists, occupational therapists, physicians, and patient peers may lead the sessions, which can be held in person or online. In the studies reviewed, sessions generally occurred 3 times weekly, but varied from 2 to 6 times weekly.\nAlthough effect sizes are generally small, the benefits of participation in self-efficacy and self-management programs are consistent across studies, and risks are minimal.\nSefl-management programs is Recommend for Hand osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nThese programs use a multidisciplinary group–based format combining sessions on skill-building (goal-setting, problem-solving, positive thinking), education about the disease and about medication effects and side effects, joint protection measures, and fitness and exercise goals and approaches. Health educators, National Commission for Certification Services–certified fitness instructors, nurses, physical therapists, occupational therapists, physicians, and patient peers may lead the sessions, which can be held in person or online. In the studies reviewed, sessions generally occurred 3 times weekly, but varied from 2 to 6 times weekly.\nAlthough effect sizes are generally small, the benefits of participation in self-efficacy and self-management programs are consistent across studies, and risks are minimal.\n\nSefl-management programs is Recommend for knee osteoarthritis EducationTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nSelf-management programs refer to formalized training and education programs that are taught by both healthcare professionals and trained layperson instructors. They typically include several sessions over several weeks. These programs train people in several elements of self-management for osteoarthritis including medication compliance, pain management and pain coping strategies, joint protection strategies during physical activity, exercise advice, problem-solving approaches, and stress management techniques.\nFour high-quality studies (Saffari 2018, Somers 2012, Hurley 2007, Omidi 2018) and one moderate-quality study (Coleman 2012) compared self-management to usual care or no treatment. These studies reported greater improvements in pain, function, or both compared to the control groups. In addition, some of these studies reported greater improvements in quality of life, pain catastrophizing, and self-efficacy in the self-management groups (Saffari 2018, Somers 2012).\nOne high-quality study (Marconcin 2018) and three moderate-quality studies examined the combined use of self-management and exercise to either groups that received self-management or exercise alone (Bennell 2016) or usual care (Yip 2007, Kao 2012). Yip et al. reported greater improvements in pain, time spent in leisure activities, and self-efficacy, compared to usual care. (Yip 2007) reported greater improvements in pain and function compared to the control groups. Bennell, et al, reported improvements in pain and function in all groups. There were no differences between groups on pain measures but the combined use of self-management (i.e., pain coping skills training) and exercise had greater improvements in function compared to those receiving only self-management or exercise (Bennell 2016).\nAn attempt was made to examine the literature on cognitive-behavioral therapy (CBT) in the management of people with knee osteoarthritis. One high-quality study (Helminen 2015) and 4 moderate-quality (Focht 2012, Focht 2017, Smith 2015, Lerman 2017) studies were reviewed. Control groups consisted of usual care (Helminen 2015), traditional exercise approaches for knee osteoarthritis (Focht 2012, Focht 2017), or behavioral desensitization (Smith 2015, Lerman 2017). Inconsistency in outcome results across studies made it difficult to provide a recommendation for this intervention approach at this time.\nSefl-management programs is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nThese programs use a multidisciplinary group–based format combining sessions on skill-building (goal-setting, problem-solving, positive thinking), education about the disease and about medication effects and side effects, joint protection measures, and fitness and exercise goals and approaches. Health educators, National Commission for Certification Services–certified fitness instructors, nurses, physical therapists, occupational therapists, physicians, and patient peers may lead the sessions, which can be held in person or online. In the studies reviewed, sessions generally occurred 3 times weekly, but varied from 2 to 6 times weekly.\nAlthough effect sizes are generally small, the benefits of participation in self-efficacy and self-management programs are consistent across studies, and risks are minimal.\nSefl-management programs is Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with and without comorbidities.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional\/Strong","CertaintyofEvidence":"Not specified\/Ia"},{"Guideline specific question":"Is short course of manual therapy (stretching, soft tissue and\/or joint mobilisation and\/or manipulation) recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Short course of manual therapy (stretching, soft tissue and\/or joint mobilisation and\/or manipulation) is Recommend for Knee osteoarthritis ExerciseTreatment and Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Short course of manual therapy (stretching, soft tissue and\/or joint mobilisation and\/or manipulation) is Recommend for Knee osteoarthritis ExerciseTreatment and Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nThis should be considered only as an adjunctive treatment to enable engagement with active management strategies, and only for short term, cognisant of issues related to cost and access.\nManual therapy generally refers to skilled hands-on techniques where accurately determined and specifically directed manual force is applied to the body. The purported aims of manual therapy include: • reducing pain • increasing range of motion and mobility • reducing soft tissue inflammation • increasing circulation • improving soft tissue repair • inducing relaxation • facilitating movement • improving function. Manual therapy comprises a number of techniques, the most common being manipulation and mobilisation. Manipulation techniques are defined as forceful small-amplitude, high-velocity movements of a joint, often applied at end range. Mobilisation techniques are repetitive passive movements of low velocity and varying amplitudes applied at different points throughout range. Other techniques include soft tissue mobilisation and stretching, and myofascial techniques. Massage may also be considered by some to be a form of manual therapy\nThere is a very low risk of harm reported.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is Stationary cycling and\/or Hatha yoga recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Stationary cycling and\/or Hatha yoga is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Stationary cycling and\/or Hatha yoga is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nClinicians should prescribe an individualised exercise program, taking into account the person’s preference, capability, and the availability of resources and local facilities. Realistic goals should be set. Dosage should be progressed with full consideration given to the frequency, duration and intensity of exercise sessions, number of sessions, and the period over which sessions should occur. Attention should be paid to strategies to optimise adherence. Referral to an exercise professional to assist with exercise prescription and to provide supervision either in person or remotely may be appropriate for some people.\nThis recommendation is specific to exercise performed on land for people with knee OA, including muscle strengthening, stretching\/range of motion, aerobic conditioning, neuromuscular\/balance, cycling, Tai Chi and yoga. Exercise dosage can vary in frequency, intensity and duration. Additionally, the exercise can involve expensive, specialised equipment, or no equipment at all; it can be delivered in a group setting or individually, either in-person or remotely via telephone or videoconference\nThere is a very low likelihood of serious adverse effects; most are minor and include temporary increased pain at the affected joint or pain at other sites","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is Stem Cell Injection recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Stem Cell Injection is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nStem Cell Injection is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n\nStem Cell Injection is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nStem Cell Injection is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Stem Cell Injection is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nThere is concern regarding the heterogeneity and lack of standardization in available preparations of stem cell injections, as well as techniques used.\nStem Cell Injection is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nStem cells are cells that have the ability to divide and develop into many different types of cell in the body, and can be categorised as pluripotent and multipotent. Mesenchymal stem cells (MSCs) are a common form of multipotent cells that may offer an alternative to cartilage repair techniques that is not hampered by availability and donor site morbidity. MSCs can be isolated from adipose tissue, bone marrow, synovial tissue and other sources.\nNo serious adverse events were reported in those trials. There are two groups reporting minor adverse events, including mild pain and effusion after the injections, which persisted for no more than seven days.\n\nStem Cell Injection is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nThere is concern regarding the heterogeneity and lack of standardization in available preparations of stem cell injections, as well as techniques used.\nStem Cell Injection is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nStem cells are cells that have the ability to divide and develop into many different types of cell in the body, and can be categorised as pluripotent and multipotent. Mesenchymal stem cells (MSCs) are a common form of multipotent cells that may offer an alternative to cartilage repair techniques that is not hampered by availability and donor site morbidity. MSCs can be isolated from adipose tissue, bone marrow, synovial tissue and other sources.\nNo serious adverse events were reported in those trials. There are two groups reporting minor adverse events, including mild pain and effusion after the injections, which persisted for no more than seven days.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"III\/Very low"},{"Guideline specific question":"Is strong opioids recommended for Pharmacological Treatment of  osteoarthritis.","Short_answer":"Strong opioids is Not recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Strong opioids is Not recommended for  osteoarthritis PharmacologicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nThe risks of strong opioids outweigh the benefits;\nEvidence showed that opioids also have the potential for harm, including gastrointestinal and central nervous system adverse events. The committee acknowledged further potential harms such as physical dependence, opioid-induced hyperalgesia and tolerance. Cost-effectiveness evidence showed that buprenorphine, a transdermal opioid, was generally more cost effective than oral strong opioids (such as morphine, oxycodone and tramadol). This evidence was from people having buprenorphine who had not had opioids before, but this was generally not the case for people having oral strong opioids. All people had already tried a type of analgesia such as NSAIDs or paracetamol. However, the committee acknowledged the MHRA safety warning on opioids and recommendations in NICE's guideline on medicines associated with dependence or withdrawal symptoms, which advises against the use of modified-release opioids. Therefore, the committee recommended against the use of strong opioids. Evidence from 1 small study of weak opioids showed a clinically important benefit in reducing pain. The committee agreed that there was not enough evidence of benefit and on potential risks. Although paracetamol has a low potential to cause adverse events, evidence showed that it has no additional benefit in reducing osteoarthritis pain and improving quality of life and physical function compared with placebo. However, the committee discussed that some people cannot use NSAIDS. Therefore, they recommended against the routine use of paracetamol but noted some circumstances where it may be used. Evidence on glucosamine was inconsistent and the largest benefits were shown by smaller studies that were of lower quality. Because glucosamine is not used in current practice and there is no strong evidence of benefit the committee recommended against its use for people with osteoarthritis. The committee determined that there was not enough evidence to make recommendations on antiepileptics, antidepressants, rubefacients and topical local anaesthetics. The committee made recommendations for research on antiepileptics, antidepressants, weak oral opioids and topical local anaesthetics for osteoarthritis.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is strontium ranelate recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Strontium ranelate is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Strontium ranelate is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nStrontium ranelate, a bone-acting agent, has the ability to dissociate the bone-remodelling process, and change the balance between bone resorption and formation, which has been suggested to be a potential symptom-modifying effect.\nStrontium ranelate was well tolerated for the treatment of OA in a study duration over three years. Despite its listed side effects in the approved product information (eg myocardial infarction, venous thromboembolism events, pulmonary embolism, hypersensitivity reaction), the European Medicines Agency recommended in 2014 that strontium ranelate should remain available for individuals with osteoporosis, with restrictions relative to those with existing heart disease.107 As strontium ranelate would be used as a daily treatment for OA, and its effects could be relatively slow, the potential harm caused by its side effects is a concern","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Moderate"},{"Guideline specific question":"Is Structured Land-Based Exercise Programs recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Structured Land-Based Exercise Programs is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","Full_answer":"Structured Land-Based Exercise Programs (Type 1- strengthening and\/or cardio and\/or balance training\/neuromuscular exercise) is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with and without comorbidities.\nStructured land-based exercise programs, dietary weight management in combination with exercise, and mind-body exercise (such as Tai Chi and Yoga) were considered by the panel to be effective and safe for all patients with Knee OA, regardless of co_x005f_x0002_morbidity. These treatments are recommended for use alone or along with interventions of any recommendation level, as deemed appropriate for the individual.\n\nStructured Land-Based Exercise Programs (Type 1- strengthening and\/or cardio and\/or balance training\/neuromuscular exercise OR Type 2- Mind-body Exercise including Tai Chi or Yoga) with or without Dietary Weight Management is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with and without comorbidities.\nStructured land-based exercise programs, dietary weight management in combination with exercise, and mind-body exercise (such as Tai Chi and Yoga) were considered by the panel to be effective and safe for all patients with Knee OA, regardless of co_x0002_morbidity. These treatments are recommended for use alone or along with interventions of any recommendation level, as deemed appropriate for the individual.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Supervised therapeutic exercise sessions recommended for Exercise Treatment of  osteoarthritis.","Short_answer":"Supervised therapeutic exercise sessions is Recommended for  osteoarthritis ExerciseTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Supervised therapeutic exercise sessions is Recommended for  osteoarthritis ExerciseTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nLimited evidence showed that supervised exercise had some benefits compared with unsupervised exercise. The committee's expert consensus was that supervised exercise is ikely to be of greater benefit than unsupervised exercise for people with osteoarthritis. This is because supervised exercise may enable tailored exercise and social support, which may increase adherence and lead to people with osteoarthritis forming a regular exercise habit.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Sustained weight loss recommended for Other Treatment of osteoarthritis.","Short_answer":"Sustained weight loss is Recommend for knee osteoarthritis OtherTreatment. The strength of recommendation is moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Sustained weight loss is Recommend for knee osteoarthritis OtherTreatment. The strength of recommendation is moderate. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nSustained weight loss is recommended to improve pain and function in overweight and obese patients with knee osteoarthritis.\nThere were 1 high (Jenkinson et. al 2009), 1 moderate (Miller 2006), and 2 low strength (Focht 2005, Rejeski 2002) studies evaluating diet and exercise as weight loss interventions to treat knee osteoarthritis. Overall pain and function improved with weight loss achieved through a combination of diet and exercise. However, when evaluating only diet vs control, 2 high (Bliddal 2011, Christensen 2015), 2 moderate (Messier 2013, Mihalko 2018) and 2 low strength (Rejeski 2002, Fochyt 2005) there was no clear clinically significant change in patient outcomes. Specifically, Christensen et al, 2015 published a high-quality study investigating the effect of weight on symptoms of knee osteoarthritis. They showed no significant difference in pain and function at 1 year. Bliddal et al, 2010 published another high-quality study which investigated the effect of weight loss on symptoms of knee OA in the obese patient, showing that perceived pain (via WOMAC) was significantly lessened despite not being able to show improvement in function and quality of life at 1 year.\n\nThere were 2 moderate strength studies (Messier 2013, Mihalko 2018) which evaluated diet vs exercise, which favored exercises. To note, Messier et al 2013 published results of the IDEA trial with moderate quality study which was an attempt to determine if a 10% reduction in body weight (induced by diet, with or without exercise) would improve “clinical and mechanistic” outcomes in sedentary lifestyle patients (BMI 27 thru 41). Interestingly, in this primary study, they were unable to show an improvement in WOMAC pain but they did show improvement in the WOMAC function subscale, and also showed improvements in the 6-minute walk test.\n\nGiven the current evidence, it is at the discretion of the surgeon as to which approach is utilized to address weight loss, however a combination of diet and exercises appears to be the preferred alternative.\n\nThe Weight Loss Intervention recommendation has been downgraded one level because of inconsistent evidence.","RecommendationStatus":"Recommend","StrengthofRecommendation":"moderate","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Tai chi recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Tai chi is Recommend for Knee osteoarthritis ExerciseTreatment and Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n","Full_answer":"Tai chi is Recommend for Knee osteoarthritis ExerciseTreatment and Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nTai chi is a traditional Chinese mind-body practice that com_x005f_x0002_bines meditation with slow, gentle, graceful movements, deep diaphragmatic breathing, and relaxation. The efficacy of tai chi may reflect the holistic impact of this mind-body practice on strength, balance, and fall prevention, as well as on depression and self efficacy.\n\nTai chi is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Strong The certainty of evidence is not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\nTai chi is a traditional Chinese mind-body practice that com_x0002_bines meditation with slow, gentle, graceful movements, deep diaphragmatic breathing, and relaxation. The efficacy of tai chi may reflect the holistic impact of this mind-body practice on strength, balance, and fall prevention, as well as on depression and self efficacy.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is TENS that can be used at home recommended for Physical\nTreatment of osteoarthritis.","Short_answer":"TENS that can be used at home is Recommend for Knee osteoarthritis PhysicalTreatment and Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"TENS that can be used at home is Recommend for Knee osteoarthritis PhysicalTreatment and Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nClinicians need to provide sufficient instructions on self-use, and consider individual accessibility and affordability.\nTENS uses low voltage electric current delivered through electrodes fixed to the skin to affect peripheral nerve activity (neuromodulation) as a mechanism to modify nociception and the experience of pain. Portable TENS units are now widely available for people to use at home as a self-management strategy. Unlike other electrotherapy devices, portable TENS may be used as a continuous therapy by individuals to modulate pain, allowing them to engage in other activities while the unit is active.\n\nNo adverse events have been reported in the included trials. However, clinicians should provide information to people about how to use portable TENS units safely and minimise the risks of possible skin irritation\n","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is The use of appropriate and comfortable shoes recommended  for Physical Treatment of osteoarthritis.","Short_answer":"The use of appropriate and comfortable shoes is recommended is Recommend for Knee osteoarthritis PhysicalTreatment and hip osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.","Full_answer":"The use of appropriate and comfortable shoes is recommended is Recommend for Knee osteoarthritis PhysicalTreatment and hip osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\n\nAlthough research evidence is scant, the group was unanimous in its view that the use of appropriate footwear should be recommended in patients with hip or knee OA. Shoes may help through different mechanisms, such as acting as shock absorbers or controlling foot pronation. Appropriate shoes implies no raised heel, thick, shock-absorbing soles, support for the arches of the foot and a shoe size big enough to give a comfortable space for the toes. In patients with hip OA there is no evidence to support the effect of specific shoes or insoles on pain or function. In patients with knee OA, the use of shoes with shock-absorbing\ninsoles for 1 month reduced pain and improved physical function in a pre–post test design. No differences in knee pain from the use of specialised shoes (unstable Masai technology shoe or variable-stiffness shoe) compared with conventional athletic shoes have been seen, but reduced pain was seen in both groups over time. In addition, decreased knee joint loads were found when specialised mobility shoes were used. The literature on the effectiveness of the use of lateral wedged insoles in patients with medial knee OA found no significant effect on pain or function. There is no support for whether one type of insole would be better than\nanother, and adverse effects including foot-sole pain, low-back pain and popliteal pain have been reported. In light of evidence for no clinical effects of the use of lateral wedged insoles and the report of adverse effects, the group rejected the recommendation.\n","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Ib"},{"Guideline specific question":"Is therapeutic ultrasound recommended for Physical\nTreatment of osteoarthritis.","Short_answer":"Therapeutic ultrasound is Not Recommend for Knee osteoarthritis PhysicalTreatment or Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Therapeutic ultrasound is Not Recommend for Knee osteoarthritis PhysicalTreatment or Hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Moderate. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n\nTherapeutic ultrasound is the application of high-frequency sound waves to soft tissues via a treatment head moved over the surface of the skin. It is a passive treatment typically provided by a clinician over a number of treatment sessions\nGenerally, there is no evidence to suggest that ultrasound therapy is unsafe. In view of its mechanisms of action, ultrasound therapy is rather unlikely to cause serious adverse events, but active surveillance of harms with formal monitoring of potential adverse events is clearly desirable.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Low\/Moderate"},{"Guideline specific question":"Is Tibiofemoral knee braces recommended for Physical Treatment of osteoarthritis.","Short_answer":"Tibiofemoral knee braces is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Tibiofemoral knee braces is Recommend for Knee osteoarthritis PhysicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nTibiofemoral knee braces are strongly recommended for patients with knee OA in whom disease in 1 or both knees is causing a sufficiently large impact on ambulation, joint sta_x005f_x0002_bility, or pain to warrant use of an assistive device, and who are able to tolerate the associated inconvenience and burden associated with bracing.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is TNF Inhibitors recommended for Pharmacologic Treatment of  osteoarthritis.","Short_answer":"TNF Inhibitors is Not Recommend for hand osteoarthritis PharmacologicTreatment, knee osteoarthritis PharmacologicTreatment or hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"TNF Inhibitors is Not Recommend for hand osteoarthritis PharmacologicTreatment, knee osteoarthritis PharmacologicTreatment or hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nInitial observations addressing the use of anti–nerve growth factor (anti-NGF) agents suggest that significant analgesic benefits may occur but that incompletely explained important safety issues may arise. A small subset of patients treated with these agents had rapid joint destruction leading to early joint replacement. The FDA temporarily halted clinical trials of anti-NGF as a result, but trials have since resumed, with ongoing collection of longer-term efficacy and safety data. As none of these agents were approved for use by the FDA and the longer-term data were not available at the time of the literature review and Voting Panel meeting, we are unable to make recommendations regarding the use of anti-NGF therapy\nTumor necrosis factor inhibitors and interleukin-1 receptor antagonists have been studied in trials using both subcutaneous and intraarticular routes of administration. Efficacy has not been demonstrated, including in erosive hand OA. Therefore, given their known risks of toxicity, we strongly recommended against their use for any form of OA.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Ib"},{"Guideline specific question":"Is Topical Capsaicin recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Topical Capsaicin is Not Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nTopical capsaicin is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nTopical capsaicin is Not Recommend for Knee \nosteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nTopical capsaicin is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Topical Capsaicin is Not Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nWe conditionally recommend against the use of topical capsaicin in hand OA because of a lack of direct evidence to support use, as well as a potentially increased risk of contamination of the eye with use of topical capsaicin to treat hand OA. \nTopical capsaicin is conditionally recommended for treat_x005f_x0002_ment of knee OA due to small effect sizes and wide confidence intervals in the available literature.\n\nTopical capsaicin is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nIn hip OA, the depth of the joint beneath the skin surface suggests that topical capsaicin is unlikely to have a meaningful effect, and thus, the Voting Panel did not examine use of topical capsaicin in hip OA.\nTopical capsaicin is conditionally recommended for treat_x0002_ment of knee OA due to small effect sizes and wide confidence intervals in the available literature.topical capsaicin is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nCapsaicin is the neurotoxin of hot chilli peppers. It binds selectively to the vanilloid compound receptor (Transient Receptor Potential Vanilloid 1 [TRPV1]) of type C afferent fibres, and increases P substance in synaptic cleft.101 While first applications of capsaicin are associated with a burning sensation over the applied surface, with continued use, persistent desensitisation and analgesia occurs because of P substance neural depletion, and reversible and selective destruction of primary afferent fibres\nMild application site burning was the most common adverse event associated with the topical use of capsaicin (35–100%), but rapidly ameliorates with continuing use.102 There have been no reports of systemic toxicity with the use of topical capsaicin in OA.\n\nTopical capsaicin is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nCapsaicin is the neurotoxin of hot chilli peppers. It binds selectively to the vanilloid compound receptor (Transient Receptor Potential Vanilloid 1 [TRPV1]) of type C afferent fibres, and increases P substance in synaptic cleft.101 While first applications of capsaicin are associated with a burning sensation over the applied surface, with continued use, persistent desensitisation and analgesia occurs because of P substance neural depletion, and reversible and selective destruction of primary afferent fibres.\nMild application site burning was the most common adverse event associated with the topical use of capsaicin (35–100%), but rapidly ameliorates with continuing use.102 There have been no reports of systemic toxicity with the use of topical capsaicin in OA.","RecommendationStatus":"Not Recommend\/Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Iib\/Low"},{"Guideline specific question":"Is Topical nonsteroidal antiinflammatory drugs (Topical NSAIDs)\nrecommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Topical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nTopical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nTopical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommended for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nTopical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommended for other than knee joint osteoarthritis PharmacologicalTreatment. The strength of recommendation is Moderate. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nTopical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nTopical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommend for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Strong The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Topical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nPractical considerations (e.g., frequent hand washing) and the lack of direct evidence of efficacy in the hand lead to a conditional recommendation for use of topical NSAIDs in hand OA.\nIn keeping with the principle that medications with the least systemic exposure (i.e., local therapy) are preferable, topical NSAIDs should be considered prior to use of oral NSAIDs.\n\nTopical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nPractical considerations (e.g., frequent hand washing) and the lack of direct evidence of efficacy in the hand lead to a conditional recommendation for use of topical NSAIDs in hand OA.\nIn keeping with the principle that medications with the least systemic exposure (i.e., local therapy) are preferable, topical NSAIDs should be considered prior to use of oral NSAIDs.\nTopical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommended for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nEvidence on topical NSAIDs came from studies including people with knee osteoarthritis and 1 study including people with hand osteoarthritis. The evidence showed no clinically important difference for hand osteoarthritis, but the committee noted this was uncertain because it was based on 1 study. The committee noted that although evidence only showed benefit for knee osteoarthritis, other people with osteoarthritis-affected joints may also benefit from topical NSAIDs. There was some evidence showing that topical capsaicin reduces pain in knee osteoarthritis, but not hand osteoarthritis, and has minimal adverse events. However, capsaicin is more expensive and topical NSAIDs were considered a better option. The committee made a recommendation for research on topical medicines for osteoarthritis-affected joints other than the knee.\nTopical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommended for other than knee joint osteoarthritis PharmacologicalTreatment. The strength of recommendation is Moderate. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nEvidence on topical NSAIDs came from studies including people with knee osteoarthritis and 1 study including people with hand osteoarthritis. The evidence showed no clinically important difference for hand osteoarthritis, but the committee noted this was uncertain because it was based on 1 study. The committee noted that although evidence only showed benefit for knee osteoarthritis, other people with osteoarthritis-affected joints may also benefit from topical NSAIDs. There was some evidence showing that topical capsaicin reduces pain in knee osteoarthritis, but not hand osteoarthritis, and has minimal adverse events. However, capsaicin is more expensive and topical NSAIDs were considered a better option. The committee made a recommendation for research on topical medicines for osteoarthritis-affected joints other than the knee.\nTopical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 Osteoarthritis Research Society International (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.\nThe recommendation is for patients with and without comorbidities.\nHigh quality evidence involving a large number of patients showed modest benefits over the course of 12 weeks. The adverse events from topical NSAIDs were minimal and mild. The most common adverse events associated with topical NSAIDs were local skin reactions, which were minor and transient. Topical NSAIDs were also strongly recommended for Knee OA patients with GI or CV comorbidities and for patients with frailty for the same\nreasons as described above.\nTopical nonsteroidal antiinflammatory drugs (Topical NSAIDs) is Recommend for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nTopical NSAIDs should be used to improve function and quality of life for treatment of osteoarthritis of the knee, when not contraindicated.\nTwelve high-quality studies (Baer 2005, Roth 2004, Conaghan 2013, Simon 2009, Kneer 2013, Rother 2013, Bookman 2004, Wadsworth 2016, Sandelin 1997, Dehghan 2019, Dehghan 2020, Rother 2007) and two moderate-quality studies (Barthel 2009, Ottillinger 2001) show that topical NSAIDs could result in improved function and quality of life over placebo gel. However, inconsistent evidence suggests no significant difference in pain and adverse events between topical NSAIDs and control.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional\nStrong\nStrongModerate\nStrong\nConditional\nStrong","CertaintyofEvidence":"Ia\/Not specified"},{"Guideline specific question":"Is Tramadol recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Tramadol is Recommend for Hand osteoarthritis PharmacologicTreatment, Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Tramadol is Recommend for Hand osteoarthritis PharmacologicTreatment, Knee osteoarthritis PharmacologicTreatment and Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ia (Meta-analysis of randomised controlled trials). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nHowever, RCT evidence addressing the use of tramadol and other opioids for periods longer than 1 year is not available. C\nRecent work has highlighted the very modest level of ben_x005f_x005f_x005f_x005f_x0002_eficial effects in the long-term (3 months to 1 year) management of non-cancer pain with opioids.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Ia"},{"Guideline specific question":"Is transcutaneous electrical nerve stimulation (TENS) \nrecommended for Physical Treatment of osteoarthritis.","Short_answer":"Transcutaneous electrical nerve stimulation (TENS)  is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nTranscutaneous electrical nerve stimulation (TENS)  is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nTranscutaneous electrical nerve stimulation (TENS)  is Not Recommend for hip osteoarthritis PhysicalTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nTranscutaneous electrical nerve stimulation (TENS)  is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Transcutaneous electrical nerve stimulation (TENS)  is Not Recommend for knee osteoarthritis PhysicalTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nStudies have demonstrated a lack of benefit for knee OA. Studies examining the use of TENS have been of low quality with small size and variable controls, making comparisons across trials difficult. \nTranscutaneous electrical nerve stimulation (TENS)  is may be used for knee osteoarthritis PhysicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nA meta-analysis was performed using pain data from two high-quality studies (Palmer 2014, Inal 2016) and one moderate-quality study (Atamaz 2012) in which Transcutaneous Electrical Nerve Stimulation (TENS) was compared to sham TENS in subjects with knee osteoarthritis. Blinding effectiveness was considered fair in all three studies. The results of the meta-analysis can be seen in Figure 15 in the appendix. The overall findings were in favor of receiving TENS for reducing pain in subjects with knee osteoarthritis. A similar meta-analysis was performed using the same studies for measures of function. The results of this meta-analysis can be seen in Figure 16 in the appendix. The overall findings did not favor the use of TENS to improve measures of function in subjects with knee osteoarthritis.\nThe Transcutaneous Electrical Nerve Stimulation recommendation has been downgraded two levels because of inconsistent evidence and a lack of internal consistency with recommendations of equal supporting evidence.\n\nTranscutaneous electrical nerve stimulation (TENS)  is Not Recommend for hip osteoarthritis PhysicalTreatment. The strength of recommendation is Strong. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nStudies examining the use of TENS have been of low quality with small size and variable controls, making comparisons across trials difficult.\n\nTranscutaneous electrical nerve stimulation (TENS)  is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nAlthough there were many studies on electrotherapy, the findings were inconsistent and mostly showed little benefit. The committee acknowledged that most studies were small, with fewer than 100 participants, and that evidence from direct comparisons of electrotherapy with other interventions was uncertain. The committee agreed there is not enough evidence to recommend electrotherapy for people with osteoarthritis.Extracorporeal shockwave therapy showed some evidence of benefit compared with a sham intervention. However, this evidence was uncertain because of the small trial sizes and challenges in using appropriate sham techniques. The committee agreed that further research using an appropriate sham with more than 51 participants in each study arm is needed and made a recommendation for research on extracorporeal shockwave therapy.","RecommendationStatus":"Not Recommend\/may be used","StrengthofRecommendation":"Strong\/limited\/Not specified","CertaintyofEvidence":"III\/Not specified"},{"Guideline specific question":"Is transdermal opioids recommended for Pharmacologic\nTreatment of osteoarthritis.","Short_answer":"Transdermal opioids is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \n","Full_answer":"Transdermal opioids is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.  \n\nTransdermal opioid patch is a long-acting formulation with a delayed onset of effect initially and a prolonged duration of action and, as such, these are best reserved for opioid-tolerant individuals with stable opioid requirements. Transdermal opioid delivery avoids first-pass metabolism by the liver, increasing bio-availability and limiting variation in plasma concentration.99\nCompared with oral opioid, transdermal patches increase drug bio-availability, which enables the use of lower drug doses, thus reducing the incidence of adverse events. However, from the evidence, the risk of adverse effects significantly increased after administration of opioids, regardless of the delivery methods. Other potential risks, such as deliberate misuse, are also not different from oral opioids.\n\n","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Low"},{"Guideline specific question":"Is Turmeric recommended for Pharmacological Treatment of osteoarthritis.","Short_answer":"Turmeric is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).","Full_answer":"Turmeric is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nTurmeric may be helpful in reducing pain and improving function for patients with mild to moderate knee osteoarthritis.\nOne high-quality study (Srivastava 2016) that met inclusion criteria showed that Turmeric extract could be used over control to improve adverse events, function, and pain in patients with osteoarthritis of the knee.\n\nThis recommendation has been downgraded two levels because of inconsistency and the need for additional clarity of efficacy.","RecommendationStatus":"may be used","StrengthofRecommendation":"limited","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is ultrasound therapy recommended for Physical Treatment of  osteoarthritis.","Short_answer":"Ultrasound therapy is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Ultrasound therapy is Not recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nAlthough there were many studies on electrotherapy, the findings were inconsistent and mostly showed little benefit. The committee acknowledged that most studies were small, with fewer than 100 participants, and that evidence from direct comparisons of electrotherapy with other interventions was uncertain. The committee agreed there is not enough evidence to recommend electrotherapy for people with osteoarthritis.Extracorporeal shockwave therapy showed some evidence of benefit compared with a sham intervention. However, this evidence was uncertain because of the small trial sizes and challenges in using appropriate sham techniques. The committee agreed that further research using an appropriate sham with more than 52 participants in each study arm is needed and made a recommendation for research on extracorporeal shockwave therapy.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Ultrasound-guided intraarticular glucocorticoid injection recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Ultrasound-guided intraarticular glucocorticoid injection is Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Ultrasound-guided intraarticular glucocorticoid injection is Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Not specified. According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nWhen available, ultrasound guidance for steroid injection may help ensure accurate drug delivery into the joint, but is not required for knee and hand joints.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is unloading shoes, minimalist footwear or rocker-sole shoes recommended for Other Treatment of osteoarthritis.","Short_answer":"Unloading shoes, minimalist footwear or rocker-sole shoes is Not Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Unloading shoes, minimalist footwear or rocker-sole shoes is Not Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nHowever, clinicians may consider advising people with OA to wear footwear with shock-absorbing properties and avoid high-heeled shoes\nA number of footwear styles have been developed and\/or marketed for OA and other musculoskeletal conditions. Unloading shoes are walking shoes that contain variable-density midsoles and a lateral wedge insole, designed to reduce medial tibiofemoral compartment knee loads. Minimalist shoes are footwear styles that are flexible, flat and non-heeled, advertised to reflect barefoot walking and develop intrinsic foot muscle strength. Rocker-sole shoes are shoes with a thicker than normal sole and a convex curvature in the sagittal plane, designed to create an unstable platform, thereby encouraging increased muscle activity while walking.\nThere is a low likelihood of adverse effects.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Very low"},{"Guideline specific question":"Is valgus unloading\/realignment braces recommended for Other Treatment of osteoarthritis.","Short_answer":"Valgus unloading\/realignment braces is Not Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Valgus unloading\/realignment braces is Not Recommend for Knee osteoarthritis OtherTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nValgus unloading braces provide a valgus-directed force that aims to reduce varus malalignment in those with medial tibiofemoral compartment knee OA\nThere is a low likelihood of adverse effects, which can include skin irritation","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Low"},{"Guideline specific question":"Is viscosupplementation injection recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Viscosupplementation injection is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Viscosupplementation injection is Not Recommend for Knee osteoarthritis PharmacologicTreatment or Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\n\nHyaluronate is a naturally occurring component of cartilage and synovial fluid, and responsible for the rheologic properties of synovial fluid, enabling it to act as a lubricant or shock absorber. In OA, synovial hyaluronate is depolymerised and cleared at higher rates than normal. The therapeutic goal of intraarticular hyaluronate administration is to provide and maintain intraarticular lubrication. This in turn increases the viscoelastic properties of synovial fluid, and is sometimes termed ‘viscosupplementation’. It has also been reported that hyaluronate exerts anti-inflammatory, analgesic and possibly chondroprotective effects on the articular cartilage and joint synovium.\nMinor side effects include pain at the injection site (1–33%), local joint pain and swelling (","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional\/Strong","CertaintyofEvidence":"Low"},{"Guideline specific question":"Is Vitamin D recommended for Pharmacologic Treatment of osteoarthritis.","Short_answer":"Vitamin D is Not Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nVitamin D is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nVitamin D is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nVitamin D is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\n\nVitamin D is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\nVitamin D is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Vitamin D is Not Recommend for Hand osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nin addition, limited and questionable health benefits from vitamin D supplementation have been suggested in other contexts\nA number of trials in OA demonstrated small effect sizes with vitamin D treatment, while others have shown no benefit and pooling data across studies yielded null results.\n\nVitamin D is Not Recommend for knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nin addition, limited and questionable health benefits from vitamin D supplementation have been suggested in other contexts\nA number of trials in OA demonstrated small effect sizes with vitamin D treatment, while others have shown no benefit and pooling data across studies yielded null results.\nVitamin D is Not Recommend for Knee osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nVitamin D is a hormone that controls calcium levels in the blood, which is crucial for bone, cartilage and muscle development. Oral supplementation with vitamin D is readily available. In the studies analysed, a daily dose of 800–2000 IU, or a monthly dose of 50,000–60,000 IU, were used.\nVitamin D is relatively safe; however, there is a non-statistically significant increase in hypercalciuria. There is no clinical effect or safety concern.\nVitamin D is may be used for knee osteoarthritis PharmacologicalTreatment. The strength of recommendation is limited. The certainty of evidence is Not specified. According to 2021 American Academy of Orthopedic Surgeons (AAOS) Management of Osteoarthritis of the Knee (Non-Arthroplasty).\nVitamin D may be helpful in reducing pain and improving function for patients with mild to moderate knee osteoarthritis.\nThree high-quality studies (McAlindon 2013, Sanghi 2013, and Jin 2016) and 1 moderate-quality study (Arden 2016) that met inclusion criteria showed either improvement or no significant difference in patient outcomes for those with osteoarthritis of the knee between Vitamin D and control. \nThis recommendation has been downgraded two levels because of inconsistency and the need for additional clarity of efficacy.\n\nVitamin D is Not Recommend for hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is IIb(At least one type of quasi-experimental study). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nin addition, limited and questionable health benefits from vitamin D supplementation have been suggested in other contexts\nA number of trials in OA demonstrated small effect sizes with vitamin D treatment, while others have shown no benefit and pooling data across studies yielded null results.\nVitamin D is Not Recommend for Hip osteoarthritis PharmacologicTreatment. The strength of recommendation is Conditional. The certainty of evidence is Very low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.\nVitamin D is a hormone that controls calcium levels in the blood, which is crucial for bone, cartilage and muscle development. Oral supplementation with vitamin D is readily available. In the studies analysed, a daily dose of 800–2000 IU, or a monthly dose of 50,000–60,000 IU, were used.\nVitamin D is relatively safe; however, there is a non-statistically significant increase in hypercalciuria. There is no clinical effect or safety concern.\n\n","RecommendationStatus":"Not Recommend\/may be used","StrengthofRecommendation":"Conditional\/limited","CertaintyofEvidence":"Iib\/Low\/Very low\/Not specified"},{"Guideline specific question":"Is Vocational rehabilitation recommended for Physical Treatment of osteoarthritis.","Short_answer":"Vocational rehabilitation is Recommend for Knee osteoarthritis PhysicalTreatment and hip osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\n.","Full_answer":"Vocational rehabilitation is Recommend for Knee osteoarthritis PhysicalTreatment and hip osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\n People with hip or knee OA at risk of work disability or who want to start\/return to work should have rapid access to vocational rehabilitation, including counselling about modifiable work-related factors such as altering work behaviour, changing work tasks or altering work hours, use of assistive technology, workplace modification, commuting to\/from work and support from management, colleagues and family towards employment\nThe proportion of employed people who have work disability due to OA is substantial. Although there are known occupational risk factors for knee OA and its progression—for example, heavy work, knee squatting or bending, lifting and specific sports, there are no studies to support the effect of vocational rehabilitation on pain, physical function or quality of life specifically in patients with hip or knee OA. One study in patients with peripheral OA found that a specialist-run, protocol-based early intervention significantly reduced the number of days of sick leave compared with standard primary care. The intervention was administered by a rheumatologist and comprised three main elements: education, protocol-based clinical management and administrative duties. The educational part included information about the condition, reassurance that serious disease was not present, self-management, exercises, ergonomic care, booklets, optimal level of physical activity and early return to work. Descriptive studies have found that environmental factors, such as having access to public transport or a car for mobility outside home are facilitators and that the absence of these is associated with limitations to daily activity. Some elements in this recommendation may have to be adapted to the country in which they are executed, since availability and accessibility of services in the healthcare and social security system may vary greatly. The group concluded that there is a clear paucity of research evidence for work-related interventions in people with hip and knee OA.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"III"},{"Guideline specific question":"Is walking aids (such as walking sticks) recommended for Physical Treatment of osteoarthritis.","Short_answer":"Walking aids (such as walking sticks) is Recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Walking aids (such as walking sticks) is Recommended for  osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\n\nEvidence from a small study on walking aids showed that they benefit quality of life andreduce pain compared with no device. The committee agreed that walking aids have the advantage of reducing the pressure in the leg joints, which helps stability and movement to encourage physical activity and independence. This is particularly the case while waiting for joint replacement or if surgery cannot be undertaken, because the aid helps support exercise and confidence with walking. Overall, they agreed that the evidence, supported by their expert opinion, was enough to recommend walking aids for people with lower limb osteoarthritis.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Not specified"},{"Guideline specific question":"Is Walking aids, assistive technology and adaptations at home and\/or at work recommended for Physical Treatment of osteoarthritis.","Short_answer":"Walking aids, assistive technology and adaptations at home and\/or at work  is may be used for Knee osteoarthritis PhysicalTreatment and hip osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.","Full_answer":"Walking aids, assistive technology and adaptations at home and\/or at work  is may be used for Knee osteoarthritis PhysicalTreatment and hip osteoarthritis PhysicalTreatment. The strength of recommendation is Not specified. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2013 European League Against Rheumatism(EULAR) recommendations for the non-pharmacological core management of hip and knee osteoarthritis.\n\nWalking aids, assistive technology and adaptations at home and\/or at work should be considered, to reduce pain and increase participation—for example:\na† a walking stick used on the contralateral side, walking frames and wheeled ‘walkers’\nb* increasing the height of chairs, beds and toilet seats\nc* hand-rails for stairs\nd* replacement of a bath with a walk-in shower\ne* change to car with high seat level, easy access and automatic gear change\nThe frequent use of assistive technology and the high satisfaction rates with its use indicate that walking aids, assistive technology and adaptations are important and useful for people with hip or knee OA. There are, however, no clinical trials to substantiate elements in this proposition, except for the use of a cane in patients with knee OA. However, the group was unanimous in its view that in all patients with hip or knee OA walking aids, assistive technology and adaptations at home and\/or at work should be considered systematically and recurrently. The group noted that the value of some of these interventions is so obvious and has an immediate effect in individual cases that further research into the effectiveness of specific devices or adaptations can hardly be expected. Cross-sectional studies show that walking aids, assistive technology and adaptations at home and\/or work are important and often used by people with hip or knee OA. Most people with severe hip (63%) or knee pain (90%) reported the use of walking aids. In people with arthritis, a mean of 9.9–10.8 devices has been reported to be in use and the satisfaction rate for all categories of device was more than 87%. Moreover, unmet needs for new assistive technology to help perform activities that individuals could not do were identified. Having access to a walking aid or other assistive technologies can be a help and provide security for individuals with constant fluctuating symptoms. The group found that future observational studies on the use, satisfaction from and suggestions for\nnew technology or improvements of existing technology are needed","RecommendationStatus":"may be used","StrengthofRecommendation":"Not specified","CertaintyofEvidence":"III"},{"Guideline specific question":"Is Walking recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Walking is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Walking is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Low"},{"Guideline specific question":"Is Muscle-strengthening exercise recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Muscle-strengthening exercise is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Muscle-strengthening exercise is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Low"},{"Guideline specific question":"Is Tai Chi recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Tai Chi is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Tai Chi is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Strong. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Strong","CertaintyofEvidence":"Low"},{"Guideline specific question":"Is wedged insoles recommended for Physical\nTreatment of osteoarthritis.","Short_answer":"Wedged insoles is Not Recommend for knee osteoarthritis PhysicalTreatment or hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Wedged insoles is Not Recommend for knee osteoarthritis PhysicalTreatment or hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nThe currently available literature does not demonstrate clear efficacy of lateral or medial wedged insoles.\nwedged insoles is Not Recommend for hip osteoarthritis PhysicalTreatment. The strength of recommendation is Conditional The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee\n\nThe currently available literature does not demonstrate clear efficacy of lateral or medial wedged insoles.","RecommendationStatus":"Not Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"III"},{"Guideline specific question":"Is Weight loss recommended for Other Exercise Treatment of osteoarthritis.","Short_answer":"Weight loss is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nWeight loss is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nWeight loss is Recommended for  osteoarthritis OtherTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.","Full_answer":"Weight loss is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nA loss of ≥5% of body weight can be associated with changes in clinical and mechanistic outcomes. Furthermore, clinically important benefits continue to increase with weight loss of 5–10%, 10–20%, and >20% of body weight. The efficacy of weight loss for OA symptom management is enhanced by use of a concomitant exercise program.\nA dose-response has been noted with regard to the amount of weight loss that will result in symptom or functional improvement in patients with OA.\n\nWeight loss is Recommend for Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Ib(At least one randomised controlled trial). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\nA loss of ≥5% of body weight can be associated with changes in clinical and mechanistic outcomes. Furthermore, clinically important benefits continue to increase with weight loss of 5–10%, 10–20%, and >20% of body weight. The efficacy of weight loss for OA symptom management is enhanced by use of a concomitant exercise program.\nA dose-response has been noted with regard to the amount of weight loss that will result in symptom or functional improvement in patients with OA.\n\nWeight loss is Recommended for  osteoarthritis OtherTreatment. The strength of recommendation is Not specified. The certainty of evidence is Not specified. According to 2022 National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis in over 16s: diagnosis and management.\nany amount of weight loss is likely to be beneficial, but losing 10% of their body weight is likely to be better than 5%.\nThe committee acknowledged that evidence on the effects of weight loss for people with osteoarthritis had limitations. However, for people with knee osteoarthritis, the evidence generally showed that as more weight was lost, the benefits for quality of life, pain and physical function increased. The committee acknowledged the challenges people can have with losing weight and maintaining this weight loss, and recommended that they are supported. \nThe committee acknowledged that, for people who are overweight, losing more than 10% of their body weight may be the most beneficial, but this may not be achievable for all. They wanted to emphasise that losing any amount of weight would be beneficial, but that losing more would have more benefits. They agreed that also explaining that losing 10% of their body weight is likely to be better than 5% might help provide an incentive and encourage weight loss. They also agreed that advising on the amount of weight to lose can help people with osteoarthritis by providing a target for them to work towards. The committee determined that, although evidence was from people with knee osteoarthritis, this could be applied to people with other osteoarthritis-affected joints. This is because of the potential additional benefits of weight loss seen in other populations, such as reducing inflammatory factors, that may be beneficial for all joint sites and general wellbeing. The committee also agreed that osteoarthritis is a multi-joint disease and people presenting with the condition in 1 joint may end up getting it in another Weight loss.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional\/Not specified","CertaintyofEvidence":"Ib\/Not specified"},{"Guideline specific question":"Is weight management plus exercise recommended for Exercise\nTreatment of osteoarthritis.","Short_answer":"Weight management plus exercise is Recommend for Knee osteoarthritis ExerciseTreatment and  Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis.","Full_answer":"Weight management plus exercise is Recommend for Knee osteoarthritis ExerciseTreatment and  Hip osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is Low. According to 2018 Royal Australian College of General Practitioners Guideline for the management of knee and hip osteoarthritis. \nFor those who are overweight (body mass index [BMI] ≥25 kg\/m2 ) or obese (BMI ≥30 kg\/m2 ), a minimum weight loss target of 5–7.5% of body weight is recommended. It is beneficial to achieve a greater amount of weight loss given that a relationship exists between the amount of weight loss and symptomatic benefits. Weight loss should be combined with exercise for greater benefits. For people of healthy body weight, education about the importance of maintaining healthy body weight is essential.\nWeight loss is usually achieved through a combination of dietary modification and exercise, and in extreme cases, bariatric surgery.\nThere are low risk of harms associated with this recommendation. However, there are currently no clearly defined BMI thresholds for older adults (aged >65 years). There is evidence to suggest that the cut-offs should be higher for older adults.84 The need for weight loss in older adults should be considered on an individual basis. If weight loss is appropriate, care should be taken to ensure maintenance of lean body mass and bone density, especially when it is accompanied with high intensity resistance and\/or impact loading training. People should be monitored for bone health if needed and strengthening exercise included as part of the treatment program.","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"Low\/Very low"},{"Guideline specific question":"Is Yoga recommended for Exercise Treatment of osteoarthritis.","Short_answer":"Yoga is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","Full_answer":"Yoga is Recommend for Knee osteoarthritis ExerciseTreatment. The strength of recommendation is Conditional. The certainty of evidence is III (Descriptive studies, such as comparative studies, correlation studies or case–control studies). According to 2019 American College of Rheumatology\/Arthritis Foundation(ACR) Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.\n\nYoga is a mind-body practice with origins in ancient Indian philosophy and typically combines physical postures, breath_x005f_x005f_x005f_x005f_x0002_ing techniques, and meditation or relaxation (National Center for Complementary and Integrative Health [\n. Due to lack of data, no recommendation can be made regarding use of yoga to help manage symptoms of hip OA. Other mind-body practices could not be assessed due to insufficient evidence, as well as a lack of standard definitions of certain interventions (hypnosis, qi gong).","RecommendationStatus":"Recommend","StrengthofRecommendation":"Conditional","CertaintyofEvidence":"III"}]