Quality of clinical practice guidelines relevant to rehabilitation of knee osteoarthritis: A systematic review.

OBJECTIVE: This systematic review summarized the rehabilitation recommendations for treating and managing knee osteoarthritis (OA) in practice guidelines and evaluated their applicability and quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. DATA SOURCES: PubMed, the Cochrane Library, EMBASE, CINAHL, PEDro, Guideline central, Guideline International Network and Agency for Healthcare Research and Quality (AHRQ) were used to search for relevant studies published between 1 January 2008 and 31 May 2022. METHODS: AGREE II was used to evaluate the included guidelines quality, SPSS 25.0 statistical software was used for data analysis, and the intra-group correlation coefficient value was calculated to verify the consistency between the raters. The two-way random effects model was used to calculate concordance scores, and each domain's total scores were calculated. Additionally, the median and interquartile range for domain and total scores were calculated. RESULTS: Twenty-four guidelines recommending knee OA rehabilitation were included. Inter-rater consistency evaluation ranged from 0.62 to 0.90. The domains where the guideline's overall and rehabilitation parts scored highest and lowest were scope and purpose (domain 1) and applicability (domain 5), respectively. The highly recommended rehabilitation opinions included aerobic exercise programs (21/24), weight control (16/24), self-education and management (16/24), gait/walking aids (7/24), and tai chi (6/24). However, the orthopedic insole and hot/cold therapy roles remain controversial. CONCLUSION: The clinical practice guidelines' overall quality for knee OA rehabilitation is good; however, the applicability is slightly poor. Therefore, we should improve the promoting factors and hindering factors, guideline application recommendations, tools, and resources when developing relevant guidelines.

Effects of cold-damp and hot-damp environment on VEGF and IL-1 expression in joint cartilage cells in adjuvant arthritis in rats.

OBJECTIVE: To study the effects of environmental factors on the degree of injury and expression of vascular endothelial growth factor (VEGF) and interleukin-1 (IL-1) in cartilage cells of the joint in a rat model of adjuvant arthritis (AA). METHODS: SD rats aged 10 months were randomly divided into 4 groups that varied by temperature and humidity housing conditions and induction of AA: a control group, a model group, a cold-damp group, and a hot-damp group. All groups except the control group were induced with AA. After 4 w, VEGF and IL-1 expression in cartilage cells of ankle joints of hind limbs were observed. RESULTS: Mean area, optical density, and numbers of VEGF- and IL-1-positive cells in the model group, the cold-damp group, and the hot-damp group were significantly higher than that of the control group (all P < 0.05). Optical density and positive cell numbers in the cold-damp group and the hot-damp group were significantly higher than that of the model group (all P < 0.05). Optical density and positive cell numbers in the hot-damp group were significantly higher than that of the cold-damp group. Bone in the hot-damp and cold-damp groups was severely injured. CONCLUSION: Environmental factors such as high humidity combined with either high or low temperature increase the severity of damage and expression of VEGF and IL-1 in cartilage cells of joints in rats induced with AA.