Quality and consistency of clinical practice guidelines for diagnosis and management of osteoarthritis of the hip and knee: a descriptive overview of published guidelines.

OBJECTIVE: To present a descriptive overview of the quality and recommendations of clinical practice guidelines (CPGs) on diagnosis or management of osteoarthritis (OA) of the hip and/or knee. DATA SOURCES: CPGs were identified from several research databases (MEDLINE, EMBASE and The Cochrane Library) and guideline-specific databases from 1966 to August 2005. GUIDELINE RETRIEVAL: Thirty-four relevant CPGs were identified. DATA EXTRACTION: Recommendations were extracted from CPGs and categorised into: assessment and diagnosis, pharmacological management, nonpharmacological management, complementary/alternative therapy, or surgery. The quality of the CPGs were assessed by two appraisers using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. DATA SYNTHESIS: Most recommendations for aspects of diagnosis and treatment of OA of the hip and/or knee were consistent among the CPGs included in this study. However, quality varied considerably, with few CPGs being "strongly recommended" according to the AGREE quality appraisal instrument. CONCLUSIONS: Given the number of CPGs available relevant to OA, and the consistency of recommendations within them, and considering the time and resources required for CPG development, future efforts to guide management of OA of the hip and/or knee may be better directed towards adapting existing CPGs to the local context, implementing practices known to be effective, and facilitating research to answer important questions where there is little evidence.

Referral of people with osteoarthritis to self-management programmes: barriers and enablers identified by general practitioners.

PURPOSE: We conducted a qualitative descriptive study involving general practitioners (GPs) in Victoria, Australia, to examine the barriers to, and drivers of, referral of patients with osteoarthritis (OA) to self-management programmes. METHOD: Participating GPs were asked to respond to a series of open-ended questions regarding their referral of patients with OA to self-management programmes and their perception of the advantages and disadvantages of these programmes for people with OA. Interviews were audio-taped, transcribed verbatim, and analysed to identify primary themes in the data. RESULTS: Results suggest current referral of OA patients to self-management programmes from within general practice is influenced by GP-related factors, patient-related factors, and programme-related factors. A major barrier to referral was GPs limited knowledge about the availability of local programmes and the types of services these programmes provide to people with OA. Some GPs felt OA is less conducive to self-management interventions compared to other chronic conditions (e.g., diabetes, asthma) and questioned the clinical benefit of programmes for people with OA. Enablers of GP referral included GP knowledge about content and availability of programmes, positive GP attitudes towards patient involvement in these programmes, and patient awareness of the value and availability of these programmes (i.e., patient-mediated referral). CONCLUSION: This study suggests multiple barriers and drivers of referral of patients with OA to self-management programmes that could be targeted in the future in order to increase referral to, and uptake of, these programmes in general practice.