Abstract
Clinical practice guidelines (CPGs) have been developed to summarize evidence about the management of rheumatoid arthritis (RA) and facilitate the uptake of evidence-based knowledge by consumers, health professionals, health administrators and policy makers. The objectives of this review was to assess the quality of CPGS on non-pharmacological management of RA with a standardized and validated instrument - the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool and summarize the key recommendations from these CPGs. Scientific literature databases from 2001 to 2013 were systematically searched and a total of 13 CPGs for RA was identified. Only a minority of AGREE II domains were effectively addressed by the CPGS. Scope and purpose was effectively addressed in 10 out of 13 CPGs, stakeholder involvement in 11 CPGs, rigor of development in 6 CPGs, clarity/presentation in 9 CPGs, editorial independence in 1 CPGs, and applicability in none of the CPGs. The overall quality of the included CPGs according to the 7-point AGREE II scoring system was 4.8±1.04. Patient education/self-management, aerobic, dynamic and stretching exercises were the commonly recommended for the non-pharmacological management of RA by the high-quality CPGs. The general clinical management recommendations tended to be similar among high-quality CPGs. Non-pharmacological management interventions were superficially addressed in more than half of the selected CPGs. CPGs creators should use the AGREE II criteria when developing guidelines. Innovative and effective methods of CPGs implementation to users are needed to ultimately enhance the quality of life of arthritic individuals. In addition, it was difficult to establish between strongly recommended, recommended and weakly recommended, as there is no consensus between the strength of the recommendations between the appraised CPGs.
Highlights
Rheumatoid arthritis (RA) is an autoimmune pathology characterised by inflammation at the joints and in tissues surrounding other organs, which is usually accompanied by severe pain [1]
Evidence-based practice (EBP) can include the use of clinical practice guidelines (CPGs) which are ‘‘systematically developed statements to guide the daily practice of health professionals about optimal health care for specific clinical circumstances’’ [9]
Based on the title and abstract, 811 citations were subsequently excluded because they did not address a CPG related to non-pharmacological management of RA and twelve CPGs were included (Figure S1)
Summary
Rheumatoid arthritis (RA) is an autoimmune pathology characterised by inflammation at the joints and in tissues surrounding other organs, which is usually accompanied by severe pain [1]. The prevalence of RA in the US in 2007 was about 1.5 million adults [2], and women were affected three times more than men [3]. RA carries a great economic impact due to higher incidence in adults during their peak productivity years and the fact that long term treatment is required [5]. The estimated medical expenses for arthritis and rheumatism (excluding cost of time lost from paid or unpaid work) were estimated to be between $1.7 billion and $2.5 billion [6]. There is a need for health professionals to include the best evidence-based practice (EBP) in order to provide optimal care to their patients [8]. EBP can include the use of clinical practice guidelines (CPGs) which are ‘‘systematically developed statements to guide the daily practice of health professionals about optimal health care for specific clinical circumstances’’ [9]
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