Ayurveda interventions against osteoarthritis – A structured study protocol for systematic review and network meta-analysis

Abstract

BackgroundOsteoarthritis (OA) is an age-related degenerative disease and is the second leading contributor to the global burden of musculoskeletal disorders. Ayurveda is one of the traditional systems of Indian medicine commonly practiced in Southeast Asian countries. Osteoarthritis can be compared with Sandhigata Vata mentioned in the Ayurveda text. Despite having diverse Ayurveda treatment options against OA, there is a lack of evidence-based treatment guidelines. MethodsThis review will be written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the PRISMA extension for network meta-analyses (PRISMA-NMA). Electronic searches will be carried out in PubMed, Scopus, TRIP, INDMED, the Cochrane Register for Controlled Trials (CENTRAL), The Clinical Trials Registry- India (CTRI), AYUSH research portal, and DHARA, and other pre-print repositories since its inception till 31st July 2024. The risk of bias will be assessed with ROB-2, ROBINS-I, and other revised risk of bias tools for cross-over studies and cluster randomized studies recommended by the Cochrane collaboration. To evaluate the credibility of the findings, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method for network meta-analysis will be implemented. A narrative approach to synthesize and report qualitative and quantitative data will be used, and where feasible, we will conduct network meta-analyses using R/STATA software. ConclusionTo rationalize Ayurveda treatment modalities, there is an urgent need to develop and issue clinical practice guidelines containing recommendations for the treatment of OA. This study will facilitate the process by providing the treatment hierarchy to the policymakers and the stakeholders. Protocol registrationThis study has been registered prospectively in PROSPERO [CRD42023423393].