Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism
Tiraje TUNCER, 1 Hasan Fatih ÇAY, 2 Cahit KAÇAR, 1 Lale ALTAN, 3 Osman Şahap ATİK, 4 Ahmet Turan AYDIN, 5 F. Figen AYHAN, 6 Burcu ÇÖREKÇİ YANIK, 7 Berrin DURMAZ, 8 Nurten ESKİYURT, 9 Hakan GENÇ, 6 Yeşim GÖKÇE KUTSAL, 10 Rezzan GÜNAYDIN, 11 Simin HEPGÜLER, 8 Sami HİZMETLİ, 12 Taciser KAYA, 11 Yeşim KURTAİŞ, 13 Neşe ÖLMEZ, 14 Merih SARIDOĞAN, 15 Dilşad SİNDEL, 9 Birkan SONEL TUR, 13 Serap SÜTBEYAZ, 16 Ömer Faruk ŞENDUR, 17 Hatice UĞURLU, 18 Zeliha ÜNLÜ19
1Department of Physical Medicine and Rehabilitation, Medical Faculty of Akdeniz University, Antalya, Turkey
2Department of Physical Medicine and Rehabilitation and Rheumatology, Antalya Training and Research Hospital Antalya, Turkey
3Department of Physical Medicine and Rehabilitation, Medical Faculty of Uludağ University, Bursa, Turkey
4Department of Orthopaedics and Traumatology, Medical Faculty of Gazi University, Ankara, Turkey
5Department of Orthopaedics and Traumatology, Medical Faculty of Akdeniz University, Antalya, Turkey
6Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital Ankara, Turkey
7Department of Physical Medicine and Rehabilitation, Medical Faculty of Fatih University, Ankara, Turkey
8Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, İzmir, Turkey
9Department of Physical Medicine and Rehabilitation, İstanbul Medical Faculty of İstanbul University, İstanbul, Turkey
10Department of Physical Medicine and Rehabilitation, Medical Faculty of Hacettepe University, Ankara, Turkey
11Department of Physical Medicine and Rehabilitation, Bozyaka Training and Research Hospital, İzmir, Turkey
12Department of Physical Medicine and Rehabilitation, Medical Faculty of Cumhuriyet University, Sivas, Turkey
13Department of Physical Medicine and Rehabilitation, Medical Faculty of Ankara University, Ankara, Turkey
14Department of Physical Medicine and Rehabilitation, Atatürk Training and Research Hospital, İzmir, Turkey
15Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty of İstanbul University, İstanbul, Turkey
16Department of Physical Medicine and Rehabilitation, Kayseri Training and Research Hospital, Kayseri, Turkey
17Department of Physical Medicine and Rehabilitation, Medical Faculty of Adnan Menderes University, Aydın, Turkey
18Department of Physical Medicine and Rehabilitation, Meram Medical Faculty of Selçuk University, Konya, Turkey
19Department of Physical Medicine and Rehabilitation, Medical Faculty of Celal Bayar University, Manisa, Turkey
Keywords: Knee osteoarthritis; TLAR; treatment guideline
Abstract
Objectives: Knee osteoarthritis (OA) is a common disease which causes pain, disability and great socioeconomic burden as a result. Turkish League Against Rheumatism (TLAR) initiated a project to prepare national, “evidence-based recommendations for the management of knee osteoarthritis” supported by expertopinion in order to assist the physicians who are interested in knee OA in their daily clinical practice.
Materials and methods: The expert committee was composed of 25 academicians, 23 of whom were physical medicine and rehabilitation (PM&R) specialists (three also had rheumatology subspeciality) and two were orthopedic surgeons. At the first meeting, the previous guidelines were discussed, and 2008 Osteoarthritis Research Society International (OARSI) recommendations were decided to be taken as the fundamental template for national recommendations. Databases of the Pubmed, Embase, Cochrane, and Turkish Medical Index were used to search the literature, and this was carried out for the period between 2009-2010 for international publications since studies up to 2009 were present in the 2010 OARSI update. No limit was applied for searching of national publications. The selected relevant publications were graded according to evidence level and quality, and were sent to the members who were then asked to suggest propositions according to their experiences, knowledge, and review of the literature. After amalgamation and editing of new proposals, Delphi rounds were started. After five Delphi rounds, the propositions on which the members were in consensus, were discussed with regard to evidence and the “strength of recommendation” was determined by measuring on visual analog scale (VAS) for each proposal at the final meeting.
Results: Nineteen propositions (one for general principles, nine for nonpharmacologic treatments, seven for pharmacologic treatments, and two for surgical treatments) were accepted as the “TLAR Evidence-Based Recommendations for the Management of Knee OA” in consensus as a result of Delphi rounds.
Conclusion: Evidence-based recommendations for the management of knee OA were developed by TLAR for the first time in our country. The recommendations should be updated regularly according to new evidence and insights. It is expected that physicians who are interested in knee OA will benefit greatly from this report in their daily clinical practice.