Objective To evaluate quality of orthopedic clinical practice guidelines in China by AGREE Ⅱ Instrument. Methods A systematic search of relevant literature databases (CBM, WanFang Data, VIP and CNKI) was conducted to identify the orthopedic clinical practice guidelines of China published up to October 2016. Guidelines selection and data extraction were independently performed by two authors. AGREEⅡ instrument was used to evaluate the quality of the included guidelines. Intra-class correlation coefficient tests were performed to appraise the uniformity of the overall assessment scores. Results A total of 54 guidelines for orthopedics were finally included. The mean scores of six domains by AGREE Ⅱ instrument were 60.44%, 21.40%, 5.17%, 22.17%, 6.02% and 0.56%. The overall intra-class correlation coefficient was 0.84. Conclusion The quality of orthopedic clinical practice guidelines in China was low or moderate in general. The methodology of making guidelines, especially in terms of rigor of development, applicability and editorial independence, should be improved.
In order to develop the clinical practice guideline (CPG) of intra-articular injection for knee osteoarthritis, based on the definition of Institution of Medicine (IOM) about CPG, the WHO handbook, the GRADE instrument, the AGREE Ⅱinstrument, and the Right for Reporting CPG, Chinese Orthopaedic Association,Chinese Journal of Orthopaedics, Arthritis Clinic and Research Center of Peking University People’s Hospital, Chinese GRADE Center established the guideline working groups and develop protocol of the guideline.
ObjectivesTo systematically review the prevalence and disease burden of knee osteoarthritis (KOA) in China.MethodsPubMed, EMbase, CNKI, WanFang Data and VIP databases were searched to collect cross-sectional studies about the prevalence and disease burden of KOA in China from January 1st 1995 to August 31st 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using R statistical software.ResultsA total of thirty-three studies were included. The results of meta-analysis showed the prevalance rate of KOA was 18% (95%CI 14% to 22%), and it was higher in women (19%, 95%CI 16% to 23%) than in men (11%, 95%CI 9% to 13%) (P<0.05). The prevalence rates of KOA in different regions were as follows: 11% (95%CI 8% to 14%) in north, 17% (95%CI 15% to 20%) in north-east, 21% (95%CI 13% to 32%) in east, 21% (95%CI 13% to 33%) in north-west, 22% (95%CI 6% to 57%) in south-west, and 18% (95%CI 13% to 23%) in south-central, respectively.ConclusionsThe prevalence of KOA in China is high, and the disease burden is heavy. Due to the quantity and quality of included studies, more high-quality studies are required to verify the above conclusions in future.
Surgical management of osteoarthritis of the knee: evidence based guideline contains 38 recommendations pertaining to the preoperative, perioperative, and postoperative care of patients with knee osteoarthritis (KOA) who are considering surgical treatment. Compared with the domestic consensus on diagnosis and treatment for KOA, this clinical practice guideline (CPG) prepared by the American Academy of Orthopedic Surgeons (AAOS) has some advantages in terms of methodology selection and recommendation. Therefore, it is necessary for us to interpret this CPG to speed up the understanding and dissemination of the CPG. The ultimate aims are to: ① strengthen the standardization and understanding of surgical treatment of KOA; ② enhance the understanding of clinicians for this CPG in treating KOA; ③ speed up the development of guideline development methodologies in China; ④ provide methodological guidance for the development of CPG based on the current situation in China.
ObjectiveTo systematically review the efficacy of total hip arthroplasty by direct anterior approach (DAA) and direct lateral approach (DLA). MethodsCNKI, WanFang Data, VIP, CBM, EMbase, PubMed, The Cochrane Library, ClinicalTrials.gov and PROSPERO databases or websites were electronically searched to collect randomized controlled trials (RCTs) of DAA and DLA for THA from inception to August 6th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 9 RCTs were included. The results of meta-analysis showed that at 3 months post-operation, the Harris hip score (HHS) of the DAA group was higher than the DLA group (MD=4.83, 95%CI 2.09 to 7.56, P=0.000 5). Besides, compared with the DLA group, the DAA group showed shorter incision length (MD=−2.35, 95%CI −3.90 to −0.79, P=0.003), less intraoperative bleeding (MD=−68.24, 95%CI −119.07 to −17.41, P=0.009), and shorter hospital stay (MD=−0.84, 95%CI −1.54 to −0.15, P=0.02). However, no significant differences were found between DLA and DAA in operation duration and HHS at 6 weeks after operation. ConclusionsCurrent evidence shows that DAA can provide better HHS at 3 months post-operation, shorter incision length, less intraoperative bleeding, and shorter hospitalization length than DLA. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo understand the current national status of the rating of published orthopedic guidelines and consensus in China, to help users select the appropriate use of these clinical guidelines, to guide clinical practice, and to promote the targeted improvement of the quality of Chinese orthopedic guidelines and consensus. MethodsChinese biomedical databases, including CNKI, WanFang Data, and SinoMed were searched electronically from January 2016 to October 2023, and relevant Chinese orthopedic clinical practice guidelines and consensus documents were collected. Two evaluators independently screened the retrieved literature and extracted data. The scientificity, transparency, and applicability rankings (STAR) tool was used to comprehensively rate Chinese orthopedic guidelines and consensus documents published in medical journals since 2016. Any dispute between the two evaluators was resolved by consulting a third evaluator. Kappa values were used to evaluate the consistency of the results between the two evaluators. ResultsA total of 191 orthopedic-related guidelines and consensus documents were obtained, including 74 guidelines and 117 consensus documents. The average score of the guidelines included in the evaluation was 34.4 points, while the average score of consensus documents included in the evaluation was 21.7 points. Guidelines scored higher than consensus documents in areas such as registration, planning, workgroups, clinical issues, evidence, consensus methods, recommendations, accessibility, and other fields. The Kappa value test result was 0.684. ConclusionThere has been a progressive increase in methodological scores of Chinese orthopedic clinical practice guidelines and consensus documents published in recent years, but the overall quality is not high. Future guidelines development needs to improve methodology further, especially in terms of transparent funding, formation of recommendations, guidelines release, and dissemination.
Grading the evidence of systematic reviews on animal studies will contribute to the improvement in the feasibility of transforming the results of animal studies into clinical trials or clinical practice. High quality evidence from animal studies is more likely to be successfully applied into clinical practice (i.e. more confident). Therefore, the present study will introduce the principles, methods and challenges of the application of GRADE in systematic reviews on animal studies.
Chinese guideline for diagnosis and treatment of osteoarthritis (2021 edition) was published in the Chinese Journal of Orthopaedics, providing abundant recommendations on osteoarthritis (OA) issues. In this paper, the methodological and reporting qualities of the guideline were explained and assessed by using quality appraisal tools, such as appraisal of guidelines research and evaluation-China (AGREE-China), Institute of Medicine Committee (IOM), and reporting items for practice guidelines in healthcare (RIGHT). It also aimed to provide personalized treatments for specific patients, support readers in understanding the principle of OA treatment, and standardize OA treatment strategies. In addition, this study would contribute to the clinical promotion of the current guidelines and provide the necessary references for clinical practice guidelines in treating OA in the future.
Osteoarthritis research society international (OARSI) guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis in 2019 contained some recommendations in treating patients with osteoarthritis (OA) who are considering non-surgical treatment. Compared with domestic consensus on diagnosis and treatment for OA, this clinical practice guideline (CPG) prepared by OARSI had some advantages in terms of methodology selection and recommendation. Therefore, it is necessary to interpret this CPG to accelerate the understanding and dissemination of the CPG. The ultimate aims were: to strengthen the normative and understanding of non-surgical treatment of OA; to enhance the understanding of clinicians for this CPG in treating OA; to accelerate the development of guideline development methodologies in China; to provide methodological guidance for the development of CPG based on the current situation in China.
Objective The purpose of the extension of the RIGHT statement for introductions and interpretations of clinical practice guidelines (RIGHT for INT) was to promote the development of comprehensive and clear article those introduced and interpreted clinical practice guidelines. MethodsThe RIGHT for INT checklist was developed following methods recommended by the EQUATOR Network. The development process included three stages. In the first stage, a multidisciplinary team of experts was recruited by email and WeChat and further divided into three groups (a steering group, a consensus group, and a secretariat group); in the second stage, the initial items were collected by literature review and brainstorming; and in the third stage, the final items were formed through a Delphi survey and expert consultation. ResultsA total of 40 initial items were collected through literature review and brainstorming. A final checklist of 27 items was formed after the Delphi survey and expert consultation. ConclusionThe RIGHT for INT checklist provides guidance for guideline interpreters on how to introduce and interpret clinical practice guidelines in a scientific and comprehensive manner.