학술논문
Evidence-based recommendations for the management of knee osteoarthritis: a consensus report of the Turkish League Against Rheumatism / Diz osteoartrit tedavisinde kanita dayali oneriler: Turkiye Romatizma Arastirma ve Savas Dernegi uzlasi raporu
Recommendation
Recommendation
Document Type
Report
Author
Tuncer, Tiraje; Cay, Hasan Fatih; Kacar, Cahit; Altan, Lale; Atik, Osman Sahap; Aydin, Ahmet Turan; Ayhan, F. Figen; Yanik, Burcu Corekci; Durmaz, Berrin; Eskiyurt, Nurten; Genc, Hakan; Kutsal, Yesim Gokce; Gunaydin, Rezzan; Hepguler, Simin; Hizmetli, Sami; Kaya, Taciser; Kurtais, Yesim; Olmez, Nese; Saridogan, Merih; Sindel, Dilsad; Tur, Birkan Sonel; Sutbeyaz, Serap; Sendur, Omer Faruk; Ugurlu, Hatice; Unlu, Zeliha
Source
Turkish Journal of Rheumatology. March 2012, Vol. 27 Issue 1, p1, 17 p.
Subject
Language
English
ISSN
1309-0291
Abstract
Osteoarthritis (OA) is a degenerative joint disease which increases in frequency with age. Pain, disability, and deterioration in quality of life are the main consequences of the disease. It might [...]
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. Key words: Knee osteoarthritis; TLAR; treatment guideline. Amac: Diz osteoartriti (OA) sik gorulen ve neden oldugu agri ve sakatlik sonucunda sosyoekonomik yuk bindiren bir hastaliktir. Turkiye Romatizma Arastirma ve Savas Dernegi (TRASD) OA tedavisi ile ugrasan hekimlere gunluk klinik uygulamalarinda yardimci olmak amaciyla, uzman gorusleri ile desteklenmis, ulusal "diz osteoartrit tedavisinde kanita dayali onerileri" hazirlamak icin bir proje baslatmistir. Gerec ve yontemler: Uzmanlar komitesi 23'u fiziksel tip rehabilitasyon (FTR) uzmani (ucu ayrica romatoloji yan dal uzmani) ikisi ise ortopedi ve travmatoloji uzmani olan 25 akademisyenden olusturulmustur. ilk toplantida konu ile ilgili onceden yayinlanmis rehberler uzerinde tartisilmis ve 2008 Osteoarthritis Research Society International (OARSI) onerilerinin ulusal oneriler icin temel sablon olarak kullanilmasina karar verilmistir. Literatur taramasi icin Pubmed, Embase, Cochrane ve Turk Tip Dizini veritabanlari kullanilmis olup, uluslararasi taramalar icin, 2009 yilina kadar yayinlanmis calismalarin 2010 OARSI guncellemesinde yer almasindan dolayi, 2009-2010 yillarini kapsayacak bir sure kisitlamasi yapilmistir. Ulusal yayinlarin taranmasi icin tarih sinirlamasi yapilmamistir. Konuyla ilgili calismalar arasindan secilen makaleler kanit duzeyi ve kalite acisindan derecelendirilmis, uzmanlar kurulu uyelerine gonderilerek kendilerinden mevcut kanitlar ve kendi bilgi ve deneyimleri isiginda tedavi onerileri hazirlamalari istenmistir. Hazirlanan oneriler bir araya getirilmis, duzeltmeler yapilmis, sonrasinda Delphi turlari baslatilmistir. Bes Delphi turu sonunda, uzerinde gorus birligi saglanan oneriler son toplantida kanitlar isiginda tartisilmis ve vizuel analog skala (VAS) uzerinden degerlendirilerek her bir oneri icin "oneri gucu" belirlenmistir. Bulgular: Delphi turlari sonucunda, uzerinde gorus birligi saglanmis olan 19 oneri (biri genel prensip, dokuzu nonfarmakolojik, yedisi farmakolojik ve ikisi cerrahi tedaviler ile ilgili olmak uzere) "TRASD Diz Osteoartriti Kanita Dayali Tedavi Onerileri" olarak kabul edilmistir. Sonuc: TRASD tarafindan, ulkemizde diz OA'si ile ilgili ilk kanita-dayali tedavi onerileri olusturulmustur. Bu onerilerin yeni kanitlar ve gorusler isiginda duzenli olarak guncellenmesi gerekmektedir. Bu onerilerin, diz OA'si ile ilgilenen hekimlerin gunluk pratiklerine katkisi olacagi beklenmektedir. Anahtar sozcukler: Diz osteoartriti; TRASD; tedavi rehberi.
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. Key words: Knee osteoarthritis; TLAR; treatment guideline. Amac: Diz osteoartriti (OA) sik gorulen ve neden oldugu agri ve sakatlik sonucunda sosyoekonomik yuk bindiren bir hastaliktir. Turkiye Romatizma Arastirma ve Savas Dernegi (TRASD) OA tedavisi ile ugrasan hekimlere gunluk klinik uygulamalarinda yardimci olmak amaciyla, uzman gorusleri ile desteklenmis, ulusal "diz osteoartrit tedavisinde kanita dayali onerileri" hazirlamak icin bir proje baslatmistir. Gerec ve yontemler: Uzmanlar komitesi 23'u fiziksel tip rehabilitasyon (FTR) uzmani (ucu ayrica romatoloji yan dal uzmani) ikisi ise ortopedi ve travmatoloji uzmani olan 25 akademisyenden olusturulmustur. ilk toplantida konu ile ilgili onceden yayinlanmis rehberler uzerinde tartisilmis ve 2008 Osteoarthritis Research Society International (OARSI) onerilerinin ulusal oneriler icin temel sablon olarak kullanilmasina karar verilmistir. Literatur taramasi icin Pubmed, Embase, Cochrane ve Turk Tip Dizini veritabanlari kullanilmis olup, uluslararasi taramalar icin, 2009 yilina kadar yayinlanmis calismalarin 2010 OARSI guncellemesinde yer almasindan dolayi, 2009-2010 yillarini kapsayacak bir sure kisitlamasi yapilmistir. Ulusal yayinlarin taranmasi icin tarih sinirlamasi yapilmamistir. Konuyla ilgili calismalar arasindan secilen makaleler kanit duzeyi ve kalite acisindan derecelendirilmis, uzmanlar kurulu uyelerine gonderilerek kendilerinden mevcut kanitlar ve kendi bilgi ve deneyimleri isiginda tedavi onerileri hazirlamalari istenmistir. Hazirlanan oneriler bir araya getirilmis, duzeltmeler yapilmis, sonrasinda Delphi turlari baslatilmistir. Bes Delphi turu sonunda, uzerinde gorus birligi saglanan oneriler son toplantida kanitlar isiginda tartisilmis ve vizuel analog skala (VAS) uzerinden degerlendirilerek her bir oneri icin "oneri gucu" belirlenmistir. Bulgular: Delphi turlari sonucunda, uzerinde gorus birligi saglanmis olan 19 oneri (biri genel prensip, dokuzu nonfarmakolojik, yedisi farmakolojik ve ikisi cerrahi tedaviler ile ilgili olmak uzere) "TRASD Diz Osteoartriti Kanita Dayali Tedavi Onerileri" olarak kabul edilmistir. Sonuc: TRASD tarafindan, ulkemizde diz OA'si ile ilgili ilk kanita-dayali tedavi onerileri olusturulmustur. Bu onerilerin yeni kanitlar ve gorusler isiginda duzenli olarak guncellenmesi gerekmektedir. Bu onerilerin, diz OA'si ile ilgilenen hekimlerin gunluk pratiklerine katkisi olacagi beklenmektedir. Anahtar sozcukler: Diz osteoartriti; TRASD; tedavi rehberi.