(PDF) PT 505 Hip OA CPG | Yip Chan

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keyboard_arrow_downTitleAbstractIntroductionGuideline Review Process and ValidationMethods (Continued)Prevalence 2009 SummaryPathoanatomical Features 2009 SummaryAnd 2017 SummaryRisk Factors 2009 RecommendationNatural History 2009 SummaryImaging Studies 2009 and 2017 SummaryPhysical Impairment Measures 2009 RecommendationBest-Practice Point Essential Data ElementsSummaryAnti-Inflammatory Agents 2009 and 2017 SummaryAlternative/Complementary Medication 2009 SummaryPatient Education 2009 RecommendationManual Therapy 2009 RecommendationWeight Loss 2009 RecommendationRecommendationdownload

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Download Free PDFPT 505 Hip OA CPGYip Chanhttps://doi.org/10.2519/JOSPT.2017.0301visibility

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Abstract

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This clinical practice guideline outlines the criteria for clinicians to classify adults over 50 years with hip osteoarthritis using the ICD and ICF frameworks. It emphasizes the importance of revising diagnoses and care plans based on patient history and activity limitations. The guideline aims to standardize evidence-based practice in orthopedic physical therapy concerning hip osteoarthritis, providing definitions, classifications, and interventions based on the best available evidence.

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Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2017Michael Cibulka

Journal of Orthopaedic & Sports Physical Therapy, 2017

A Clinicians should use the following criteria to classify adults over the age of 50 years into the International Statistical Classification of Diseases and Related Health Problems (ICD) category of coxarthrosis and the associated International Classification of Functioning, Disability and Health (ICF) impairment-based category of hip pain (b28016 Pain in joints) and mobility deficits (b7100 Mobility of a single joint): moderate anterior or lateral hip pain during weightbearing activities, morning stiffness less than 1 hour in duration after wakening, hip internal rotation range of motion less than 24° or internal rotation and hip flexion 15° less than the nonpainful side, and/or increased hip pain associated with passive hip internal rotation. DIFFERENTIAL DIAGNOSIS 2017 Recommendation F Clinicians should revise the diagnosis and change their plan of care, or refer the patient to the appropriate clinician, when the patient's history, reported activity limitations, or impairments of body function and structure are not consistent with those presented in the diagnosis/classification section of this guideline, or when the patient's symptoms are not diminishing with interventions aimed at normalization of the patient's impairments of body function. EXAMINATION-OUTCOME MEASURES: ACTIVITY LIMITATION/ SELF-REPORT MEASURES 2017 Recommendation A Clinicians should use validated outcome measures that include domains of hip pain, body function impairment, activity limitation, and participation restriction to assess outcomes of treatment of hip osteoarthritis. Measures to assess hip pain may include the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, Brief Pain Inventory (BPI), pressure pain threshold (PPT), and pain visual analog scale (VAS). Activity limitation and participation restriction outcome measures may include the WOMAC physical function subscale, the Hip disability and Osteoarthritis Outcome Score (HOOS), Lower Extremity Functional Scale (LEFS), and Harris Hip Score (HHS). EXAMINATION-ACTIVITY LIMITATION/PHYSICAL PERFORMANCE MEASURES 2017 Recommendation A To assess activity limitation, participation restrictions, and changes in the patient's level of function over the episode of care, clinicians should utilize reliable and valid physical performance measures, such as the 6-minute walk test, 30-second chair stand, stair measure, timed up-and-go test, self-paced walk, timed singleleg stance, 4-square step test, and step test. A Clinicians should measure balance performance and activities that predict the risk of falls in adults with hip osteoarthritis, especially those with decreased physical function or a high risk of falls because of past history. Recommended balance tests for patients with osteoarthritis include the Berg Balance Scale, 4-square step test, and timed single-leg stance test. F Clinicians should use published recommendations from the Academy of Geriatric Physical Therapy of the American Physical Therapy Association 6 to guide fall risk management in patients with hip osteoarthritis to assess and manage fall risk. EXAMINATION-PHYSICAL IMPAIRMENT MEASURES 2017 Recommendation A When examining a patient with hip pain/hip osteoarthritis over an episode of care, clinicians should document the flexion, abduction, and external rotation (FABER or Patrick's) test and passive hip range of motion and hip muscle strength, including internal rotation, external rotation, flexion, extension, abduction, and adduction. INTERVENTIONS-PATIENT EDUCATION 2017 Recommendation B Clinicians should provide patient education combined with exercise and/or manual therapy. Education should include teaching activity modification, exercise, supporting weight reduction when overweight, and methods of unloading the arthritic joints. INTERVENTIONS-FUNCTIONAL, GAIT, AND BALANCE TRAINING 2017 Recommendation C Clinicians should provide impairment-based functional, gait, and balance training, including the proper use of assistive devices (canes, crutches, walkers), to patients with hip osteoarthritis and activity limitations, balance impairment, and/or gait limitations when associated problems are observed and documented during the history or physical assessment of the patient. C Clinicians should individualize prescription of therapeutic activities based on the patient's values, daily life participation, and functional activity needs. INTERVENTIONS-MANUAL THERAPY 2017 Recommendation A Clinicians should use manual therapy for patients with mild to moderate hip osteoarthritis and impairment of joint mobility, flexibility, and/or pain. Manual therapy may include thrust, nonthrust, and soft tissue mobilization. Doses and duration may range from 1 to 3 times per week over 6 to 12 weeks in patients with mild to moderate hip osteoarthritis. As hip motion improves, clinicians should add exercises including stretching and strengthening to augment and sustain gains in the patient's range of motion, flexibility, and strength.

downloadDownload free PDFView PDFchevron_rightInternational clinical guidelines at the american unicersity of Beirut, physical therapy department: Strategy of Implementation and evaluationRob A.B. Oostendorp

2010

The purpose of the study is (1) to describe the selection process of an international clinical guideline (CGL) for patients with low back pain (LBP) for adoption and implementation at the Physical Therapy Department at the American University of Beirut Medical Center (AUBMC), and (2) to evaluate the physiotherapists' compliance. Method. International guidelines were identified through a literature search and compared according to the AGREE instrument for selection. Quality indicators were selected. Physiotherapists were educated about guidelines' benefits and the content of the adopted guidelines during interactive sessions; patients' files were optimized and audited in order to evaluate compliance. Results. Out of six guidelines for LBP, we selected that of the Royal Dutch Association of Physiotherapy. Full adherence of physiotherapists to the educational sessions was noted. A total of 72 patient files were available. However, only 23 out of 72 files (32%) were complete to test the therapists' adherence to the new assessment forms using 13 quality indicators. A high level of compliance with a mean score of 90% was recorded for the diagnostic process indicators, and a low level for the mean score of therapeutic process indicators (42%) except the indicator for the advice to stay active (100%). The mean score for the outcome of care was very low (13%). Conclusions. Dutch guidelines for low back pain were selected for adoption and implementation. A relatively high level of adherence to guidelines recommendations was noticed in the diagnostic process and a low level in the therapeutic process.

downloadDownload free PDFView PDFchevron_rightProfessional interventions for general practitioners on the management of musculoskeletal conditionsOlwyn Westwood

The Cochrane Library, 2008

This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2008, Issue 4 http://www.thecochranelibrary.com ... Professional interventions for general practitioners on the management of musculoskeletal conditions ( ...

downloadDownload free PDFView PDFchevron_rightAmerican Academy of Orthopaedic Surgeons Clinical Practice Guideline onCharles Turkelson

Journal of Bone and Joint Surgery, American Volume, 2011

The following is a summary of the recommendations in the AAOS' clinical practice guideline, The Treatment of Glenohumeral Joint Osteoarthritis. This summary does not contain rationales that explain how and why these recommendations were developed nor does it contain the evidence supporting these recommendations. All readers of this summary are strongly urged to consult the full guideline and evidence report for this information. We are confident that those who read the full guideline and evidence report will also see that the recommendations were developed using systematic evidence-based processes designed to combat bias, enhance transparency, and promote reproducibility. This summary of recommendations is not intended to stand alone. Treatment decisions should be made in light of all circumstances presented by the patient. Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician and other healthcare practitioners. The physician work group listed the recommendations below in order of patient care. 1. We are unable to recommend for or against physical therapy for the initial treatment of patients with osteoarthritis of the glenohumeral joint.

downloadDownload free PDFView PDFchevron_rightInternational Clinical Guidelines at the American University of Beirut, Physical Therapy Department: Strategy of Implementation and EvaluationClaude Maroun

The Internet Journal of Allied Health Sciences & Practice, 2010

Purpose. The purpose of the study is (1) to describe the selection process of an international clinical guideline (CGL) for patients with low back pain (LBP) for adoption and implementation at the Physical Therapy Department at the American University of Beirut Medical Center (AUBMC), and (2) to evaluate the physiotherapists' compliance. Method. International guidelines were identified through a literature search and compared according to the AGREE instrument for selection. Quality indicators were selected. Physiotherapists were educated about guidelines' benefits and the content of the adopted guidelines during interactive sessions; patients' files were optimized and audited in order to evaluate compliance. Results. Out of six guidelines for LBP, we selected that of the Royal Dutch Association of Physiotherapy. Full adherence of physiotherapists to the educational sessions was noted. A total of 72 patient files were available. However, only 23 out of 72 files (32%) were complete to test the therapists' adherence to the new assessment forms using 13 quality indicators. A high level of compliance with a mean score of 90% was recorded for the diagnostic process indicators, and a low level for the mean score of therapeutic process indicators (42%) except the indicator for the advice to stay active (100%). The mean score for the outcome of care was very low (13%). Conclusions. Dutch guidelines for low back pain were selected for adoption and implementation. A relatively high level of adherence to guidelines recommendations was noticed in the diagnostic process and a low level in the therapeutic process.

downloadDownload free PDFView PDFchevron_rightWhat is the quality of clinical practice guidelines accessible on the world wide web for the treatment of musculoskeletal conditions in physiotherapy?I. Graham

Physiotherapy Theory and Practice, 2004

Background: Acute lateral ankle ligament sprains (LALS) are a common injury seen by many different clinicians. Knowledge translation advocates that clinicians use Clinical Practice Guidelines (CPGs) to aid clinical decision making and apply evidence-based treatment. The quality and consistency of recommendations from these CPGs are currently unknown. The aims of this systematic review are to find and critically appraise CPGs for the acute treatment of LALS in adults. Methods: Several medical databases were searched. Two authors independently applied inclusion and exclusion criteria. The content of each CPG was critically appraised independently, by three authors, using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) instrument online version called My AGREE PLUS. Data related to recommendations for the treatment of acute LALS were abstracted independently by two reviewers. Results: This study found CPGs for physicians and physical therapists (Netherlands), physical therapists, athletic trainers, physicians, and nurses (USA) and nurses (Canada and Australia). Seven CPGs underwent a full AGREE II critical appraisal. None of the CPGs scored highly in all domains. The lowest domain score was for domain 5, applicability (discussion of facilitators and barriers to application, provides advice for practical use, consideration of resource implications, and monitoring/ auditing criteria) achieving an exceptionally low joint total score of 9% for all CPGs. The five most recent CPGs scored a zero for applicability. Other areas of weakness were in rigour of development and editorial independence. Conclusions: The overall quality of the existing LALS CPGs is poor and majority are out of date. The interpretation of the evidence between the CPG development groups is clearly not consistent. Lack of consistent methodology of CPGs is a barrier to implementation. Systematic review: Systematic review registered with PROSPERO (CRD42015025478).

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2008

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Osteoarthritis and Cartilage, 2007

As a prelude to developing updated, evidence-based, international consensus recommendations for the management of hip and knee osteoarthritis (OA), the Osteoarthritis Research Society International (OARSI) Treatment Guidelines Committee undertook a critical appraisal of published guidelines and a systematic review (SR) of more recent evidence for relevant therapies.Sixteen experts from four medical disciplines (primary care two, rheumatology 11, orthopaedics one and evidence-based medicine two), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. Three additional experts were invited to take part in the critical appraisal of existing guidelines in languages other than English. MEDLINE, EMBASE, Science Citation Index, CINAHL, AMED, Cochrane Library, seven Guidelines Websites and Google were searched systematically to identify guidelines for the management of hip and/or knee OA. Guidelines which met the inclusion/exclusion criteria were assigned to four groups of four appraisers. The quality of the guidelines was assessed using the AGREE (Appraisal of Guidelines for Research and Evaluation) instrument and standardised percent scores (0–100%) for scope, stakeholder involvement, rigour, clarity, applicability and editorial independence, as well as overall quality, were calculated. Treatment modalities addressed and recommended by the guidelines were summarised. Agreement (%) was estimated and the best level of evidence to support each recommendation was extracted. Evidence for each treatment modality was updated from the date of the last SR in January 2002 to January 2006. The quality of evidence was evaluated using the Oxman and Guyatt, and Jadad scales for SRs and randomised controlled trials (RCTs), respectively. Where possible, effect size (ES), number needed to treat, relative risk (RR) or odds ratio and cost per quality-adjusted life year gained (QALY) were estimated.Twenty-three of 1462 guidelines or consensus statements retrieved from the literature search met the inclusion/exclusion criteria. Six were predominantly based on expert opinion, five were primarily evidence based and 12 were based on both. Overall quality scores were 28%, 41% and 51% for opinion-based, evidence-based and hybrid guidelines, respectively (P = 0.001). Scores for aspects of quality varied from 18% for applicability to 67% for scope. Thirteen guidelines had been developed for specific care settings including five for primary care (e.g., Prodigy Guidance), three for rheumatology (e.g., European League against Rheumatism recommendations), three for physiotherapy (e.g., Dutch clinical practice guidelines for physical therapy) and two for orthopaedics (e.g., National Institutes of Health consensus guidelines), whereas 10 did not specify the target users (e.g., Ontario guidelines for optimal therapy). Whilst 14 guidelines did not separate hip and knee, eight were specific for knee but only one for hip. Fifty-one different treatment modalities were addressed by these guidelines, but only 20 were universally recommended. Evidence to support these modalities ranged from Ia (meta-analysis/SR of RCTs) to IV (expert opinion). The efficacy of some modalities of therapy was confirmed by the results of RCTs published between January 2002 and 2006. These included exercise (strengthening ES 0.32, 95% confidence interval (CI) 0.23, 0.42, aerobic ES 0.52, 95% CI 0.34, 0.70 and water-based ES 0.25, 95% CI 0.02, 0.47) and nonsteroidal anti-inflammatory drugs (NSAIDs) (ES 0.32, 95% CI 0.24, 0.39). Examples of other treatment modalities where recent trials failed to confirm efficacy included ultrasound (ES 0.06, 95% CI −0.39, 0.52), massage (ES 0.10, 95% CI −0.23, 0.43) and heat/ice therapy (ES 0.69, 95% CI −0.07, 1.45). The updated evidence on adverse effects also varied from treatment to treatment. For example, while the evidence for gastrointestinal (GI) toxicity of non-selective NSAIDs (RR = 5.36, 95% CI 1.79, 16.10) and for increased risk of myocardial infarction associated with rofecoxib (RR = 2.24, 95% CI 1.24, 4.02) were reinforced, evidence for other potential drug related adverse events such as GI toxicity with acetaminophen or myocardial infarction with celecoxib remained inconclusive.Twenty-three guidelines have been developed for the treatment of hip and/or knee OA, based on opinion alone, research evidence or both. Twenty of 51 modalities of therapy are universally recommended by these guidelines. Although this suggests that a core set of recommendations for treatment exists, critical appraisal shows that the overall quality of existing guidelines is sub-optimal, and consensus recommendations are not always supported by the best available evidence. Guidelines of optimal quality are most likely to be achieved by combining research evidence with expert consensus and by paying due attention to issues such as editorial independence, stakeholder involvement and applicability. This review of existing guidelines provides support for the development of new guidelines cognisant of the limitations in existing guidelines. Recommendations should be revised regularly following SR of new research evidence as this becomes available.

downloadDownload free PDFView PDFchevron_rightMusculoskeletal disorders: primary and secondary interventionsRobert Gatchel

Journal of Electromyography and Kinesiology, 2004

downloadDownload free PDFView PDFchevron_rightCourse, Prognosis and Management of Nonspecific Musculoskeletal DisordersHarald Miedema

2016

Musculoskeletal disorders (MSDs) are universally prevalent among all age and gender groups and across all socio-demographic strata of society. Besides causing pain and decreased functional capacity, MSDs have a substantial influence on work capacity and quality of life. Altogether, they inflict an enormous financial burden on society through direct medical costs as well as indirect costs due to loss of productivity and social security benefits. The yearly burden of disease in the Netherlands for the two most important groups of MSDs, low back pain (LBP) and neck and upper extremity complaints, is over € 5.500 million. The majority of MSDs fall into the category of nonspecific disorders. Often these nonspecific disorders are related to overload, deconditioning or workrelated overexertion. Although much research has been performed, especially with regard to LBP, knowledge about the long-term pain patterns or predictors over the life course is limited. For many possible prognostic indi...

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