OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16:137-62.

摘要

The recent expert-consensus guidelines for the management of knee and hip osteoarthritis (OA) are very insightful and should serve as a powerful clinical tool for many providers1. Although minimal attention is given to the positive effects of manual physical therapy despite strong randomized control trials (RCT) in the literature2'3, the fact that the panel unanimously recommends evaluation and referral to a physical therapist is promising. These RCT's evaluating-manual physical therapy were included in the OsteoArthritis Research Society International (OARSI) panel's literature review, however the emphasis of the actual recommendation appears to be focused more on the provision of assisted devices for ambulation, although none of the RCT's referenced in that section include that as a studied intervention. As in many other disciplines, the specific intervention provided by a clinician can vary. When evaluating the efficacy of these interventions it is important for the medical provider to distinguish between current practice and best evidence-based practice when interpreting the results published in the literature. In this case, recommendations would be better served based on specific evidence-validated interventions provided by physical therapists. In addition, the statement that no RCT's for management of hip OA by a physical therapist exist might imply a lack of thoroughness in the literature review for this portion. In a 2004 RCT in Arthritis and Rheumatism by Hoeksma et at., a 5-week manual therapy program was shown to be significantlysuperior to exercise therapy not only in general perceived improvement, but also in pain, hip function, walking speed, range of motion, and quality of life4.