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Ottawa Methods Group
University Research Chair in Evidence-Based Practice in Rehabilitation, Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
Department of Epidemiology and Community Medicine, University of Ottawa
Centre for Global Health, Institute of Population Health, University of Ottawa
Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa
Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa
Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa
Centre for Global Health, Institute of Population Health
Physiotherapy Program, School of Rehabilitation Sciences, Queen' University, Kingston, Ontario, Canada
Medical Library, Centre for Global Health, Institute of Population Health, University of Ottawa
Canadian Physiotherapy Association, Ottawa, Ontario, Canada
Department of Epidemiology and Community Medicine, University of Ottawa
External Experts
Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
Sisters of Charity of Ottawa Health Service, Ottawa, Ontario, Canada
University of Laval, Québec City, Québec, Canada
Sisters of Charity of Ottawa Health Service
The Arthritis Society, Ontario Division, Research Co-ordinator, Toronto, Ontario, Canada
Ottawa Hospital, General Campus, Ottawa, Ontario, Canada
Canadian Physiotherapy Association and Ottawa Arthritis Rehabilitation and Education Program, Ottawa, Ontario, Canada
Canadian Association of Occupational Therapists and Ottawa Arthritis Rehabilitation and Education Program
person with osteoarthritis (named with her written permission)
Assistant Manuscript Writer
School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa
Address all correspondence and requests for reprints to: Lucie Brosseau, PhD, Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, 451 Smyth Rd, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5 (Lucie.Brosseau{at}uottawa.ca)
Background and Purpose. Osteoarthritis (OA) affects a large and growing proportion of the population. The purpose of this project was to create guidelines for the use of therapeutic exercises and manual therapy in the management of adult patients (>18 years of age) with a diagnosis of OA. All stages of the disease were included in the analysis, and studies of patients who had recent surgery or other rheumatologic, musculoskeletal, or spinal problems or of subjects without known pathology or impairments were excluded. Methods. The Ottawa Methods Group used Cochrane Collaboration methods to find and synthesize evidence from comparative controlled trials and then asked stakeholder groups to nominate representatives to serve on a panel of experts. The Ottawa Panel agreed on criteria for grading the strength of the recommendations and their supporting evidence. Of the 609 potential articles on therapeutic exercises for OA that were identified, 113 were considered potentially relevant, and 26 randomized controlled trials and controlled clinical trials were ultimately used. Results. Sixteen positive recommendations of clinical benefit were developed for therapeutic exercises, especially strengthening exercises and general physical activity, particularly for the management of pain and improvement of functional status. Manual therapy combined with exercises also is recommended in the management of patients with OA. Discussion and Conclusion. The Ottawa Panel recommends the use of therapeutic exercises alone, or combined with manual therapy, for managing patients with OA. There were a total of 16 positive recommendations: 13 grade A and 3 grade C+. The Ottawa Panel recommends the use of therapeutic exercises because of the strong evidence (grades A, B, and C+) in the literature.
Key Words: Clinical practice guidelines • Epidemiology • Evidence-based practice • Osteoarthritis • Physical rehabilitation • Rheumatology
This article has been cited by other articles:
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  L. Brosseau, G. A Wells, P. Tugwell, M. Egan, K. G Wilson, C.-J. Dubouloz, L. Casimiro, V. A Robinson, J. McGowan, A. Busch, et al. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Strengthening Exercises in the Management of Fibromyalgia: Part 2 Physical Therapy, July 1, 2008; 88(7): 873 - 886. [Abstract] [Full Text] [PDF]
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 B. R. Hando, N. W. Gill III, J. Beaty, J. J. Jacobs, D. Berry, and N. E. Lane Osteoarthritis of the hip. N. Engl. J. Med., January 31, 2008; 358(5): 534 - 534. [Full Text] [PDF]
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L. L Currier, P. J Froehlich, S. D Carow, R. K McAndrew, A. V Cliborne, R. E Boyles, L. T Mansfield, and R. S Wainner Development of a Clinical Prediction Rule to Identify Patients With Knee Pain and Clinical Evidence of Knee Osteoarthritis Who Demonstrate a Favorable Short-Term Response to Hip Mobilization Physical Therapy, September 1, 2007; 87(9): 1106 - 1119. [Abstract] [Full Text] [PDF]
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 W. A. Katz Themed Review: Nonpharmacologic Approaches to Osteoarthritis American Journal of Lifestyle Medicine, August 1, 2007; 1(4): 249 - 255. [Abstract] [PDF]
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L. Terre Behavioral Medicine Review: The Dialectic of Tradition and Progress in Osteoarthritis Management American Journal of Lifestyle Medicine, August 1, 2007; 1(4): 267 - 270. [Abstract] [PDF]
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 W Zhang and M Doherty EULAR recommendations for knee and hip osteoarthritis: a critique of the methodology Br. J. Sports Med., August 1, 2006; 40(8): 664 - 669. [Abstract] [Full Text] [PDF]
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