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Ottawa Panel Evidence-Based Clinical Practice Guidelines for Therapeutic Exercises and Manual Therapy in the Management of Osteoarthritis

Ottawa Methods Group

Lucie Brosseau

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

George A Wells

Department of Epidemiology and Community Medicine, University of Ottawa

Peter Tugwell

Centre for Global Health, Institute of Population Health, University of Ottawa

Mary Egan

Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa

Claire-Jehanne Dubouloz

Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa

Lynn Casimiro

Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa

Vivian A Robinson

Centre for Global Health, Institute of Population Health

Lucie Pelland

Physiotherapy Program, School of Rehabilitation Sciences, Queen' University, Kingston, Ontario, Canada

Jessie McGowan

Medical Library, Centre for Global Health, Institute of Population Health, University of Ottawa

Maria Judd

Canadian Physiotherapy Association, Ottawa, Ontario, Canada

Sarah Milne

Department of Epidemiology and Community Medicine, University of Ottawa

External Experts

Mary Bell

Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada

Hillel M Finestone

Sisters of Charity of Ottawa Health Service, Ottawa, Ontario, Canada

France Légaré

University of Laval, Québec City, Québec, Canada

Catherine Caron

Sisters of Charity of Ottawa Health Service

Sydney Lineker

The Arthritis Society, Ontario Division, Research Co-ordinator, Toronto, Ontario, Canada

Angela Haines-Wangda

Ottawa Hospital, General Campus, Ottawa, Ontario, Canada

Marion Russell-Doreleyers

Canadian Physiotherapy Association and Ottawa Arthritis Rehabilitation and Education Program, Ottawa, Ontario, Canada

Martha Hall

Canadian Association of Occupational Therapists and Ottawa Arthritis Rehabilitation and Education Program

Gerry Arts

person with osteoarthritis (named with her written permission)

Assistant Manuscript Writer

Marnie Lamb

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

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