膝骨性关节炎的注射治疗：指南系统回顾（二）
英语晨读 ·
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本次文献选自Pavone V, Vescio A, Turchetta M, et al. Injection-Based Management of Osteoarthritis of the Knee: A Systematic Review of Guidelines. Front Pharmacol. 2021;12:661805.本次学习由林小雯副主任医师主讲。
METHODS
Searching and Guidelines Selections
The MEDLINE, Cochrane Library, SPORTDiscus with Full Text, ScienceDirect, Scopus, CINAHL, Google Scholar and PEDro databases were investigated to detect all most recent guidelines, protocols, and recommendations for the management or treatment of knee OA. In addition, Internet searches of all relevant arthritis organizations were undertaken. Guidelines that included intra-articular steroid injection, hyaluronic acid injection and platelet rich plasma injection, against placebo for osteoarthritis of the knee were included (Table 1). Six guidelines were identified for evaluation, selecting just those considered “recommended” after the application of the AGREE II (AGREE, 2009). One was excluded (Kolasinski et al., 2020), because the recommendation was not clear for the AGREE II appraisal guidelines tool. Due to high clinical impact of American College of Rheumatology/Arthritis Foundation (ACR) guidelines, the society recommendations were included as “warming”.
The OA guidelines used from evidence-based investigation, consensus, and/or expert opinion were considered eligible and included. No restrictions on severity or site of OA, sex, or age were applied.
方法
检索和指南选择
对 MEDLINE、科克伦图书馆、全文体育光盘、科学直定、斯科普斯、CINAHL、谷歌学术和 PEDro 数据库进行了检索，以获得所有最新关于膝OA 管理或治疗的指南、流程和建议。此外，还对所有相关关节炎协会进行了互联网搜索。指南中应包含关节腔类固醇注射、透明质酸注射和富含血小板血浆注射同安慰剂治疗膝骨关节炎进行对比（表1）。共有6个指南被纳入，并通过选择在《AGREE II》中被"推荐"的准则进行评估。其中1个指南被排除在外，因为AGREE对其的推荐级别不确切。由于美国风湿病/关节炎基金会（ACR）指南对临床影响很大，同样被纳入标准。
于循证调查、共识和/或专家意见的OA指南被认为符合条件并纳入。未对OA的严重程度或部位、性别或年龄施加任何限制。
Quality Appraisal and Data Extraction
Appraisal of Guidelines for REsearch and Evaluation II (AGREE II) instrument was chosen to assess the quality of all guidelines. The assessment of each was study was performed independently. Sixty percent was chosen as the adequate coverage value for domains (5,6). For each guideline recommendation, the related involvements were ranked on an individual weighting scale from +3 to −1. Recommendations were rated and collected according to median score into strongly recommended, recommended, recommended with caution, and unsupported. If one intervention is recommended by 4 guidelines with rates of 2, 2, 2, 2, resulting in a median score of 2 and grading of recommended (Table 2).
质量评估和数据提取
选择AGREE II对指南进行质量评估。对每项研究的评估都是独立进行的。60% 被选为域的适当覆盖值。对于每个推荐指南，按照权重等级从 +3 到 −1 进行排序。建议根据中位数评分进行评级和收集，分为强烈推荐、推荐、谨慎推荐和不支持。如果一项被 4 个指南分别评分为 2、2、2、2，则取中位数2并分级推荐（表 2）。
The AGREE II
The critical assessment of the guidelines was performed according to Appraisal of Guidelines for REsearch and Evaluation II (AGREE II). AGREE II is a high construct validity quality appraisal scale. It composed of 23 items organized into 6 domains: scope and purpose (3 items), stakeholder involvement (3 items), rigor of development (8 items), clarity of presentation (3 items), applicability (4 items), and editorial independence (2 items). Each item is ranked between strongly agree and strongly disagree. Percentage score was calculated for each domain. A domain was evaluated effective addressed and recommended if its score was 60%.
AGREE II
对准则的客观性评估是根据AGREE II进行的。AGREE II是一个高结构的有效性质量评价尺度。它由23个项目组成，分为6个领域：适用范围和目的（3个项目）、利益相关者参与（3个项目）、严格的开发（8个项目）、陈述的清晰性（3个项目）、适用性（4个项目）和编辑独立性（2个项目）。每个项目之间的排名强烈同意和强烈不同意。每个域的百分比分数计算。如果域的分数为 60%，则对其进行有效处理并推荐该域。