Review article (meta-analysis)
Ottawa Panel Evidence-Based Clinical Practice Guidelines for Aerobic Walking Programs in the Management of Osteoarthritis

https://doi.org/10.1016/j.apmr.2012.01.024Get rights and content

Abstract

Loew L, Brosseau L, Wells GA, Tugwell P, Kenny GP, Reid R, Maetzel A, Huijbregts M, McCullough C, De Angelis G, Coyle D, and the Ottawa Panel. Ottawa Panel evidence-based clinical practice guidelines for aerobic walking programs in the management of osteoarthritis.

Objective

To update the Evidence-Based Clinical Practice Guidelines (EBCPGs) on aerobic walking programs for the management of osteoarthritis (OA) of the knee.

Data Sources

A literature search was conducted using the electronic databases MEDLINE, PubMed, and the Cochrane Library for all studies related to aerobic walking programs for OA from 1966 until February 2011.

Study Selection

The literature search found 719 potential records, and 10 full-text articles were included according to the selection criteria. The Ottawa Methods Group established the inclusion and exclusion criteria regarding the characteristics of the population, by selecting adults of 40 years old and older who were diagnosed with OA of the knee.

Data Extraction

Two reviewers independently extracted important information from each selected study using standardized data extraction forms, such as the interventions, comparisons, outcomes, time period of the effect measured, and study design. The statistical analysis was reported using the Cochrane collaboration methods. An improvement of 15% or more relative to a control group contributes to the achievement of a statistically significant and clinically relevant progress. A specific grading system for recommendations, created by the Ottawa Panel, used a level system (level I for randomized controlled studies and level II for nonrandomized articles). The strength of the evidence of the recommendations was graded using a system with letters: A, B, C+, C, D, D+, or D–.

Data Synthesis

Evidence from 7 high-quality studies demonstrated that facility, hospital, and home-based aerobic walking programs with other therapies are effective interventions in the shorter term for the management of patients with OA to improve stiffness, strength, mobility, and endurance.

Conclusions

The greatest improvements were found in pain, quality of life, and functional status (grades A, B, or C+). A common limitation inherent to the EBCPGs is the heterogeneity of studies included with regards to the characteristics of the population, the interventions, the comparators, the outcomes, the period of time, and the study design. It is strongly recommended to use the Cochrane Risk of Bias Summary assessment to evaluate the methodologic quality of the studies and to consider avenues for future research on how aerobic walking programs would be beneficial in the management of OA of the hip.

Section snippets

Protocols and Registration

The development process of the EBCPGs was similar to that of the Philadelphia Panel and other EBCPGs created by the Ottawa Panel.12 The methodology of this project followed the Preferred Reporting Items for Systematic and Meta-Analyses17 checklist from the Journal of the American Physical Therapy Association, the Ottawa Expert Panel methods, and used a quantitative grading system.

In conjunction with the methodology of previous Ottawa Panel publications,18 the construction of the EBCPGs was

Study Selection

The literature search found 719 potential records (see appendix 2). The reviewers (L.L. and G.M.) screened 88 eligible articles on aerobic walking programs and OA. According to the selection criteria (see table 2), 10 full-text articles were included and 78 articles were excluded for the following reasons (appendix 4): no walking program intervention in 31 trials28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58 dropout

Discussion

The Ottawa Panel created an EBCPG with this systematic review of aerobic walking programs in the management of OA of the knee. In this systematic review, the Ottawa Panel developed recommendations based on 7 out of 10 comparative controlled studies with higher quality (with a Jadad scale score of 3/5).25, 26, 27, 99, 101, 103, 104 The Ottawa Panel concluded that aerobic walking combined with stretching and strengthening exercises, education, and/or behavior programs are recommended to improve

Conclusions/Clinical Implications

The Ottawa Panel found important evidence to support the use of aerobic walking programs in the management of OA, for subjects aged over 40 years who are diagnosed with mild to moderate OA of 1 or both knees. Evidence from 7 high-quality studies demonstrates that facility, hospital, and home-based aerobic walking programs with other therapies are effective interventions in the shorter term for the management of patients with OA to improve stiffness, strength, mobility, and endurance. Moreover,

Acknowledgments

The Ottawa EBCPGs Development Group thanks the following people for their technical support and support with data extraction and data analysis: France Légaré, MD, PhD, Catherine Caron, MD, Martha Hall, MSc, Alison Marshall, MA, Gabrielle Ménard, BSc, Lilliane Francoeur, BSc, Courtney Cohoon, MA, Karen Hidalgo, MScS, Adam Teav, BSc, George Gray, BSc, Catherine Lamothe, BSc, Judith Robitaille, BSc, Lucie Lavigne, BSc, Michel Boudreau, BSc, Guillaume Michaud, BSc, Michelle Vaillant, MSc, Chantal

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    Supported by the Canadian Institute of Health Research, The Arthritis Society, the Ontario Ministry of Health and Long-Term Care (Canada), The University of Ottawa, Faculty of Health Sciences, and the Ministry of Human Resources, Summer Students Program (Canada).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    The Ottawa Panel Includes: Mary Egan, PhD,1 Claire-Jehanne Dubouloz, PhD,1 Judy King, PhD,1 Lynn Casimiro, PhD,4 Sydney Brooks-Lineker, PhD,6 Mary Bell, MD,7 Hillel M. Finestone, MD,8 Lucie Laferrière, MHA,9 Angela Haines-Wangda, MSc,10 Marion Russell-Doreleyers, MSc,6 Vivian A. Welch, PhD,2,3 Sarah Milne, MSc,1 Lisa Levesque, BSc,1 Daniel Sredic, BSc,1 Laura Trafford, BSc,1 Jessica McEwan, MLIS,5 Guy Longchamps.11

    From the 1School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; 2Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, Ottawa, ON, Canada; 3Centre for Global Health, Institute of Population Health, Ottawa, ON, Canada; 4Department of Academic Affairs, Montfort Hospital, Ottawa, ON, Canada; 5University of Ottawa Health Sciences Library, Ottawa, ON, Canada; 6The Arthritis Society, Ontario Division, Canada; 7Continuing Education and Knowledge Transfer, University of Toronto, Toronto, ON, Canada; 8SCO Health Services, Elisabeth Bruyère Health Centre, Ottawa, ON, Canada; 9Directorate Force Health Protection, Canadian Forces Health Services Group Headquarters, National Defense, Ottawa, ON, Canada; 10The Ottawa Hospital, General Campus, Ottawa, ON, Canada; 11Consumer expert.

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