Analysis of the Evidence Underpinning the American Academy of Orthopedic Surgeons Knee Osteoarthritis Clinical Practice Guidelines

Background: CPGs are important tools which support decision-making by clinicians in patient management and should be based upon a comprehensive review of available literature. Because these guidelines have wide-reaching implications in patient care, these CPGs should be critically appraised to ensure their recommendations adhere to high-quality standards of reporting. The objective of this study was to evaluate the methodological quality and completeness of reporting of randomized controlled trials (RCTs) used to underpin clinical practice guidelines (CPGs) published by the American Academy of Orthopedic Surgeons (AAOS).

Methods: We evaluated the completeness of reporting for each Consolidated Standards of Reporting Trials (CONSORT) checklist item for all RCTs included in our analysis. Screening and extraction of RCTs included in the AAOS CPGs for surgical and non-surgical management of osteoarthritis of the knee was conducted in a double-blind fashion. We then evaluated the adherence of RCTs according to the CONSORT 2010 checklist criteria. We conducted a multiple regression analysis assessing CONSORT adherence against characteristics of the included studies (i.e. type of intervention, funding source, etc.).

Results: A representative sample of 179 RCTs were assessed for adherence to CONSORT criteria. The overall adherence was 68.5% with significant differences between those published prior to and since the development of the 2010 CONSORT guidelines (p=0.02). We found that RCTs receiving funding from Industry/Private sources showed more complete adherence than RCTs which reported receiving no funding (p<0.01). We found that RCTs cited in the CPGs often failed to adequately report methods for randomization and blinding according to the standards set forth by CONSORT 2010 guidelines. Finally, studies that included a Conflict of Interest statement had significantly higher CONSORT adherence (p=0.018).

Conclusion: We found suboptimal CONSORT adherence for RCTs cited in AAOS CGPs for management of osteoarthritis of the knee. Therefore, the AAOS CPGs are likely supported by outdated evidence and lack of high-quality reporting. It is important that the evidence used to guide clinical decision-making be of the highest quality in order to optimize patient outcomes. In order for clinicians to confer the greatest benefits to their patients, CPGs should provide the totality of evidence and emphasize emerging high-quality RCTs to ensure up-to-date, evidence-based clinical decision making.