Table 2.
Recommended therapies or modalities considered in four comprehensive treatment guidelines for lower-limb osteoarthritis published within the past 5 yearsa
| Guideline [reference] | ||||
| ADMMC OA [14,15,16] | EULAR [6] (Strength of | |||
| Therapy/modality | (Grade of evidenceb) | ICSI [17,18] | recommendationc) | ACR [4,5] |
| Acetaminophen | Recommended (A) | Recommended | Recommended (A) | Recommended |
| (mild to moderate OA) | ||||
| NSAIDs | Recommended (A) | Recommended | Recommended (A) | Recommended |
| (moderate to severe OA) | ||||
| Cox-2-specific NSAIDs | Not discussed | Recommended | Not discussed | Recommended |
| (2nd-line therapy) | (2nd-line therapy in patient | |||
| with high gastrointestinal risk) | ||||
| Corticosteroid joint injection | Recommended (A) | Recommended | Recommended (A) | Recommended |
| Hyaluronic acid joint injection | Recommended (A) | Recommended | Recommended (B) | Recommended |
| Capsaicin cream | Recommended (A) | Recommended | Recommended (A) | Recommended |
| Other topical cream | Not discussed | Recommended | Recommended (A) | Recommended |
| (e.g. NSAID cream) | ||||
| Opioid analgesics | Recommended (B) | Recommended | Recommended (B) | Recommended |
| Aerobic exercise | Recommended (A) | Recommended | Recommended (A) | Recommended |
| Strengthening and | Recommended (B) | Recommended | Recommended (A) | Recommended |
| range-of-motion exercise | ||||
| Education | Recommended (no grade) | Recommended | Recommended (A) | Recommended |
| Arthritis self-management | Recommended (A) | Recommended | Recommended (A) | Recommended |
| education | ||||
| Physical therapy | Recommended (no grade) | Recommended | Recommended | Recommended |
| Occupational therapy | Recommended (C) | Recommended | Recommended | Recommended |
| Telephone contact | Recommended (A) | Recommended | Recommended (B) | Recommended |
| Weight loss | Recommended (B) | Recommended | Recommended (B) | Recommended |
| Walking assistive devices | Recommended (C) | Recommended | Recommended (B) | Recommended |
| (e.g. shoe inserts, cane) | ||||
| Assistive devices for | Recommended (C) | Recommended | Not discussed | Recommended |
| activities of daily living | ||||
| Glucosamine (with or | Not discussed | Recommended | Recommended (A) | Not recommended |
| without chondroitin) | ||||
| Knee brace or taping | Not discussed | Not discussed | Recommended (B) | Recommended |
| Hot pack or ice pack | Recommended (no grade) | Recommended | Not discussed | Recommended |
| Joint protection techniques | Recommended (no grade) | Recommended | Recommended (A) | Recommended |
| Planning activities | Recommended (no grade) | Recommended | Recommended (A) | Recommended |
| Acupuncture | Not discussed | Recommended | Not discussed | Not recommended |
| Electrical stimulation (e.g. TENS) | Not discussed | Recommended | Not discussed | Not discussed |
| Massage | Not discussed | Recommended | Not discussed | Not discussed |
aThis table covers only the four comprehensive treatment guidelines. For summary of recommendations of NSAID-specific guidelines, see Results section. bGrade of evidence: A = at least one high-quality randomized controlled trial with adequate power; B = evidence from underpowered randomized controlled; prospective controlled or historical controlled studies; C = consensus/expert opinion/uncontrolled trials; no grade = the therapy/modality was discussed in the text of the guideline, no level of evidence was provided to support the therapy/modality. cStrength of recommendation: A = directly based on category-1 evidence (meta-analysis of one or more randomized, controlled trials; B = directly based on category-2 evidence (at least one controlled study without randomization or at least one quasi-experimental study) or extrapolated recommendations from category-1 evidence; C = directly based on category-3 evidence (descriptive studies, such as comparative studies, correlation studies, or case-control studies) or extrapolated recommendations from category-1 or -2 evidence; D = directly based on category-4 evidence (expert committee reports or opinions and/or clinical experience of respected authorities) or extrapolated recommendations from category-2 or -3 evidence. ACR = American College of Rheumatology; ADMMC = Algorithms for the Diagnosis and Management of Musculoskeletal Complaints; COX-2 = cyclooxygenase-2; EULAR = European League Against Rheumatism; ICSI = Institute for Clinical Systems Improvement; NSAID = nonsteroidal anti-inflammatory drug; OA = osteoarthritis; TENS = transcutaneous electrical nerve stimulation.