Table 1.

Comparison of methodologies used to develop recommendations for non-surgical management of knee and hip OA.

	ACR/AF	OARSI	VA/DoD
Objectives	To formulate an evidence-based guidelines for the management of (OA) and, update the 2012 ACR recommendations for the management of hand, hip, and knee OA to guide patients and clinicians in choosing among the available treatment options	To perform an updated review of the literature and to expand upon prior OARIS guidelines by developing patient-centered treatment recommendations for hip, knee, and polyarticular OA. Besides, it provides guidance for the treatment of four subgroups of comorbidities that are common in OA patients	To improve the management of OA among patients eligible to receive care in the VA and/or DoD healthcare systems by developing general guidelines and updating the 2014 recommendations for the management of patients with hip and knee OA
Panels	The ACR/AF workgroup included rheumatologists, internists, physical and occupational therapists, and patient representatives A core leadership team of 6 members lead the work, a core expert panel of 11 members supervised the project, 15 members were included in the voting panel and 10 individuals comprised the literature review panel	The OARSI workgroup included rheumatologists, primary care physicians, orthopedic surgeons, pharmacists, sport medicine specialists, epidemiologists, physical medicine and rehabilitation specialists as well as patient representatives A core expert panel of 6 members supervised the project, 13 members were in the voting panel and 5 individuals were in the literature review panel	The VA/DoD workgroup included 40 individuals from different organizations including 3 champion leaders. The workgroup included different specialties: primary care, nursing, physical therapy, clinical pharmacology, internal medicine, dietetics, orthopedic surgery, rheumatology, family medicine, sports medicine, physical medicine and rehabilitation, and pain management. There was also a peer review group that provided feedbacks to drafted guidelines as well as patient representatives
Literature search	Database search included OVID Medline, PubMed, EMBASE, and the Cochrane Library GRADE criteria were used to rate the quality of evidence Search items include but not limited to, ‘osteoarthritis’, ‘osteoarthrosis’, ‘degenerative arthritides’, ‘non-inflammatory arthritis’, ‘aerobic exercise’, ‘aquatic therapy’, ‘hip’, ‘knee’ Original searches were run from the inception of databases to 10/15/17. Updates were run from 10/15/17 to 8/1/18 A meta-analysis of the reviewed manuscripts was done	Database search included Medline, EMBASE, Cochrane, PubMed, Google Scholar Modified GRADE criteria were used to rate the quality of evidence Search items include but not limited to, ‘osteoarthritis’, ‘arthroplasty’, ‘arthrosis’, ‘randomized controlled trials’, ‘controlled trial’, ‘single-blind’, ‘double-blind’ The literature search covered the period until December 2017 and there was no start date A meta-analysis of the reviewed manuscripts was done	Database search was Cochrane, EMBASE, Medline PreMedline, PubMed and AHRQ website Modified GRADE criteria were used to rate the quality of evidence Search items include but not limited to, ‘osteoarthritis’, ‘hip’, ‘knee’, ‘arthrosis’, ‘degenerative joint’, ‘intraarticular’, ‘cutaneous administration’, ‘opiate’, ‘hip replacement’, ‘knee replacement’ The literature search period was from December 1, 2012 to June 3, 2019 A meta-analysis of the reviewed manuscripts was not done
Voting procedure	Voting procedure was done via group emails and two-day face-to-face meeting	Voting was carried online using an anonymous survey application	Voting procedure was not specified
Strength of recommendations	A strong recommendation means that >75% of the voting panel recommended this intervention without reservations. A conditional recommendation means that between 50 and 75% recommended the intervention and that needed to be discussion of the benefits and risks with the patient. Recommendations are considered strong if they have high or moderate-quality evidence. Low-quality evidence mandates a weak recommendation	Recommendations were considered strong if ​≥ ​75% of the voting panel voted either for or against. Considered conditional if 26–74% of the panel voted for or against	Recommendations were considered strong if it indicates high confidence in the quality of the available scientific evidence, the clear difference between harms and benefits, similar provider and patient preferences, and understood influence of other implications like feasibility and resource use

ACR/AF, American College of Rheumatology/Arthritis Foundation; AHRQ, Agency for Healthcare Research and Quality; GRADE, The Grading of Recommendations Assessment, Development and Evaluation; OA, Osteoarthritis; OARSI, The Osteoarthritis Research Society International; VA/DoD, Veterans Affairs and Department of Defense.