ICF linked Dutch physiotherapy guidelines concerning initial assessment, treatment and evaluation in hip and knee osteoarthritis.

Purpose: In 2001 the Royal Dutch Society for Physical Therapy (KNGF) Guideline for hip and knee osteoarthritis (HKOA) was developed. Since then, many scientific papers on physical therapy interventions as well as national and international guidelines were published. Relevance: An update of the physical therapy guideline was needed to support the physical therapy practice in performing the best clinical practice based on current evidence inHKOA. Participants: This guideline is developed by a guideline development committee consisting 10 expert physical therapists working in different centers specialized in care for HKOA patients. Methods: Topics concerning the three guideline chapters: initial assessment, treatment and evaluation were selected by the guideline development committee. With respect to treatment a systematic literature search (up to June 2009) within various databases was performed aiming to identify reviews and randomized controlled trials (RCTs) on the effectiveness of physical therapy interventions and the evidencewas graded (1–4). For initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated (5 consensus meetings and 8 feedback rounds) and graded (A–D). For the initial assessment, a description of relevant health related topics in HKOA was made according to the International Classification of Functioning, disability and health (ICF) core set for osteoarthritis (OA). Concerning treatment, 22 systematic reviews and 74 RCTs were reviewed. Analysis: A first draft of the guideline was reviewed by 17 experts from different professional backgrounds (2 feedback rounds). A second draft was field-tested by 45 physical therapists working in daily practice. The comments of both groups have been processed in the definite guideline. Results: Recommended were: exercise therapy, education and self management interventions, a combination of exercise and manual therapy, and postoperative exercise therapy in HKOA, and taping of the patella in knee OA. Neither recommended nor advised against were: balneotherapy, hydrotherapy, and preoperative physical therapy in HKOA; thermotherapy, TENS, and Continuous Passive Motion in knee OA. Not recommended were: massage, ultrasound, electrotherapy, electromagnetic field and Low Level Laser Therapy. For the evaluation of treatment goals the use of one or more of the following measurement instruments was recommended: daily activities and participation: Lequesne index,Western Ontario and McMaster Universities osteoarthritis index questionnaire, Hip disability and Knee injury and Osteoarthritis Outcome Scores, 6 Minute Walk test, Timed Stand Up and Go test and Patient Specific Complaint list; body functions and structures: Visual Analogue Scale for pain, Intermittent and Constant OsteoArthritis Pain questionnaire, goniometry, Medical Research Council for strength, Handheld Dynamometer. Conclusions: This update of the Dutch physical therapy guideline concerning HKOA included recommendations on the initial assessment, treatment and evaluation. The revised guideline has been launched in April 2010 and published on www.fysionet.nl (including an English translation). Implications: This guideline is helpful in physical therapy practice to perform the best practice based on current evidence. Working according guidelines is a requirement to stand registered in the Dutch physical therapy quality register