The initial systematic literature search was designed to build upon the literature in the first edition, and to update the evidence published after the last search date for those guidelines.8 To accomplish this, we searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library (including Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials [CENTRAL]) for studies published from January 2005 to December 2016. (For detailed information on search strategies, refer to Appendix 1 of the Guideline for the management of knee and hip osteoarthritis: Technical document.)
A medical librarian developed and conducted searches using search terms determined by the working group’s preliminary recommendations, database-specific medical subject headings, free-text terms, and study type filters were applied where appropriate. Studies of adults with hip and/or knee OA that involved one or more therapeutic interventions of interest were sought. Searches were limited to systematic reviews and randomised controlled trials (RCTs), which are classified as Level 1 and Level 2 evidence according to the National Health and Medical Research Council (NHMRC) hierarchy of evidence (Table 1).63
Adapted with permission from National Health and Medical Research Council. Additional levels of evidence and grades for recommendations for developers of guidelines. Canberra: NHMRC, 2009.
No limits were placed on language, and studies published in languages other than English were translated whenever possible. Details of the search strategies are available in Appendix 1 of the Guideline for the management of knee and hip osteoarthritis: Technical document. Electronic searches were supplemented with manual searches of reference lists of recent systematic reviews to ensure all pertinent resources were obtained. Searches were also performed within published supplements of relevant conference proceedings up to and including August 2017. Working group members were consulted regarding the evidence procured for each topic and, based on their expert knowledge of prior and emerging research in the field, reference to any additional resources that were not collected were requested. All electronic searches were updated in August 2017.
The initial searches for most interventions were then expanded to identify studies published prior to 2005. This was done to accommodate the transition of the current guideline to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, thus to provide a comprehensive assessment of the quality of the entire body of evidence available for a given intervention. Consequently, the working group reviewed a GRADE summary table, which comprised all available RCT evidence regarding a given intervention to date, in order to make the most informed voting decision.
Study selection and PICO question matching
Systematic reviews and RCTs of adults with hip and/or knee OA in which the majority of the enrolled study population (≥80%) was aged 45 years or older were included. Only studies reporting participant health outcomes that were determined to be of interest by the working group’s recommendations were considered eligible for inclusion. Detailed patient health outcomes of interest, and inclusion and exclusion criteria are presented in Appendix 2 of the Guideline for the management of knee and hip osteoarthritis: Technical document.
The results of the literature searches were uploaded onto the Centre for Treatment Comparison and Integrative Analysis (CTCIA) web-based screening platform, which was used for primary and secondary literature screenings. Primary literature screening involved reviewing each record’s title and abstract for eligibility. Primary screening of each record was performed in duplicate by two independent reviewers (any paired combination among the pool of investigators from the working group or named in the Guideline for the management of knee and hip osteoarthritis: Technical document – Xia Wang, Mikala Osani, Elizaveta Vaysbrot and Mia-Cara Musetti), with conflicts resolved by a third reviewer (Raveendhara Bannuru).
Secondary literature screening involved the thorough review of fulltext articles. This was performed on all publications considered potentially eligible during the primary screening. Secondary literature screening followed the same independent duplicate review procedure, with conflict resolution undertaken by the same third reviewer. During secondary screening, all included articles were tagged with PICOrelated terms (eg intervention type(s), reported outcome(s)), to facilitate more efficient matching of the literature with PICO questions. Upon completion of secondary screening, the screening input for the references were exported on a database, and references were sorted in sequence by ‘Study design’, then by ‘Intervention’, ‘Comparator’, and finally ‘Date’.
Preliminary PICO designations were assigned to the references within the sorted document based on their ‘Interventions’ and ‘Comparators’; these designations were verified by a manual review of the included publications. Prior to the initiation of data extraction, the included articles were summarised by order of their matched PICO questions for the members of the working group, who assisted with reconciling possible mismatches or omissions. The study flow diagram in Figure 1, Appendix 2 of the Guideline for the management of knee and hip osteoarthritis: Technical document illustrates in detail the numbers of abstracts identified, full-text manuscripts retrieved, and studies selected for inclusion in the systematic literature review for these guidelines.