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Guideline for the management of knee and hip osteoarthritis

The Recommendations

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The Royal Australian College of General Practitioners (RACGP) has used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the quality of evidence and determine the strength of recommendations. The recommendations have been formulated using the GRADE evidence-to decision framework by considering:

the quality of evidence
the balance between benefits and harms
values and preferences
resource use
other relevant considerations.

Strength of recommendations

Recommendation	Description
Strong recommendation for the intervention	The working group is very confident that the benefits of an intervention clearly outweigh the harms (or vice versa)
Strong recommendation against the intervention	The working group is very confident that the harms of an intervention clearly outweigh the benefits
Conditional recommendation for the intervention	Denotes uncertainty over the balance of benefits, such as when the evidence quality is low or very low, or when personal preferences or costs are expected to impact the decision, and as such refer to decisions where consideration of personal preferences is essential for decision making
Conditional recommendation against the intervention	Denotes uncertainty over the balance of harms, such as when the evidence quality is low or very low, or when personal preferences or costs are expected to impact the decision, and as such refer to decisions where consideration of personal preferences is essential for decision making
Conditional (neutral) recommendation	The working group cannot determine the direction of the recommendation

Recommendations are formulated using standardised wording, such as using the term ‘recommend offering’ for strong recommendations and ‘suggest offering’ for conditional or weak recommendations or other terminology such as ‘should’ and ‘may’.

Quality of evidence

The strength of recommendation is supported by a rating of the quality of the evidence as:

Very low
Low
Moderate
High.

Each recommendation is supported with information explaining what the intervention is, the rationale for the recommendation, and any associated harms. The intention is to provide sufficient information as to why the recommendation was made to enable a GP to discuss and recommend options for their patient. More information about the GRADE approach can be found within Section 2.4 Formulation of recommendations.

Algorithm

The accompanying algorithm (Appendix 1. Algorithm – Holistic assessment, diagnosis and management of knee and/or hip osteoarthritis) has been developed from information in the guideline to guide the holistic assessment and diagnosis, non-surgical management and surgical management of symptomatic OA in adults.

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The Recommendations

Strength of recommendations

Quality of evidence

Algorithm

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