Clinical Practice Guidelines (CPGs) aim to support management of hip and knee osteoarthritis (OA), but recommendations are often conflicting and implementation is poor, contributing to evidence-to-practice gaps. This systematic review investigated the contextual and methodological factors contributing to conflicting recommendations for hip and knee OA. Our systematic review appraised CPGs for managing hip and knee OA in adults ≥18 years (PROSPERO CRD42021276635). We used AGREE-II and AGREE-REX to assess quality and extracted data on treatment gaps, conflicts, biases, and consensus. Heterogeneity of recommendations was determined using Weighted Fleiss Kappa (K). The relationship between (K) and AGREE-II/AGREE-REX scores was explored. We identified 25 CPGs across eight countries and four international organisations. The ACR, EULAR, NICE, OARSI and RACGP guidelines scored highest for overall AGREE-II quality (83%). The highest overall AGREE-REX scores were for BMJ Arthroscopy (80%), RACGP (78%) and NICE (76%). There were associations between guideline quality and agreement scores. Future guideline development should be informed by robust evidence, editorial independence and methodological rigour to ensure a harmonisation of recommendations. End-users of CPGs must recognise the contextual factors associated with the development of OA CPGs and balance these factors with available evidence.

中文翻译：

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骨关节炎临床实践指南建议的质量评估和异同分析：系统评价


临床实践指南 (CPG) 旨在支持髋关节和膝关节骨关节炎 (OA) 的治疗，但建议往往相互矛盾，且实施情况不佳，导致证据与实践之间存在差距。本系统综述调查了导致髋关节和膝关节 OA 的相互冲突的建议的背景和方法因素。我们的系统评价评估了 CPG 用于治疗 18 岁以上成人髋关节和膝关节 OA 的效果 (PROSPERO CRD42021276635)。我们使用 AGREE-II 和 AGREE-REX 来评估质量并提取有关治疗差距、冲突、偏见和共识的数据。使用加权 Fleiss Kappa (K) 确定建议的异质性。探讨了 (K) 与 AGREE-II/AGREE-REX 分数之间的关系。我们确定了来自 8 个国家和 4 个国际组织的 25 个 CPG。 ACR、EULAR、NICE、OARSI 和 RACGP 指南在 AGREE-II 总体质量方面得分最高 (83%)。 AGREE-REX 总体得分最高的是 BMJ 关节镜检查 (80%)、RACGP (78%) 和 NICE (76%)。指南质量和一致性分数之间存在关联。未来指南的制定应以强有力的证据、编辑独立性和方法严谨性为依据，以确保建议的协调一致。 CPG 的最终用户必须认识到与 OA CPG 开发相关的背景因素，并用现有证据平衡这些因素。