This decision aid was developed for clinicians to help them discuss non-operative treatment options with patients living with osteoarthritis-related pain. It is derived from a systematic review of systematic reviews.1 Effectiveness data are generated from randomized controlled trials comparing active treatment with inert control, often placebo.1 The evidence focuses on the proportion of patients attaining meaningful reductions in pain, generally defined as a 30% or more reduction in pain, but specific definitions of clinically meaningful vary widely across studies.
How was this tool developed?
Icon arrays were developed using risk ratio estimates from meta-analyses for patients attaining clinically meaningful improvement in pain (page e89).1 The control response rate was standardized to 40%, the approximate control response rate averaged for all included studies. The rate ratio for each intervention was applied to the average 40% control rate to attain the estimated benefit for that intervention. Standardized control rates allow easier comparison of estimated benefits from differing interventions. However, it should be noted that the estimates are from inert-controlled trials and not direct comparisons, so differences between products are approximations with some uncertainty.
Publicly (not-for-profit) sponsored studies can find lower effectiveness of interventions than for-profit or industry-sponsored studies do.2 We indicated when pooled publicly sponsored studies did not find statistically significant benefit over placebo (glucosamine, chondroitin, and viscosupplementation). Adverse events were poorly reported in the systematic reviews included in our systematic review1 and so are inadequately reported here. Common prescribing resources or other studies should be consulted for further details on potential adverse events.
The decision aid
The decision aid (Figure 1)1,3–6 provides a 1-page summary (2-sided) of estimated effectiveness of treatment options for osteoarthritis pain. The back side of the page includes classification of therapies (by benefits and harms), withdrawals owing to adverse events, typical adverse events, basic prescribing tips, and estimated costs. An interactive version of treatment options can be found at www.pain-calculator.com. An easy-to-print version of the tool is also available from CFPlus.*
This decision aid is not a guideline, and the evidence was not assessed by an independent guideline committee for clinical application. Information presented here will be combined with similar systematic reviews and tools on other types of pain to inform future guideline development.
Acknowledgments
The tool was reviewed by patients and the Patient Education Committee of the College of Family Physicians of Canada. This tool was funded by Alberta Health through the Primary Health Care Opioid Response Initiative, as well as by the College of Family Physicians of Canada and the Alberta College of Family Physicians.
Notes
We encourage readers to share some of their practice experience: the neat little tricks that solve difficult clinical situations. Praxis articles can be submitted online at http://mc.manuscriptcentral.com/cfp or through the CFP website (www.cfp.ca) under “Authors and Reviewers.”
Footnotes
Competing interests
None declared
This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.
This article has been peer reviewed.
La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro de mars 2020 à la page e86.
↵* An easy-to-print version of the decision aid is available at www.cfp.ca. Go to the full text of the article online and click on the CFPlus tab.
- Copyright© the College of Family Physicians of Canada
References
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