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Ottawa Panel Evidence-Based Clinical Practice Guidelines for Therapeutic Exercises in the Management of Rheumatoid Arthritis in Adults

Ottawa Methods Group

Lucie Brosseau

Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada

George A Wells

Department of Epidemiology and Community Medicine, University of Ottawa

Peter Tugwell

Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada

Mary Egan

Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa

Claire-Jehanne Dubouloz

Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa

Lynn Casimiro

Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa

Vivian A Robinson

Centre for Global Health, Institute of Population Health

Lucie Pelland

Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa

Jessie McGowan

Director, Medical Library, Centre for Global Health, Institute of Population Health

External Experts

Mary Bell

(Rheumatologist) Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada

Hillel M Finestone

(Physiatrist) Sisters of Charity of Ottawa Health Service, Ottawa, Ontario, Canada

France Légaré

(Evidence-Based Practice in Family Medicine), University of Laval, Québec City, Québec, Canada

Catherine Caron

(Family Physician) Sisters of Charity of Ottawa Health Service

Sydney Lineker

The Arthritis Society, Ontario Division, Research Co-ordinator, Toronto, Ontario, Canada

Angela Haines-Wangda

Ottawa Hospital, General Campus, Ottawa, Ontario, Canada

Marion Russell-Doreleyers

who practices acupuncture, MSc, Canadian Physiotherapy Association and Ottawa Arthritis Rehabilitation and Education Program, Ottawa, Ontario, Canada

Martha Hall

Canadian Association of Occupational Therapists and Ottawa Arthritis Rehabilitation and Education Program

Paddy Cedar

patient with rheumatoid arthritis (named with her written permission)

Assistant Manuscript Writer

Marnie Lamb

School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa

Address all correspondence and requests for reprints to: Lucie Brosseau, PhD, Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, 451 Smyth Rd, University of Ottawa, Ottawa, Ontario, Canada K1H 8M5 (lbrossea{at}uottawa.ca).

Background and Purpose. The purpose of this project was to create guidelines for the use of therapeutic exercises and manual therapy in the management of adult patients (>18 years of age) with a diagnosis of rheumatoid arthritis according to the 1987 American Rheumatism Association criteria. Methods. Evidence from comparative controlled trials was identified and synthesized using The Cochrane Collaboration methods. An expert panel was formed by inviting professional stakeholder organizations to each nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. Results. Six positive recommendations of clinical benefit were developed on therapeutic exercises. The efficacy of manual therapy interventions could not be determined for lack of evidence. Discussion and Conclusion. The panel recommends the use of therapeutic exercises for rheumatoid arthritis. Further research is needed to determine the efficacy of manual therapy in the management of this disease.

Key Words: Clinical practice guidelines • Epidemiology • Evidence-based practice • Physical rehabilitation • Rheumatology • Rheumatoid arthritis

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