Randomized controlled trials have been developed essentially in the
context of pharmacological treatments (ie, oral drugs; intra-articular injection;
and topical, intramuscular, and intravenous treatments), but assessment of
the effectiveness of nonpharmacological treatments (ie, surgery, arthroscopy,
joint lavage, rehabilitation, acupuncture, and education) presents specific
To compare the quality of articles of nonpharmacological and pharmacological
treatments of hip and knee osteoarthritis and to identify specific methodological
issues related to assessment of nonpharmacological treatments.
Design and Setting
We searched MEDLINE and the Cochrane Central Register of Controlled
Trials for articles of randomized controlled trials published between January
1, 1992, and February 28, 2002, in 28 general medical and specialty journals
with high impact factors and assessing nonpharmacological and pharmacological
treatments in patients with hip or knee osteoarthritis.
Main Outcome Measures
The quality of the methods reported in the selected articles was assessed
by 2 independent reviewers using the Jadad scale, the Delphi list, and guidelines
found in the Users' Guides to the Medical Literature.
Investigators also used a checklist of items developed by the authors to analyze
A total of 110 articles were included in the analysis; 50 (45.5%) assessed
nonpharmacological treatments and 60 (54.5%) assessed pharmacological treatments.
Reports of nonpharmacological treatments had a lower global quality score
than did reports of pharmacological treatments as measured by the Jadad scale
(mean [SD] score, 1.4 [1.3] vs 3.0 [1.3]) and the Delphi list (mean [SD] score,
5.2 [1.5] vs 7.5 [1.1]). Lack of reporting adequate random sequence generation
and intention-to-treat analyses were found in both nonpharmacological and
pharmacological articles. Nonpharmacological treatments were less often compared
with a placebo than were pharmacological treatments (28.0% of articles vs
71.7%). Compared with pharmacological articles, nonpharmacological articles
less often described blinding of patients (26.0% vs 96.7%), care providers
(6.0% vs 81.7%), and outcome assessors (68.0% vs 98.3%). Care providers' skill
levels could influence treatment effect in 84.0% of nonpharmacological articles
vs 23.3% of pharmacological articles.
In this analysis of reports of hip and knee osteoarthritis therapy,
nonpharmacological articles scored lower than pharmacological articles in
terms of quality. Assessments of nonpharmacological treatments must take into
consideration additional methodological issues.