SYSTEMATIC REVIEW   Free access

European Journal of Physical and Rehabilitation Medicine 2021 April;57(2):273-9

DOI: 10.23736/S1973-9087.21.06581-3

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Osteoporosis guidelines from a rehabilitation perspective: systematic analysis and quality appraisal using AGREE II

Giovanni IOLASCON ¹, Alessandro de SIRE ² ✉, Claudio CURCI ³, Marco PAOLETTA ¹, Sara LIGUORI ¹, Dario CALAFIORE ³, Francesca GIMIGLIANO ⁴, Antimo MORETTI ¹

¹ Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy; ² Department of Medical and Surgical Sciences, University of Catanzaro “Magna Grecia”, Catanzaro, Italy; ³ Section of Neuromotor Rehabilitation, Department of Neuroscience, ASST Carlo Poma, Mantua, Italy; ⁴ Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy

INTRODUCTION: People affected by osteoporosis and fragility fractures often report disability and poor health-related quality of life. Albeit rehabilitation has a crucial role in older people, post-menopausal women and other subjects with high risk of fragility fractures, the rehabilitation perspective has been poorly investigated in the available guidelines for osteoporosis. The aim of this systematic review was to systematically evaluate the quality of guidelines for osteoporosis from a rehabilitation perspective.
EVIDENCE ACQUISITION: On May 2020, we performed a systematic search on medical literature of all guidelines published in the last 10 years on PubMed, Pedro, and international guideline databases. The study selection was based on key terms “exercise,” “physical activity” or “rehabilitation.” All authors independently assessed the methodological quality through the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, consisting of six domains (scope, stakeholder involvement, rigor and development, clarity of presentation, applicability, editorial independence).
EVIDENCE SYNTHESIS: Out of 331 documents retrieved, a total of 34 guidelines were selected after the screening phases. Twenty (58.8%) high quality guidelines were reported. According to AGREE II instrument, a mean score of 78.1±21.8% was reported for “scope and purpose” domain; for stakeholder involvement, the mean score was 58.1±22.1%; the rigor of development was good (mean score of 61.3±27.3%); for clarity of presentation the mean score was 79.4±20.3%; the applicability was poor (mean score of 30.9±25.2%); for editorial independence the mean score was 75.1±24.6%. Rehabilitation recommendations for osteoporotic patients were reported in 21 (61.8%) of the selected guidelines.
CONCLUSIONS: This is the first systematic analysis evaluating quality of the guidelines for osteoporosis using AGREE II instrument. Starting from a state of the art of the currently available evidence, we could conclude that therapeutic exercise at moderate to high intensity is encouraged by several guidelines for the management of people with osteoporosis and fragility fractures. More than half of guidelines were of high-quality. However, most guidelines are lacking specific indications about exercise features. This study might support the implementation of a rehabilitation perspective in the guidelines for osteoporotic patients.

KEY WORDS: Guideline; Osteoporosis; Rehabilitation; Osteoporotic fractures; Exercise therapy