Australian Journal of Physiotherapy 2007 Vol. 53 – © Australian Physiotherapy Association 2007 209
Appraisal Clinical Practice Guidelines
Chronic obstructive pulmonary disease
Title: The Australian and New Zealand Guidelines for the
Management of Chronic Obstructive Pulmonary Disease.
Date of latest update: April, 2006. Date of next update:
Not mentioned. Patient group: Adults with Chronic
Obstructive Pulmonary Disease (COPD). Intended
audience: Practitioners working with people with COPD.
Additional versions: Original guidelines published as a
supplement to the Medical Journal of Australia in March
2003. Expert working group: Twenty-three people from
Australia and New Zealand comprised the writing and
steering committees. This included respiratory physicians,
respiratory medical scientists, thoracic physicians, a
pharmacist, physiotherapist, consumer representative,
general practitioner, epidemiologist, cardiothoracic surgeon,
respiratory and lung transplant physician, and a respiratory
educator. Twenty-three other experts encompassing the
above areas of expertise plus respiratory nurses and
psychologists also contributed. Funded by: The Australian
Lung Foundation. Consultation with: A draft of the
original guideline was circulated to key stakeholder groups
and professional organisations, and published on the
Australian Lung Foundation website for feedback.
Approved by: The Thoracic Society of Australia and New
Zealand, The Australian Lung Foundation. Location:
http://www.copdx.org.au.
Description: 66 page document, including 4 appendices
and 243 references. This guideline provides comprehensive
information about COPD, including its aetiology and
natural history. It presents an evaluation of the evidence for
many issues relevant to the physiotherapist. These include:
diagnostic tests (eg spirometry), methods to assess severity
(eg spirometry, exercise testing), interventions to optimise
function (eg pharmacology, pulmonary rehabilitation,
chest physiotherapy, exercise training), intervention to
prevent deterioration (eg smoking cessation, vaccinations),
evidence for the importance of developing a support
network and management plan (eg multidisciplinary teams,
multidisciplinary care plans, self-management plans),
and evidence for optimal management of exacerbations
including indications for hospitalisation. There is a 2-page
summary of the guidelines and the level of evidence for each
recommendation on pages 11-12. The recommendation
categories and corresponding levels of evidence precede
this on page 10.
Sandra Brauer
The University of Queensland
Hand osteoarthritis
Title: The management of hand osteoarthritis. Date of
latest update: October, 2006. Date of next update: Not
mentioned. Patient group: Adults with hand osteoarthritis.
Intended audience: Practitioners working with people
with hand osteoarthritis. Additional versions: Further
information including appendices detailing search strategies,
study designs and 35 of the 74 cited articles can be accessed
free at: http://ard.bmj.com/cgi/content/full/66/3/377.
Expert working group: Twenty-one experts in the field of
osteoarthritis representing 15 European countries comprised
the panel. This included 16 rheumatologists, one physiatrist,
one orthopaedic surgeon, two allied health professionals and
one evidence based medicine expert. Funded by: EULAR
Standing Committee for International Clinical Studies
Including Therapeutics (ESCISIT) Consultation with: Nil
mentioned. Approved by: EULAR Standing Committee
for International Clinical Studies Including Therapeutics
(ESCISIT). Location: Zhang W et al (2007) EULAR
evidence based recommendations for the management of
hand osteoarthritis: Report of a Task Force of the EULAR
Standing Committee for International Clinical Studies
Including Therapeutics (ESCISIT). Ann Rheum Dis 66:
377–388. Also available through: http://ard.bmj.com.
Description: 13 page paper including 95 references. These
clinical practice guidelines follow journal article structure,
presenting a background (the need for these guidelines),
methods (the process), results (the recommendations),
and discussion (comparison with other OA guidelines
and limitations of these guidelines). Eleven key
recommendations for the management of hand OA were
developed using a combination of research-based evidence
and clinical expertise through three Delphi rounds. These
encompassed general considerations (eg clinical features,
risk factors), and various types of intervention including
non-pharmacological (eg education plus exercise, local
heat, splinting), pharmacological (eg paracetamol, NSAIDs,
COX-2 inhibitors), invasive (eg intra-articular injections),
and surgical (eg arthroplasty, osteotomy, arthrodesis).
Strength of recommendations was based on both the research
evidence (efficacy, safety, and cost-effectiveness) and their
clinical expertise (logistics, patients perceived acceptance,
tolerability). Six of the eleven recommendations were
supported by research evidence and included: education
plus exercise, NSAIDs, COX-2 inhibitors, topical NSAIDs,
topical capsaicin, and chondroitin sulphate.
Sandra Brauer
The University of Queensland Brauer 
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