It was also noted that find protocol there were variations across the guidelines in the recommendations made. Currently, there

is no critical appraisal of international guidelines that has synthesized, graded, and comprehensively presented all the relevant recommendations for the physical management of OA. Therefore, a systematic critical appraisal of international OA guidelines was undertaken to comprehensively present all the relevant evidence-based recommendations on the physical management of OA. A systematic literature search was performed. The Cochrane Library, MEDLINE, CINAHL, SPORTDiscus with Full Text, Scopus, ScienceDirect, PEDro, and Google Scholar databases were searched (2000–2013) to identify all guidelines, protocols, and recommendations for the management or treatment of OA. An experienced health science librarian assisted with the development of the search strategy. MEDLINE, CINAHL, and SPORTDiscus with Full Text databases were searched using key word proximity searches to identify guidelines or recommendations for the management of OA ([osteoarthrit* N5 guideline*] OR [osteoarthrit* N5 evidence*] OR [osteoarthrit* N5 recommend] OR [osteoarthrit* N5 best*]). Scopus and Protease Inhibitor Library purchase ScienceDirect databases used the same proximity search logic but with the appropriate syntax. PEDro and The Cochrane Libraries were searched

using ([osteoarthriti* and guideline] AND [osteoarthriti* and protocol]). A manual search was conducted on reference lists found in relevant guidelines, systematic reviews, and meta-analysis (MA), which returned additional resources. A thorough Internet search was conducted to identify international arthritis organizations and guideline clearinghouses. The names of organizations were also found during the process of reviewing guidelines and recommendations identified during the electronic database

searches. The websites of these organizations were reviewed, and any relevant guidelines were included. A list of these organizations is given in appendix 1. The primary source of literature O-methylated flavonoid for this review was recommended guidelines developed from evidence-based research, consensus, and/or expert opinion. Guidelines that included only pharmacological therapy, injection therapy, or surgical interventions were excluded. There were no restrictions on severity or site of OA, sex, or age. The search was confined to articles published in English and available electronically between the period of 2000 and end of April 2013. Animal-based studies were not included. If there had been updates to guidelines, only the latest version of the guideline was reviewed. All titles and/or abstracts were reviewed to determine whether they met the eligibility criteria of this critical appraisal. When citations met the criteria, the full-text articles were retrieved and reviewed. Nineteen guidelines were identified for evaluation.