理学療法ジャーナル53巻3号

2019年03月発行

講座 理学療法に関するガイドラインupdate 2・3

理学療法に関するガイドラインupdate—膝関節疾患

著者： 田中亮¹ 天野徹哉² 井上優³⁴ 田中繁治⁵

所属機関： ¹広島大学大学院総合科学研究科身体運動科学研究領域 ²常葉大学保健医療学部理学療法学科 ³倉敷平成病院リハビリテーション部 ⁴吉備国際大学保健福祉研究所 ⁵神奈川県立保健福祉大学保健福祉学部リハビリテーション学科

ページ範囲：P.280 - P.290

はじめに

　厚生労働省は，2000年よりevidence-based medicine（EBM）の普及に向けた取り組みを推進している．EBMは，「個々の患者のケアに関わる意思を決定するために，最新かつ最良の根拠（エビデンス）を，一貫性を持って，明示的な態度で，思慮深く用いること」と定義される^1）．EBMの手順は，ステップ1：患者の臨床問題や疑問点を明確にし，ステップ2：それに関する質の高い臨床研究の結果を効率よく検索し，ステップ3：検索した情報の内容を批判的に吟味し，ステップ4：その情報の患者への適用を検討し，ステップ5：ステップ1〜4までのプロセスと患者への適用結果を評価する，からなる．

　診療ガイドライン（以下，ガイドライン）は，EBMのステップ3で活用される情報に位置づけられ，日本理学療法士協会は2011年に「理学療法診療ガイドライン」の第1版を発行している．しかしながら，最新のエビデンスは毎年発表されていることから，ガイドラインは定期的に更新される必要がある．そこで本稿では，膝関節疾患のなかでも罹患率の高い変形性膝関節症（knee osteoarthritis：膝OA）に着目し，2011年以降に国際的な組織が発行した理学療法関連のガイドラインを紹介する．また，EBMのステップ4を想定して，実際の症例に対する推奨内容の適用例を挙げて推奨内容の具体的な活用方法についても解説する．このとき，近年報告されたランダム化比較試験（randomized controlled trial：RCT）やシステマティックレビュー（systematic review：SR）も参考にする．

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