Contextualizing osteoarthritis care and the reasons for the gap between evidence and practice

Osteoarthritis (OA) is not an easy condition to manage. It is very heterogeneous, has an unpredictable natural history, and has variable effects on health status. A wide range of management options is available to OA patients and their health care advisors. Guidelines help the clinician through this complexity. There are many similarities in the advice offered by different guidelines, suggesting a good deal of consensus on what should and should not be offered to patients with OA. Several authoritative international guidelines on OA management have appeared in recent years. In this article the authors evaluate the United Kingdom National Institute for Clinical Excellence guidelines as a contemporary tool to assess the context within which care is delivered and as the basis for discussion on the gap between evidence and practice.