Critical Appraisal of Fish Oil in Knee Osteoarthritis

1
Research and Evidence in Practice Lena Saleh ID# 19516083
Lena Saleh
La Trobe University
Research and Evidence in Practice
Critical Appraisal of Fish Oil in Knee Osteoarthritis

2
Research and Evidence in Practice Lena Saleh ID# 19516083
Critical Appraisal of Fish oil in knee osteoarthritis
Introduction
In this essay, the article Fish oil in Knee osteoarthritis: a randomised clinical trial of
low dose versus high dose by (Hill et al. 2016) is critically evaluated using the CASP tool. In
this study, the researchers tried to examine the effects of a high dose anti-inflammatory fish
oil with a lower dose of fish oil. In this study a randomised controlled trial method was used
and almost 202 participants were allocated randomly in two groups, a high dose group and a
low dose group. The researchers also tried to establish a relationship between the change of
cartilage degradation among Osteoarthritis (OA) patients after consuming the high dose fish
oil. In previous studies it was observed that the use of fish oil among patients of rheumatoid
arthritis was effective in preventing structural degradation (Di Giuseppe et al., 2014) and
researchers expected that it would improve the condition of the OA patients as the structural
degradation was common among the two types of arthritis (Pap & Korb-Pap, 2015).
Research Question
The study of (Hill et al. 2016) is based on the examination of the effectiveness of high
dose fish oil in comparison with the low dose supplementation in treatment of Knee OA in
older people. The research question of this study is, in people with knee osteoarthritis does
high dose fish oil have remarkable efficiency than low dose fish oil in improving
symptomatic and structural outcomes?
Eligibility Criteria
Researchers selected the populations who had pre-defined knee OA and the
determination of the disease was done by the following the American College of
Rheumatology (ACR) criteria. The subject population must be 40 years or older. In addition,
the visual analogue scale of knee pain was also used. A scale of 0-100 mm, the people that

3
Research and Evidence in Practice Lena Saleh ID# 19516083
had a knee pain score >20 mm was counted as an eligible subject for the study. However,
during the sample selection researchers followed a few exclusion criteria for this study which
were as follows:
1) People who have dementia or a disability to sign the consent form
2) Women who are pregnant or lactating
3) Previous knee replacement surgery
4) People who have contraindications to MRI scan
5) People with severe radiographic knee OA index that is grade 3 radiographic joint
space narrowing as per guidelines of Osteoarthritis Research Society International
Atlas.
People having one or more criteria were excluded from the study. In addition, before
starting the study a 4-week trial period was performed and, in this process, similarly
flavoured oil was used to detect any people that do not tolerate the oil and they were
eliminated from the study.
Sample
In the final study, there were two groups and the treatment were different for each group.
The first group received high dose fish oil and the second group was treated with low dose
fish oil. The high dose group composed of EPA 18%, DHA 12%. This mixture was supplying
4.5 grams of DHA plus EPA per day (Hill et al., 2016) The low dose group had a ratio of 1:9
low dose fish oil and sunola oil and was supplying 0.45 grams DHA plus EPA per day and
was equivalent to 1.5 standard 1 g fish oil capsule. Both groups were given Paracetamol
(500mg) and they were instructed that they could have the drug up to 8 times a day (Hill et
al., 2016).
Primary Outcome: