MAT71004-2017-3 Evidence Based Nursing Research: Article Review

This report presents a critical review of a research article investigating the efficacy of glucosamine and chondroitin, both individually and in combination, for reducing knee pain and joint space narrowing (JSN) in patients with symptomatic knee osteoarthritis. The original study was a double-blind, randomized, placebo-controlled clinical trial with a two-year follow-up. The review assesses the validity and importance of the study's results, considering factors such as randomization, blinding, and follow-up duration. It also evaluates the applicability of the findings to individual patients, considering potential benefits and harms of the treatment. The review concludes that the study provides an inadequate answer to the clinical question due to limitations such as the baseline pain levels of participants and lack of information on the stage of osteoarthritis, while also noting the potential for the combined treatment to reduce joint space narrowing and delay knee replacement.

Running head- EVIDENCE BASED NURSING RESEARCH
MAT71004-2017-3 Assignment I- Critical review of an article
Name of the Student
Name of the University
Author Note

EVIDENCE BASED NURSING RESEARCH
Fransen, M., Agaliotis, M., Nairn, L., Votrubec, M., Bridgett, L., Su, S., ... & Woodward, M.
(2015). Glucosamine and chondroitin for knee osteoarthritis: a double-blind
randomised placebo-controlled clinical trial evaluating single and combination
regimens. Annals of the rheumatic diseases, 74(5), 851-858. DOI-
http://dx.doi.org/10.1136/annrheumdis-2013-203954
Are the results from this study valid? Was the assignment of patients to treatments described as randomised?
Yes, the study was a double-blind randomised controlled trial and recruited 605
participants, aged 45-75 years, who reported chronic knee pain and medial tibio-femoral
narrowing of the compartments. 2 week placebo study capsules were provided to all and they
were made to complete the 7-day LEGS diary (Fransen et al., 2015).
 Was the randomisation list reported as concealed?
Yes. A randomisation schedule was performed by an independent statistician who was
blind to the treatment. Were the groups similar at the start of the trial apart from the experimental therapy?
Yes. Most participants were aged more than 50 years. The proportion of females was
more than 50% and 36% were categorised as obese based on their BMI values. Moreover, all
the participants demonstrated a similar range of knee pain. What was the follow-up time period?
The study was conducted for a 2 year follow-up period and a complete clinical
assessment was performed over 12 months. However, a longer follow-up period was required
in order to evaluate the treatment effects. Were all patients analysed in the groups to which they were randomised?
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EVIDENCE BASED NURSING RESEARCH
Yes. The primary outcomes in both the groups were conducted on an intention-to-treat
basis.
Who was kept “blind” to treatment?
Yes. The study was a double-blind randomised controlled trial. Therefore, both the
participants and the study staff or researchers were kept blind to the treatment allocations
(Fransen et al., 2015). Were the groups treated equally, apart from the experimental treatment?
Yes. All participants were initially made to complete the LEGS diary and were given 2
capsules, once daily. Furthermore, the placebo capsules showed similarities with their active
comparators in terms of smell, taste and packaging.
Are the results of this study important? What was the difference between the groups at the end of the study?
No significant effect was observed on maximum knee pain. The treatment combination
displayed a reduction in JSN among people who suffered from symptomatic knee OA. How precise was the difference between the groups at the end of the study?
The 95% CI for year 1 were found to be 4.03 for placebo, 3.86 for glucosamine, 3.58 for
chondroitin and 3.76 for a combination of the two treatments.
Can you apply this evidence to your patient? Do these results apply to your patient?
These results can be applied to the patients after gathering adequate information on
baseline pain features and after observing the outcomes for a longer follow-up period. Are your patients different from those in the study?
The demographics of the participants of this study match our patients. Hence, there are no
significant differences between them.
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EVIDENCE BASED NURSING RESEARCH
 Is the treatment feasible for your setting?
The study will act as a practical intervention as it does not contain any potential barriers
in terms of cost. The cost of supplements will be worth the health benefits. What are the potential benefits and harms?
The potential benefits are reduction in pain and avoidance of knee replacement surgeries
due to the combined action of glucosamine and chondroitin.
Results summary
To summarise, it can be stated that the study demonstrated a reduction in knee pain
among patients suffering from osteoarthritis on taking a combined supplementation of
glucosamine and chondroitin for 2 years. The intervention showed a probable reduction in
joint space narrowing and delay of knee replacement. The results also demonstrated that
action of glucosamine is not as effective as the combined intervention (Fransen et al., 2015).
Thus, further studies are required to determine the effect of these dietary supplements on
narrowing of joint spaces. In addition, there is a need to conduct the study for a follow-up
period longer than 2 years to assess the potential benefits.
Answer to clinical question
A thorough analysis of the study helps me to conclude that the study failed to provide
an adequate answer of the clinical question related to the effectiveness of glucosamine and
chondroitin supplements to reduce knee pain among osteoarthritis patients. The main reason
that accounts for its failure is the recruitment of people with 4.69 baseline pain out of 10.
Furthermore, a JSN greater than 2 mm is categorised as stage 2 of osteoarthritis. However,
with a progress of the disease, the amount of cartilage decreases and this result in an increase
in joint pain (Fransen et al., 2015). The study did not provide information on the stage of
osteoarthritis prevalent among the patients.
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EVIDENCE BASED NURSING RESEARCH
References
Fransen, M., Agaliotis, M., Nairn, L., Votrubec, M., Bridgett, L., Su, S., ... & Woodward, M.
(2015). Glucosamine and chondroitin for knee osteoarthritis: a double-blind
randomised placebo-controlled clinical trial evaluating single and combination
regimens. Annals of the rheumatic diseases, 74(5), 851-858.
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