Definitions and reporting of usual care in randomized trials for the treatment of knee osteoarthritis: A scoping review
Bibliographic record
Abstract
OBJECTIVE: "Usual care" is a common comparator in randomized trials (RCTs) evaluating interventions for knee osteoarthritis (OA), but it lacks a standardized definition. This scoping review aimed to systematically map how usual care has been defined and reported in knee OA RCTs, with attention to the terminology, components, and adherence to reporting standards. METHODS: We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and the ClinicalTrials.gov registry from inception to May 2025 for trials involving adults with knee OA that compared a non-surgical intervention to usual care (or similar terms). Paired reviewers independently screened citations and extracted study characteristics, terminology used to describe and components of usual care, care setting, OA severity and diagnosis, intervention type, and references to external guidelines. We summarized findings and assessed reporting quality using the Template for Intervention Description and Replication (TIDieR) and Consensus on Exercise Reporting Template (CERT) checklists, where applicable. RESULTS: Of 11804 citations screened, we identified 154 RCTs across 33 countries. "Usual care" was the most frequently used descriptor term (53.9%), with definitions that varied considerably. While 68.2% of trials provided detailed descriptions, nearly one-third offered only vague or minimal information. Only 22.7% referenced external guidelines. Usual care content ranged from minimal care to complex multimodal packages, with substantial variation by intervention type. Reporting quality was suboptimal: trials addressed, on average, just over half of TIDieR and approximately two thirds of CERT checklist items. Usual care often lacked transparency, standardization, and reference to best practice recommendations. CONCLUSION: One in three knee OA trials using usual care as a comparator did not provide a clear, detailed definition of "usual care." Variability in usual care definitions and reporting compromise trial validity, limit evidence synthesis, and hinder clinical translation. There is an urgent need for standardization of detailed reporting of usual care interventions in knee OA trials.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.528 | 0.779 |
| Meta-epidemiology (narrow) | 0.004 | 0.005 |
| Meta-epidemiology (broad) | 0.019 | 0.020 |
| Bibliometrics | 0.052 | 0.050 |
| Science and technology studies | 0.005 | 0.011 |
| Scholarly communication | 0.018 | 0.019 |
| Open science | 0.013 | 0.012 |
| Research integrity | 0.012 | 0.009 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".