Evidence-to-Recommendation Framework for 2026 ACE Clinical Guidelines on the management of knee osteoarthritis - a joint effort with patients.

Researchers in Singapore developed new clinical guidelines to help doctors better manage knee osteoarthritis, a painful joint condition that affects many people and creates significant healthcare costs. The team used a rigorous framework called GRADING to review existing research evidence and created seven key recommendations covering everything from initial assessment to treatment options. Importantly, they worked directly with patients throughout the process to ensure the guidelines reflect what matters most to people living with knee osteoarthritis. The guidelines address common problems in current care, including doctors not recommending conservative treatments enough, patients not knowing about available exercise programs and physiotherapy services in their communities, and inappropriate use of complementary and alternative therapies. The recommendations focus on comprehensive assessment that considers physical, mental, and social factors; core treatment approaches like exercise and weight management; appropriate use of pain medications; when to refer to physiotherapists and other healthcare professionals; guidance on complementary treatments including acupuncture; and when specialist referral is needed. The guideline developers carefully weighed the benefits and risks of different treatments, examined the quality of research evidence, considered patient preferences and values, and looked at practical issues like cost and availability of treatments. For patients with knee osteoarthritis considering acupuncture as part of their treatment plan, these guidelines provide doctors with evidence-based recommendations about when complementary therapies may be appropriate. If considering acupuncture, always seek care from a qualified, licensed acupuncture practitioner with experience treating osteoarthritis.

This Evidence-to-Recommendation framework details the development of Singapore's ACE Clinical Guidelines for knee osteoarthritis management using the GRADE methodology. The guideline development process identified critical management gaps including insufficient conservative treatment uptake, limited awareness of community physiotherapy resources, and inappropriate complementary therapy use. Seven evidence-based recommendations were formulated addressing biopsychosocial assessment, core management strategies, pharmacological interventions, allied health referrals, complementary and alternative treatments, and specialist referrals. The framework incorporated systematic evaluation of benefit-risk balance, evidence certainty, patient values and preferences, resource implications, feasibility, and acceptability. Patient partnership was integral to guideline development. While specific effect sizes are not detailed in this framework summary, the document provides the methodological foundation and clinical rationale supporting each recommendation. Clinicians should note the guideline's emphasis on comprehensive conservative management and evidence-based guidance for complementary therapies including acupuncture. The framework addresses healthcare utilization costs and aims to optimize clinical outcomes through structured, evidence-informed care pathways.