An explanation of PROSPECT methodology and Working Group processes can be found at the following link: http://esraeurope.org/prospect-methodology
For the THA review, the Subgroup members were:
All included studies were assessed for quality according to PROSPECT methodology (Joshi 2019, http://esraeurope.org/prospect-methodology). The study quality assessments for total hip arthroplasty are summarised here: Quality assessments and level of evidence assigned to included trials.
The methodology of the PROSPECT group is unique in that it aims to critically evaluate the available literature, considering the analgesic beneﬁt of interventions against the backdrop of basic analgesics (i.e. paracetamol and NSAIDs or COX-2-selective inhibitors) and balancing the procedure-speciﬁc efﬁcacy and beneﬁts of an intervention against its general risks and invasiveness.
For recommending an analgesic, at least two randomised controlled trials have to show efficacy. Recommendations were made according to PROSPECT methodology (Joshi 2019, http://esraeurope.org/prospect-methodology). This involved a grading of A–D according to the overall level of evidence, as determined by the quality of studies included, consistency of evidence and study design: Relationship between quality of the study and levels of evidence and grades of recommendation.
A subgroup developed draft recommendations, which were then circulated amongst all the Working Group members for review and comments. A modified Delphi approach was utilised as previously described (Joshi 2019). This included obtaining feedback from PROSPECT members via e-mail, followed by revised drafts of recommendations. This was followed by face-to-face discussions with the aim of developing a consensus. For conflicting recommendations members voted via email. The lead authors drafted the final manuscript, which was ultimately approved by the full PROSPECT group.
The limitations of this review are related to those of the included studies:
The AGREE II instrument (Brouwers 2010) is used internationally to assess the methodological rigour and transparency of practice guidelines. As far as possible, the methodology of the PROSPECT total hip arthroplasty review meets the requirements of ‘Domain 3: Rigour of development’ of the AGREE II instrument: