Genicular artery embolization for the treatment of knee osteoarthritis: protocol for a living systematic review
Creators: name: Martin, Mar Trujillo
name: Rispau, Ariadna Auladell
name: Reyes, María Ximena Rojas
Publisher: name: OSF Registries
Year: 2023
Subjects: subject: Medicine and Health Sciences
subject: health decision-making
subject: healthtechnology
subject: living evidence

description: Background
Genicular artery embolization has been recently adopted for the management of secondary pain to inflammatory diseases of the locomotor apparatus and studies assessing its use on the treatment of knee osteoarthritis have been increasing their publication rate in the recent years, hence, it constitutes a suitable target for a living evidence synthesis.
Objective
This living evidence synthesis aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of genicular artery embolization for the treatment of patients with chronic pain secondary to knee osteoarthritis refractory to standard-of-care. 
Methods 
Design
This is a Living Evidence Synthesis, which will start with a baseline synthesis report. We will include systematic reviews, randomized or non-randomized studies evaluating the effect of genicular artery versus conservative management or drug therapy (no use of the genicular artery embolization), in patients with chronic pain secondary to knee osteoarthritis refractory to standard-of-care. Main outcomes defined as critical or important for decision making include knee pain, overall functional improvement, changes in the need for pain medication, health-related quality of life (HRQoL), complications and adverse events. 
Based on its conclusions, we will set up the living evidence approach, and the evidence monitoring will begin.
Evidence identification
The evidence identification, screening, and selection will be supported by technological enablers developed by the Epistemonikos Foundation and included in its "Living Overview of Evidence (L.OVE) platform. The team maintaining the L·OVE platform will devise the literature search aimed to identify systematic reviews, randomized clinical trials, or non-randomized studies (e.g cohort and case-control studies). An automated living search will be performed in all databases following high-standard procedures. The results of the literature searches will be automatically incorporated into the L·OVE platform where two reviewers will then screen the titles and abstracts of classified references against selection criteria. We will continuously monitor the evidence by performing daily searches and a monthly screening of the retrieved references. To support the screening and monitoring, we will use an automatic classifier based on artificial intelligence (AI) algorithm and other technologies, that excludes references with a low probability of being relevant when appropriate. Additionally, every three months we will manually search for ongoing studies in the International Clinical Trials Registry Platform and the clinicaltrials.gov site.
Study selection and data extraction
Two reviewers will independently screen each study for eligibility, extract data, and assess its methodological quality using appropriate tools. 
For the baseline synthesis report, we will include systematic reviews, randomized or non-randomized studies evaluating the effect of genicular artery versus be conservative management or drug therapy (no use of the genicular artery embolization) in patients with chronic pain secondary to knee osteoarthritis refractory to standard-of-care. 
We will perform meta-analyses of the study’s results when pertinent. We will assess the certainty of the evidence for each outcome by applying the GRADE approach. These findings will be used to refine the parameters for setting up the living evidence approach. 
Living evidence approach
We will continuously monitor the evidence for 12 months. If a new study is identified as eligible, we will follow the same procedures described above prior to updating the metanalysis of the outcomes reported. We will follow a systematic and reproducible process for taking decisions related to incorporating or postponing the incorporation of new studies, updating of conclusions or recommendations this synthesis informs and for periodically reviewing the question to define its continuation, changes, or withdrawal of the living mode. The question will withdraw according to predefined specific criteria.
Results
For the baseline synthesis and the subsequent synthesis updates, the estimates for all outcomes evaluated will be presented in the GRADE summary of findings tables. Regular updates will include key messages on changes in the evidence synthesis conclusions. We will resubmit new complete updates every time the conclusions change or whenever there are substantial updates for the main outcomes of interest.

Keywords: Genicular artery, embolization, knee osteoarthritis, pain, systematic review; living evidence.