Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: A systematic review of randomized clinical trials

Abstract

Objective. To review the effectiveness of exercise therapy in patients with osteoarthritis (OA) of the hip or knee.Methods. A computerized literature search of Medline, Embase, and Cinahl was carried out. Randomized clinical trials on exercise therapy for OA of the hip or knee were selected if treatment had been randomly allocated and if pain, self-reported disability, observed disability, or patient's global assessment of effect had been used as outcome measures. The validity of trials was systematically assessed by independent reviewers. Effect sizes and power estimates were calculated. A best evidence synthesis was conducted, weighting the studies with respect to their validity and power.Results. Six of the 11 assessed trials satisfied at least 50% of the validity criteria. Two trials had sufficient power to detect medium-sized effects. Effect sizes indicated small-to-moderate beneficial effects of exercise therapy on pain, small beneficial effects on both disability outcome measures, and moderate-to-great beneficial effects according to patient's global assessment of effect. Conclusion.There is evidence of beneficial effects of exercise therapy in patients with OA of the hip or knee. However, the small number of good studies restricts drawing firm conclusions.Osteoarthritis (OA) is a relatively common musculoskeletal disorder. A population-based incidence study from the US showed incident rates of 0.5/1,000 per year for hip OA (presented for medical consultation) and 2/1,000 per year for knee OA (1). Prevalence increases with age (2,3). In recent treatment guidelines for OA of the hip and knee (4,5), exercise therapy is considered to be an important nonpharmacologic treatment approach. The goal of exercise therapy in OA patients is to reduce pain and disability. In order to achieve this, exercise therapy aims at the improvement of muscle strength, stability of joints, range of motion, and aerobic fitness. These functions are frequently impaired in patients with OA, presumably contributing to pain and disability (6). Improving these functions is assumed to result in a reduction of pain and disability. In addition, exercise therapy aims directly at reduction of disability, e.g., through corrections of the walking pattern (7).Since the publication of the treatment guidelines mentioned above, several new randomized clinical trials (RCTs) on exercise therapy in OA patients have been published (8-12). These newly published RCTs were not included in previous reviews (7,(13)(14)(15)(16)(17)(18)(19). Furthermore, the methodology for reviews of the literature has evolved considerably (20)(21)(22). Current methodology requires several explicit and systematic steps to be made in conducting reviews of the literature. These steps are a systematic search of the literature (23), selection of studies based on explicit inclusion and exclusion criteria (24), assessment of methodologic quality (25), and a

Exercise and Manual Physiotherapy Arthritis Research Trial (EMPART) for Osteoarthritis of the Hip: A Multicenter Randomized Controlled Trial

“…4,5 Although ET has demonstrated beneficial effects for hip OA in recommended core outcomes 6 of pain 7,8 and patient perceived improvement (patient global assessment-(PGA) 9,10 in the short and medium term, results for changes in physical function are conflicting. A number of randomised controlled trials (RCTs), some of which have included participants with hip or knee OA, found functional benefits with exercise 9,11,12 , but a meta-analysis, based on data from participants with hip OA only, found no effect on physical function 7 .…”

“…However, some of these studies included people with hip or knee OA 9, 10, 43 , so the evidence regarding the optimal exercise approach for hip OA alone has yet to be identified. A moderate treatment effect on pain for hip OA has been ascertained in two meta-analyses 7,8 with no significant effect on function, based on five RCTs 7 . The original RCTs which demonstrated a benefit of ET included data from trials which included participants with hip or knee OA 9,11,43 whereas the meta-analysis extracted hip OA data only.…”

Course of functional status and pain in osteoarthritis of the hip or knee: A systematic review of the literature

“…Results have demonstrated that psychological factors (9 -13), demographic and clinical factors (9,11,14), biomechanical factors (10,15,16), and treatment modalities (10,17) are associated with disability. It is not known, however, whether these factors also predict future disabil-ity.…”

Physical functioning over three years in knee osteoarthritis: Role of psychosocial, local mechanical, and neuromuscular factors

“…Results of short-term studies have suggested the greater benefit of combined approaches (e.g., acupuncture/diet/exercise versus pain therapy alone [49]). Moreover, the effect sizes for strengthening interventions appear to be enlarged by incorporating pain management, attention to psychosocial factors, self-management, or aerobic exercise into the intervention (50,51).…”