Exercise for osteoarthritis of the knee: a Cochrane systematic review

Abstract

ObjectiveTo determine whether land-based therapeutic exercise is beneficial for people with knee osteoarthritis (OA) in terms of reduced joint pain or improved physical function and quality of life.MethodsFive electronic databases were searched, up until May 2013. Randomised clinical trials comparing some form of land-based therapeutic exercise with a non-exercise control were selected. Three teams of two review authors independently extracted data and assessed risk of bias for each study. Standardised mean differences immediately after treatment and 2–6 months after cessation of formal treatment were separately pooled using a random effects model.ResultsIn total, 54 studies were identified. Overall, 19 (35%) studies reported adequate random sequence generation, allocation concealment and adequately accounted for incomplete outcome data. However, research results may be vulnerable to selection, attrition and detection bias. Pooled results from 44 trials indicated that exercise significantly reduced pain (12 points/100; 95% CI 10 to 15) and improved physical function (10 points/100; 95% CI 8 to 13) to a moderate degree immediately after treatment, while evidence from 13 studies revealed that exercise significantly improved quality of life immediately after treatment with small effect (4 points/100; 95% CI 2 to 5). In addition, 12 studies provided 2-month to 6-month post-treatment sustainability data which showed significantly reduced knee pain (6 points/100; 95% CI 3 to 9) and 10 studies which showed improved physical function (3 points/100; 95% CI 1 to 5).ConclusionsAmong people with knee osteoarthritis, land-based therapeutic exercise provides short-term benefit that is sustained for at least 2–6 months after cessation of formal treatment.

Effects of a Multicomponent Home-Based Physical Rehabilitation Program on Mobility Recovery After Hip Fracture: A Randomized Controlled Trial

“…Such changes might lead to pain and induce increased loading on the low back and on joints in the lower body, which in turn lead to activity restrictions, and eventually to a circular decline with further muscle strength decline and consequent mobility disability. However, it is also possible that muscle weakness contributes to musculoskeletal pain and fear of pain, which then leads to avoidance of physical activity, placing people on the pathway to mobility decline and further physical inactivity (Fransen & McConnell 2008, Vlaeyen & Linton 2000. In all, mobility difficulties after hip fracture complicate involvement in community activities, make daily life more difficult and increase the risk for institutionalization.…”

An update on the pathophysiology of osteoarthritis

“…However, there is an increasing body of evidence to suggest that physical activity is essential for cardiovascular, metabolic, musculoskeletal and mental health. A recent systematic review of exercise for knee OA extracted data from 54 studies to provide high-quality evidence to indicate that land-based therapeutic exercise provides benefits for patients (61). The study reports that short-term benefits were sustained for at least two to six months after cessation of formal treatment in terms of reduced knee pain.…”

Atraumatic knee pain

“…Communicating that a thorough clinical examination is often sufficient in cases of atraumatic knee pain is an important, but frequently challenging and time-consuming educational task. The patient should also be informed that 'low-tech' treatment principles -lifestyle change, active coping and individualised exercise therapyhave a documented effect on knee pain and functioning (47,48). Such measures ought to constitute the mainstay of the approach taken by the health services to patients with atraumatic knee disorders.…”