Variability in effect sizes of exercise therapy for knee osteoarthritis depending on comparator interventions

Pedersen, Julie Rønne; Sari, Dilara Merve; Juhl, Carsten Bogh; Thorlund, Jonas Bloch; Skou, Søren Thorgaard; Roos, Ewa M.

doi:10.1016/j.rehab.2022.101708

“…Nevertheless, the trend towards the benefit of the REGAIN intervention was consistent for most of the outcome measures, indicating a tangible effect. Given that our usual care group received arguably more intervention (ie, best practice usual care) than might have been offered in clinical practice, it is possible that the true effect of the REGAIN intervention is masked, as reported previously in other clinical trials 35. As such, the true effect may possibly be larger than reported when compared with no treatment.…”

Section: Discussionmentioning

confidence: 87%

“…Given that our usual care group received arguably more intervention (ie, best practice usual care) than might have been offered in clinical practice, it is possible that the true effect of the REGAIN intervention is masked, as reported previously in other clinical trials. 35 As such, the true effect may possibly be larger than reported when compared with no treatment. We report short term and long term clinical effectiveness, and we will report on cost effectiveness elsewhere.…”

Section: Discussionmentioning

confidence: 95%

Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial

McGregor,

Sandhu,

Bruce

et al. 2024

BMJ

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Objective To evaluate whether a structured online supervised group physical and mental health rehabilitation programme can improve health related quality of life compared with usual care in adults with post-covid-19 condition (long covid). Design Pragmatic, multicentre, parallel group, superiority randomised controlled trial. Setting England and Wales, with home based interventions delivered remotely online from a single trial hub. Participants 585 adults (26-86 years) discharged from NHS hospitals at least three months previously after covid-19 and with ongoing physical and/or mental health sequelae (post-covid-19 condition), randomised (1:1.03) to receive the Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) intervention (n=298) or usual care (n=287). Interventions Best practice usual care was a single online session of advice and support with a trained practitioner. The REGAIN intervention was delivered online over eight weeks and consisted of weekly home based, live, supervised, group exercise and psychological support sessions. Main outcome measures The primary outcome was health related quality of life using the patient reported outcomes measurement information system (PROMIS) preference (PROPr) score at three months. Secondary outcomes, measured at three, six, and 12 months, included PROMIS subscores (depression, fatigue, sleep disturbance, pain interference, physical function, social roles/activities, and cognitive function), severity of post-traumatic stress disorder, general health, and adverse events. Results Between January 2021 and July 2022, 39 697 people were invited to take part in the study and 725 were contacted and eligible. 585 participants were randomised. Mean age was 56 (standard deviation (SD) 12) years, 52% were female participants, mean health related quality of life PROMIS-PROPr score was 0.20 (SD 0.17), and mean time from hospital discharge was 323 (SD 144) days. Compared with usual care, the REGAIN intervention led to improvements in health related quality of life (adjusted mean difference in PROPr score 0.03 (95% confidence interval 0.01 to 0.05), P=0.02) at three months, driven predominantly by greater improvements in the PROMIS subscores for depression (1.39 (0.06 to 2.71), P=0.04), fatigue (2.50 (1.19 to 3.81), P<0.001), and pain interference (1.80 (0.50 to 3.11), P=0.01). Effects were sustained at 12 months (0.03 (0.01 to 0.06), P=0.02). Of 21 serious adverse events, only one was possibly related to the REGAIN intervention. In the intervention group, 141 (47%) participants fully adhered to the programme, 117 (39%) partially adhered, and 40 (13%) did not receive the intervention. Conclusions In adults with post-covid-19 condition, an online, home based, supervised, group physical and mental health rehabilitation programme was clinically effective at improving health related quality of life at three and 12 months compared with usual care. Trial registration ISRCTN registryISRCTN11466448.

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“…Second, the nature of the control interventions of these long duration studies included active treatments that minimized the difference between the intervention and control groups. 34,35 These control groups often provided diet with behavioral sessions, 36 another exercise, 37 or pharmacological intervention, 38 producing comparable improvements as exercise. Third, it is possible that there is a ceiling to the magnitude of improvement in pain and physical function, whereby further investment in resistance exercise provides diminishing returns.…”

Section: Discussionmentioning

confidence: 99%

“…It is noteworthy that the changes in pain and physical function for these interventions favored neither the exercise nor control intervention. Second, the nature of the control interventions of these long duration studies included active treatments that minimized the difference between the intervention and control groups 34,35 . These control groups often provided diet with behavioral sessions, 36 another exercise, 37 or pharmacological intervention, 38 producing comparable improvements as exercise.…”

Section: Discussionmentioning

confidence: 99%

Are the Effects of Resistance Exercise on Pain and Function in Knee and Hip Osteoarthritis Dependent on Exercise Volume, Duration, and Adherence? A Systematic Review and Meta‐Analysis

Marriott,

Hall,

Maciukiewicz

et al. 2024

Arthritis Care & Research

6

0

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ObjectiveThe purpose of this study was to determine dose parameters for resistance exercise associated with improvements in pain and physical function in knee and hip osteoarthritis (OA); and whether these improvements were related to adherence.MethodsWe searched 6 databases, from inception to January 28 2023, for randomized controlled trials (RCTs) comparing land‐based, resistance exercise‐only interventions with no intervention or any other intervention. There were four subgroups of intervention duration: 0 to <3 months, 3‐6 months, >6 to <12 months, ≥12 months. The between‐group effect was calculated for immediate post‐intervention pain and physical function (activities of daily living (ADL) and sports/recreation (SPORT)).ResultsFor both knee and hip, data from 280 studies showed moderate benefit for pain, physical function ADL and physical function SPORT in favour of interventions 3‐6 months. For the knee, there was also a moderate benefit for physical function ADL in favour of interventions >6 to <12 months. From 151 knee and hip studies that provided total exercise volume data (frequency, time, duration), there was no association between volume with the effect size for pain and physical function. 74 studies (69 knee, 5 hip) reported usable adherence data. There was no association between adherence with the effect size for pain and physical function.ConclusionIn knee and hip OA, resistance exercise interventions 3 to 6 months (and for the knee >6 to <12 months) duration improve pain and physical function. Improvements do not depend on exercise volume or adherence, suggesting exercise does not require rigid adherence to a specific dose.image

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“…The effect of exercise therapy for KOA varies significantly depending on the different control groups [ 44 ]. In contrast a previous meta-analysis [ 11 ], more detailed subgroup division was conducted in this study.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis: a systematic review and meta-analysis

Si

¹

,

Sun

²

,

Zheng

³

et al. 2023

J Orthop Surg Res

5

0

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Objective The objective of the study was to evaluate the effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis (KOA). Methods Five databases (PubMed, Embase, Cochrane Library, CINAHL, Web of Science Core Collection) were searched for relevant randomized controlled trials (RCTs) published from database inception to 2 August 2022. The Cochrane Collaboration’s standards were followed for study selection, eligibility criteria, data extraction and statistics, using the Cochrane Collaboration Risk of Bias Tool and PEDro for quality assessment. A meta-analysis and subgroup analyses, stratified by control condition and intervention duration, were conducted using RevMan 5.4. The study was reported in compliance with the PRISMA statement. Results A total of 12 independent RCTs with 1442 participants were included. The meta-analysis showed that the home-based exercise interventions significantly reduced pain in individuals with KOA (SMD = − 0.32, 95% CI [− 0.41, − 0.22], p < .01) and improved physical function (SMD = − 0.25, 95% CI [− 0.47, − 0.02], p = .03) and quality of life (SMD = 0.63, 95% CI [0.41, 0.85], p < .001). Subgroup analysis revealed that home-based exercise interventions were superior to health education and no treatment, in terms of pain and physical function, and similar to clinic-based exercise and pharmacologic treatment. Conclusions The effect of home-based exercise intervention is significantly better than health education and no treatment for reducing knee pain and improving physical function, and was able to achieve the effects of clinic-based exercise treatment and pharmacologic treatment. With regard to quality of life, the unsupervised home strength exercise intervention showed a significant effect compared with the health education control and combined with cognitive behavioural therapies may produce better results. Although home-based intervention provides effective treatment options for individuals with clinical treatment limitations, individual disease complications and the dosimetry of exercise need to be considered in practice. Furthermore, growing evidence supports the effectiveness of Tai Chi in the rehabilitation of KOA.

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Variability in effect sizes of exercise therapy for knee osteoarthritis depending on comparator interventions

Cited by 6 publications

References 58 publications

Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial

Clinical effectiveness of an online supervised group physical and mental health rehabilitation programme for adults with post-covid-19 condition (REGAIN study): multicentre randomised controlled trial

Are the Effects of Resistance Exercise on Pain and Function in Knee and Hip Osteoarthritis Dependent on Exercise Volume, Duration, and Adherence? A Systematic Review and Meta‐Analysis

Effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis: a systematic review and meta-analysis

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