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Exercise therapy for OA of the hip or knee (update)

 

Clinical bottom line

There is limited evidence that exercise provides modest reductions in pain and disability in patients with mild or moderate osteoarthritis of the hip or knee.



Systematic review:

M Fransen et al. Therapeutic Exercise for people with osteoarthritis of the hip or knee. A systematic review. Journal of Rheumatology 2002 29: 1737-1745.


Date review completed: 2001
Number of trials included: 15 (not all were blinded)
Number of patients: 1733
Control groups: no treatment, relaxation, telephone calls, education
Main outcomes: pain; self-reported disability; observed disability; patient's global assessment of treatment effect. .


Inclusion criteria were randomised controlled trial which assessed exercise therapy in patients with osteoarthritis (OA) of the hip or knee. Searching was extensive and used Cochrane Library and specialist musculoskeletal databases, as well as electronic databases. Attempts were made to contact authors.

Findings:

A number of new studies published in the years before 2001 were included. Two studies of OA hip and fourteen studies of OA knee formed the basis of the review. Quality scores were 3/5 or higher in 9/14 studies. Few studies had more than 100 participants. The interventions used included walking, group and individual modes, with physiotherapy and education. There was no consistent pattern of intervention, though walking was frequently mentioned.

Overall, self-reported pain was lower and physical functioning better in patients who exercised than those who did not. Studies of higher quality had a slightly greater treatment effect than studies of lower quality.

Comment

This is a good review and confirms a previous review on the topic.