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Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis

Date and Location




Saturday 21 September 2013 - 10:30 - 12:00


Presenting author and contact person

Presenting author

Danielle van der ...

Contact person

Danielle van der ...
Abstract text
Background: International guidelines recommend exercise to be part of ‘core’ management of osteoarthritis, given existing evidence regarding the beneficial effects of exercise, ease of application, few adverse effects and low costs. Objectives:To determine whether there is sufficient evidence that exercise interventions are more effective than no exercise control and compare the effectiveness of different exercise interventions in relieving pain and improving function in patients with lower limb osteoarthritis. Methods: Nine electronic databases were searched from inception to March 2012 for RCTs comparing exercise interventions either with each other, or no exercise control for adults with knee or hip osteoarthritis. Two reviewers evaluated eligibility and methodological quality. Main outcomes extracted were pain intensity and function limitation. Trial sequential analysis was used to investigate reliability and conclusiveness of available evidence for exercise interventions. Bayesian network meta-analysis was used to combine both direct (within-trial) and indirect (between-trial) evidence on treatment effectiveness. Results: A total of 51 trials covering 13 exercise interventions and 5116 patients met inclusion criteria. Sequential analysis revealed that as of 2005 sufficient evidence had been accrued to show significant benefit of exercise interventions over no exercise control. For pain relief, aquatic strengthening plus aerobic exercise (78%) was ranked as most effective followed closely by land-based flexibility plus strengthening and aerobic exercise (72%), land-based flexibility plus strengthening (70%) and land-based strengthening (69%). Flexibility plus strengthening (95%) followed by strengthening (67%) had the highest probabilities of being the overall best exercise interventions for improving function. Conclusions: As of 2005 sufficient evidence had accumulated to demonstrate significant benefit of exercise. Further trials of exercise versus no exercise are unlikely to overturn this pooled result. This network meta-analysis shows that the most effective exercise approaches are strengthening exercise alone or in combination with flexibility exercise. These results inform optimal care for lower limb osteoarthritis.