Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis

Abstract

ObjectivesTo determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life.DesignSystematic review with meta-analysis.Data sourcesMedline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018.Eligibility criteria for selecting studiesRandomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise.ResultsEight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference −1.06, 95% CI −2.01 to −0.12), but not for outcomes of pain (−0.09, 95% CI –0.96 to 0.79), patient-reported function (−0.74, 95% CI –1.56 to 0.08) or stair function (−0.7, 95% CI –1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI –0.31 to 0.56), patient-reported function (−0.15, 95% CI –0.58 to 0.29) or stair function (0.13, 95% CI –0.3 to 0.57).ConclusionWalking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.

Effects of Trigger Point Dry Needling for the Management of Knee Pain Syndromes: A Systematic Review and Meta-Analysis

“…Since TrPs are not associated with muscle atrophy, more complex mechanisms can be involved in knee OA and post-surgical knee pain. Most trials (n=3, 75%) applied the needling intervention to the knee musculature; a recent meta-analysis reported that the inclusion of exercises targeting the hip musculature resulted in greater improvements in pain and function in patients with knee OA [ 55 ]. Another explanation may be that knee OA or post-surgery knee pain can also have a neuropathic mechanism (up to 25% of the patients) [ 56 ], not influenced by the effects of dry needling.…”

WITHDRAWN: Predictive potentials of 8 muscle strength actions, KOOS-pain, and Örebro-psychosocial difficulties on self-reported activities-of-daily-life function in patients with knee osteoarthritis: an exploratory regression-based cross-sectional study

“…The strength actions shown to be discriminative (on the most affected leg) in another of our case-vs-healthy control studies (28) on the same sample, were evaluated as X 3i (cf. Results, Table 1), but therein we also included hip abduction due to prior proven causal/trial effects (26,85). For choosing the first and second candidate predictors, we also considered a confounding analysis (cf.…”

Hip abductor strength–based exercise therapy in treating women with moderate-to-severe knee osteoarthritis: a randomized controlled trial

“…Only a few of these studies were rated as high quality according to a recent meta-analysis. 19 More special targeted trials are needed to further confirm the functional benefit of strengthening the hip abductor. This study was thereby designed to determine whether the addition of hip abductor training to conventional quadriceps training could result in better performance, higher self-reported function and more pain relief in Asian women with symptomatic knee osteoarthritis.…”