Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis

Holden, Melanie; Hattle, Miriam; Runhaar, Jos; Riley, Richard D; Healey, Emma L.; Quicke, J.G.; Windt, Daniëlle A. van der; Dziedzic, Krysia; Middelkoop, Marienke van; Burke, Danielle L.; Corp, Nadia; Legha, Amardeep; Bierma-Zeinstra, Sita M A; Foster, Nadine E; Brown, J.; Ingram, Carol; Hickson, Sheila; Taylor, Robert; Walker, Christine; Abbott, J. Haxby; Allen, Kelli D.; Bennell, Kim L; Bossen, Daniël; Chaipinyo, Kanda; Cochrane, Tom; Rooij, M. de; Risberg, May Arna; Fitzgerald, G. Kelley; French, Helen; Hale, Leigh; Henriksen, Marius; Hinman, Rana S; Hopman-Rock, M.; Hurley, Michael; Keogh, Justin W L; Veenhof, Cindy; Knoop, J.; Krauß, Inga; Levinger, Pazit; McCarthy, Christopher J.; Messier, Stephen P.; Heinonen, Ari; Østerås, Håvard; Anwer, Shahnawaz; Lacerda, Ana Cristina Rodrigues; Ganesh, G. Shankar; Steinhilber, Benjamin; Suzuki, Yoshishige; Hunt, Michael A.; Talbot, Laura; Teirlinck, Carolien H; Doherty, Michael; Tsai, Pao‐Feng; Wallis, Jason; Menek, Merve Yılmaz

doi:10.1016/s2665-9913(23)00122-4

Cited by 39 publications

(15 citation statements)

References 71 publications

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“…The findings of the current study are in line with some findings of previous studies in different musculoskeletal populations, which also indicated lower pain severity levels, 37 lower number of pain location, 26 lower age, 15 , 16 , 37 high levels of protective cognitive behavioral factors ( e.g ., high self-efficacy, positive illness perceptions regarding treatment control), and low levels of cognitive behavioral risk factors ( e.g ., negative illness perceptions regarding timeline and identity) 16 , 26 , 27 , 37 , 38 as important predictive factors for good outcome after IMPT while pain duration 26 , 37 and education level 37 were not. Remarkably, a recent meta-analysis in OA patients found that higher pain severity was a moderator for better function post-treatment, 39 contrasting our and another IMPT study’s findings. 37 This difference may arise because this meta-analysis’ solely focused on exercise therapy, and not IMPT.…”

Section: Discussioncontrasting

confidence: 99%

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Clinical prediction model for interdisciplinary biopsychosocial rehabilitation in osteoarthritis patients

VERVULLENS,

BREUGELMANS,

BECKERS

et al. 2024

Eur J Phys Rehabil Med

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BACKGROUND Osteoarthritis (OA) is a heterogenous condition, in which different subgroups are present. Individualized interdisciplinary multimodal pain treatments (IMPT) based on the biopsychosocial model have resulted in positive improvement of pain, health and disability in OA patients. Moreover, predictive factors for treatment success of IMPT in different musculoskeletal pain populations have been examined, but a clinical prediction model which informs whether an OA patient is expected to benefit or not from IMPT is currently lacking. AIM The aim was to develop and internally validate a clinical prediction model to inform patient-tailored care based on identified predictors for positive or negative outcomes of IMPT in patients with OA. DESIGN Longitudinal prospective cohort study. SETTING Center for Integral Rehabilitation at six locations in the Netherlands. POPULATION Chronic OA patients. METHODS Data in this study were collected during January 2019 until January 2022. Participants underwent a 10-week IMPT program based on the biopsychosocial model. Treatment success was defined by a minimal decrease from baseline of 9 points on the Pain Disability Index (PDI). Candidate predictors were selected by experts in IMPT and literature review. Backward logistic regression analysis was performed to develop the clinical predication model and bootstrap validation was performed for internal validation. RESULTS Overall, 599 OA patients were included, of which 324 experienced treatment success. Thirty-four variables were identified as possible predictors for good IMPT outcome. Age, gender, number of pain locations, PDI baseline score, maximal pain severity, use of pain medication and alcohol, work ability, brief illness perceptions questionnaire subscales timeline, consequences, identity and treatment control, pain catastrophizing scale and self-efficacy questionnaire score were found as predictors for treatment success. The internally validated model has an acceptable discriminative power of 0.71. CONCLUSIONS This study reports a specific clinical prediction model for good outcome of IMPT in patients with OA. The internally validated model has an acceptable discriminative power of 0.71. CLINICAL REHABILITATION IMPACT After external validation, this model could be used to develop a clinically useful decision tool.

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Section: Discussioncontrasting

confidence: 99%

“…Moreover, it focused on other disability measures ( e.g ., Western Ontario and McMaster Universities Osteoarthritis Index vs. PDI in our study). 39 …”

Section: Discussionmentioning

confidence: 99%

Clinical prediction model for interdisciplinary biopsychosocial rehabilitation in osteoarthritis patients

VERVULLENS,

BREUGELMANS,

BECKERS

et al. 2024

Eur J Phys Rehabil Med

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“…Indeed, this finding appears consistent with recent publications questioning the efficacy of exercise trials in OA and, more specifically, the potentially greater influence of contextual factors (eg, placebo effects) on observed improvements after exercise trials over the specific effects of the exercise intervention. [6][7][8] Although a weak association of total exercise volume with improvements in pain may be present in hip OA, there were a limited number of studies, and only about 50% (152 of 280) provided adequate information to calculate total volume. Therefore, it is difficult to draw firm conclusions regarding the relationship.…”

Section: Discussionmentioning

confidence: 99%

“…5 However, the clinical relevance of improvements in pain and function with exercise in people with knee and/or hip OA has recently been questioned. [6][7][8] Factors that likely contribute to the exercise response include the affected joint, parameters of prescription (eg, type, duration, volume) and adherence. [9][10][11][12][13] Due to the variable response to exercise, there is a substantial gap in guiding exercise for knee and/or hip OA.…”

Section: Introductionmentioning

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

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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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“…7 In contrast, a systematic review and individual participant data meta-analysis found that the effect of various forms of exercise on pain reduction compared with control is small and of uncertain clinical importance. 8 Similarly, a recent comparison of high-intensity strength training, low-intensity strength training, and attention control in 377 patients with knee OA found no statistical difference in pain reduction between the groups at 18-month follow-up. 4 Hence, there is some question as to whether the reduction in pain with strength training is therapeutic or due mostly to contextual factors (placebo effect and regression-to-the mean).…”

mentioning

confidence: 96%

Do We Need More Exercise and Osteoarthritis Randomized Clinical Trials?

Messier

2024

Arthritis & Rheumatology

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Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis

Cited by 39 publications

References 71 publications

Clinical prediction model for interdisciplinary biopsychosocial rehabilitation in osteoarthritis patients

Clinical prediction model for interdisciplinary biopsychosocial rehabilitation in osteoarthritis patients

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

Do We Need More Exercise and Osteoarthritis Randomized Clinical Trials?

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