Responders to Exercise Therapy in Patients with Osteoarthritis of the Hip: A Systematic Review and Meta-Analysis

Teirlinck, Carolien H; Verhagen, Arianne P.; Reijneveld, Elja; Runhaar, Jos; Middelkoop, Marienke van; Ravesteyn, Leontien M. van; Hermsen, Lotte A H; Groot, Ingrid B de; Bierma-Zeinstra, Sita M A

doi:10.3390/ijerph17207380

Cited by 12 publications

(6 citation statements)

References 27 publications

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“…Although systematic reviews suggest, on average, small-to-moderate effects on pain, physical function, and quality of life, several studies have shown marked differences in individual patients’ treatment response [ 54 , 56 , 57 ]. However, recent efforts to identify potential treatment response moderators (i.e., characteristics that might impact patient response) of the effect of exercise therapy for knee OA have produced inconclusive or conflicting results.…”

Section: Which Patients Do and Do Not Benefit From Exercise?mentioning

confidence: 99%

Exercise Therapy for Knee and Hip Osteoarthritis: Is There An Ideal Prescription?

Young

Pedersen

2023

Curr Treat Options in Rheum

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Purpose of review Exercise therapy is the first line treatment for patients with knee and hip osteoarthritis (OA) but is consistently underutilized. In this review, we aim to provide health care professionals with an overview of the latest evidence in the areas of exercise therapy for OA, which can serve as a guide for incorporating the ideal exercise therapy prescription in the overall management plan for their patients with OA. Recent findings Evidence continues to be produced supporting the use of exercise therapy for all patients with knee or hip OA. Ample evidence exists suggesting exercise therapy is a safe form of treatment, for both joint structures and the patient overall. Several systematic reviews show that exercise therapy is likely to improve patient outcomes, regardless of disease severity or comorbidities. However, no single type of exercise therapy is superior to others. Summary Health care practitioners and patients should be encouraged to incorporate exercise therapy into treatment plans and can be assured of the safety profile and likelihood of improvement in important patient outcomes. Since no single exercise therapy program shows vastly superior benefit, patient preference and contextual factors should be central to the shared decision-making process when selecting and individualising appropriate exercise therapy prescriptions.

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Section: Which Patients Do and Do Not Benefit From Exercise?mentioning

confidence: 99%

Exercise Therapy for Knee and Hip Osteoarthritis: Is There An Ideal Prescription?

Young

Pedersen

2023

Curr Treat Options in Rheum

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“…The of OMERACT-OARSI responders in previous research of OA management varies widely. The proportion of responders varies from 25% to 83%, [36][37][38] hence, a conservative estimate in our trial would be 50% being classified as responders. No direct comparison of our study to other trials is to our knowledge available, increasing difficulty of specifying a non-inferior margin.…”

Section: Sample Size Calculationmentioning

confidence: 99%

Effect of a mHealth exercise intervention compared with supervised exercise therapy in osteoarthritis management: protocol of the DigiOA trial

et al. 2022

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IntroductionSoaring prevalence of hip and knee osteoarthritis (OA) inflicts high costs on the healthcare system. A further rise in the OA incidence is expected, generating increased demand of care potentially challenging accessibility and threatening to overwhelm the healthcare system. Innovative solutions that may improve accessibility to recommended OA care for patients in primary care and maintain healthcare sustainability are warranted. Digitalising home exercise therapy may be one such solution. The primary aim of this study is to evaluate the effectiveness of a mobile health app providing digitalised home exercises, compared with supervised exercise therapy in patients with OA. Second, we will evaluate the cost-efficiency of the intervention and explore potential differences in outcome and adherence to exercises in the experimental treatment group.Methods and analysisA two-armed non-inferiority randomised controlled trial will be conducted. In total, 156 patients with hip and/or knee OA will be recruited from physiotherapy clinics in primary care in Norway. Following patient education, patients will be randomised to either 6 weeks of standard treatment (2 weekly sessions of supervised exercise therapy) or experimental treatment (home exercises via the Virtual Training (VT) app). Primary outcome is the proportion of Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responders at 6 weeks. Secondary outcomes include physical performance, patient-reported outcomes related to pain, fatigue, disease activity, physical function, mental health, health related quality of life, self-efficacy, utilisation of healthcare services and medication, digital competence and use of apps.Ethics and disseminationPatients will sign an informed consent form before participating in the trial. Approval has been granted by the Regional Ethics Committee (201105) and Data Protection Officer at Diakonhjemmet Hospital (00221). Patient research partners will contribute in all parts of the study.Trial registration numberNCT04767854.

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“…1 3 The common finding of relatively small treatment effects for many interventions has nourished the belief that subgroups showing larger effects may be identified in more homogenous groups of patients. [4][5][6] This belief has driven the interest in identifying subgroups of patients likely to respond better to specific interventions or respond poorly to an intervention where other approaches may be more efficacious. 7 A well-recognised method for identifying clinically relevant subgroups in a patient population is to analyse treatment effect modifiers using randomised controlled trial (RCT) data.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical guidelines universally recommend patient education and exercise therapy as first-line treatments for knee and hip osteoarthritis (OA)1–3 complemented by weight loss, non-steroidal anti-inflammatory drugs, corticosteroids or hyaluronic acid injections, and several adjunctive medications and interventions 1 3. The common finding of relatively small treatment effects for many interventions has nourished the belief that subgroups showing larger effects may be identified in more homogenous groups of patients 4–6. This belief has driven the interest in identifying subgroups of patients likely to respond better to specific interventions or respond poorly to an intervention where other approaches may be more efficacious 7…”

Section: Introductionmentioning

confidence: 99%

Do imaging findings modify the effect of non-surgical treatment in patients with knee and hip osteoarthritis? A systematic literature review

et al. 2023

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ObjectivesTo review the available evidence on diagnostic imaging findings in knee and hip osteoarthritis (OA) as treatment effect modifiers in non-surgical OA interventions.MethodsMEDLINE, Embase and The Cochrane Central Register of Controlled Trials were searched from the earliest records published to 22 March 2022. Studies in knee and hip OA reporting subgroup analyses in randomised controlled trials with imaging findings as potential treatment effect modifiers were included. Studies were critically appraised using the Cochrane risk of bias tool and a subgroup analysis quality assessment.ResultsOf 10 014 titles and abstracts screened, eight studies met the inclusion criteria, six on knee OA and two on hip OA. The studies investigated effect modifiers in exercise therapy, intra-articular injections and unloading shoes. Imaging findings assessed as potential treatment effect modifiers were radiographic OA severity, hip effusion (ultrasound), bone marrow lesions and meniscal pathology (MRI). Two studies fulfilled the methodological quality criteria for assessing effect modification. One reported that radiographic knee OA severity modified the effect of unloading shoes on walking pain. Those with more severe radiographic knee OA had a greater response to shoe inserts. One reported no interaction between radiographic OA severity or joint effusion and the effect of intraarticular injections of corticosteroid or hyaluronic acid in hip OA, indicating no difference in response in people with greater hip joint effusion or radiographic OA severity compared with those with less severe joint disease.ConclusionOverall, methodological limitations and very few studies do not permit conclusions on diagnostic imaging findings as effect modifiers in non-surgical interventions in knee and hip OA.Radiographic severity of knee OA potentially modifies the effect of unloading shoes.PROSPERO registration numberCRD42020181934.

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Responders to Exercise Therapy in Patients with Osteoarthritis of the Hip: A Systematic Review and Meta-Analysis

Cited by 12 publications

References 27 publications

Exercise Therapy for Knee and Hip Osteoarthritis: Is There An Ideal Prescription?

Exercise Therapy for Knee and Hip Osteoarthritis: Is There An Ideal Prescription?

Effect of a mHealth exercise intervention compared with supervised exercise therapy in osteoarthritis management: protocol of the DigiOA trial

Do imaging findings modify the effect of non-surgical treatment in patients with knee and hip osteoarthritis? A systematic literature review

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