Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol

Abstract

IntroductionKnee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/do not respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions.Methods and analysis Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI.Ethics and disseminationResearch ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians.PROSPERO registration numberCRD42017054049.

Do comorbidities predict pain and function in knee osteoarthritis following an exercise intervention, and do they moderate the effect of exercise? Analyses of data from three randomized controlled trials

“…It is possible that some of the associations we detected (in particular, for the single moderator) reflect spurious findings, perhaps caused by multiple testing. Additional research, to confirm the results of the present study, and further investigate the effect of comorbidity on the outcome of exercise interventions in people with knee OA, is warranted, and currently under way (Holden et al, ).…”

Challenges and controversies of complex interventions in osteoarthritis management: recognizing inappropriate and discordant care

“…More attention is needed on adherence to exercise, which is a major obstacle in exercise programmes. Currently the OA Trial Bank [ 43 ] is supporting work to determine subgroups who may respond better to exercise [ 44 ]. As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise in patients with OA, and further trials were deemed unlikely to overturn this result [ 41 ].…”

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

“…One study evaluated predictive factors for being a OMERACT-OARSI responder to exercise therapy and found that hip OA patients with unilateral hip pain, age of ≤58 years, pain of ≥6/10 on a numeric pain rating scale, 40-m self-paced walk test time of ≤25.9 s, and duration of symptoms of ≤1 year were predictive for response to exercise therapy [ 32 ]. In addition, currently a research collaboration is ongoing to study effect modifiers for exercise therapy in knee and hip OA with individual participant data meta-analyses in a databank of trials (OA trial bank) [ 33 ]. Lastly, more consensus about the use of scales, measurements, and population (e.g., severity of symptoms) within these criteria, could improve uniformity and comparability of this measurement.…”