Mechanisms of action of therapeutic exercise for knee and hip osteoarthritis (OA) remain a black box phenomenon: an individual patient data mediation study with the OA Trial Bank
Authors' conclusion
This first IPD mediation analysis of this scale revealed that in people with knee OA, knee extension strength only mediated ±2% of the effect of therapeutic exercise on pain and physical function. ROM and proprioception did not mediate changes in outcomes, nor did knee extension strength in people with hip OA.
Study context
- Population
- People with knee/hip OA in published randomised controlled trials (RCTs) of STEER OA12 of 31 RCTs
- Participants
- 1,407 people
- Comparison
- Therapeutic exercise vs non-exercise controls
- Primary endpoint
- Percentage of the effect of exercise on pain and physical function mediated through muscle strength, proprioception and ROM (knee OA) and muscle strength (hip OA)
Methodological detailsCounterfactual framework mediation analysis
- Counterfactual framework mediation analysis
Primary result
As reported in the abstract
Mediation by change in knee extension strength
- Knee OA, pain: β −0.03
- 2.3% mediated (95% CI −0.05 to −0.01)
- Knee OA, physical function: β −0.02
- 2.0% mediated (95% CI −0.04 to −0.00)
- Hip OA, physical function: β −0.03 (95% CI −0.07 to −0.00)
- no mediation
Further findings
Effect of therapeutic exercise on pain and physical function
- Generally statistically significant effects vs non-exercise controls
Original publication
Mechanisms of action of therapeutic exercise for knee and hip OA remain a black box phenomenon: an individual patient data mediation study with the OA Trial Bank. RMD Open. Published 28 August 2023. doi:10.
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