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

Holden, MA; Hattle, M; Runhaar, J; Riley, RD; Healey, EL; Quicke, J; van der Windt, DA; Dziedzic, K; van Middelkoop, M; Burke, D; Corp, N; Legha, A; Bierma-Zeinstra, S; Foster, NE; STEER OA Patient Advisory Group; OA Trial Bank Exercise Collaborative

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

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

Lancet RheumatolPublished 12 Jun 2023Systematic review and individual participant data meta-analysis of randomised controlled trials

An erratum to this article was published (Lancet Rheumatol, Aug 2023 ↗)

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Authors' conclusion

There was evidence of a small, positive overall effect of therapeutic exercise on pain and physical function compared with non-exercise controls.

Study context

Population: People with knee OA, hip OA, or both
Participants: 4,241 people31 RCTs

Comparison: Therapeutic exercise vs non-exercise controls
Outcome: Individual patient-level moderators of the effect of therapeutic exercise on self-reported pain and physical function
Follow-up: Short term (12 weeks), medium term (6 months), long term (12 months)

Methodological detailsprospectively registered

Prospectively registered

Pooled result

As reported in the abstract

Moderators of exercise effect on pain and physical function

Baseline pain and physical function moderated the effect of exercise on pain and physical function outcomes; those with higher baseline pain and function scores (poorer function) generally benefited more, evidence most certain in the short term (12 weeks)

Further pooled results

Outcome	← Lower with therapeutic exercise ←→ Higher with therapeutic exercise →	Difference, points
Pain (standardised 0-100 scale, 100 = worst) · short termBoS 10.3%, τ2 21.6	−10−505	−6.36 (95% CI −8.45 to −4.27)
Pain (standardised 0-100 scale, 100 = worst) · medium termBoS 30.0%, τ2 14.4	−10−505	−3.77 (CI −5.97 to −1.57)
Pain (standardised 0-100 scale, 100 = worst) · long termBoS 31.7%, τ2 4.5	−10−505	−3.43 (CI −5.18 to −1.69)
Physical function (standardised 0-100 scale, 100 = worst) · short termBoS 10.5%, τ2 10.1	−10−505	−4.46 (95% CI −5.95 to −2.98)
Physical function (standardised 0-100 scale, 100 = worst) · medium termBoS 33.6%, τ2 11.9	−10−505	−2.71 (CI −4.63 to −0.78)
Physical function (standardised 0-100 scale, 100 = worst) · long termBoS 34.1%, τ2 6.4	−10−505	−3.39 (CI −4.97 to −1.81)
	−10−505Difference, points (linear scale)

Original publication

Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. Lancet Rheumatol. Published 12 June 2023. doi:10.1016/s2665-9913(23)00122-4

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