11/12/2024
Hot off the Press 🔥
Exercise for osteoarthritis of the knee
📘 This brand-new Cochrane review by Lawford and colleagues examines the effectiveness of exercise for individuals with knee osteoarthritis (OA). It synthesizes data from 139 randomized controlled trials involving 12,468 participants. (https://pubmed.ncbi.nlm.nih.gov/39625083/)
🔑 Below are the main conclusions:
📊 Effectiveness of Exercise:
👉 Pain Relief:
Exercise slightly reduces pain compared to attention control/placebo (mean reduction: 8.7 points on a 0–100 scale, 95% confidence interval (CI) 5.70 to 11.70; 28 studies,
2873 participants) and compared to no treatment/usual care (mean reduction: 13.1 points, 95% CI 10.36 to 15.91; 56 studies, 4184 participants).
When combined with another intervention (e.g., weight loss), exercise provides moderate pain relief (mean reduction: 10.4 points, 95% CI 8.06 to 12.79; 47 studies, 4441 participants).
👉 Physical Function:
Exercise likely improves physical function compared to attention control/placebo (mean improvement: 11.3 points, 95% CI 7.64 to 15.09; 24 studies, 2536 participants) and no treatment/usual care (mean improvement: 12.5 points, 95% CI 9.74 to 15.31; 54 studies, 4352 participants).
Adding exercise to another intervention also improves physical function (mean improvement: 9.7 points, 95% CI 7.48 to 11.97 (on a 0 to 100 scale); 44 studies, 4381 participants ).
👉 Quality of Life:
Exercise provides little to no improvement in quality of life 6.1 points better (on a scale of 0 to 100, 95% CI −0.13 to 12.26; 6 studies, 454 participants) with attention control/placebo, 5.4 points (95% CI 3.19 to 7.54; 28 studies, 2328 participants) with no treatment/usual care, 4.2 points (95% CI 1.36 to 7.07; 12 studies, 1660 participants).
💡 Clinical Relevance:
☝️ While statistically significant, these improvements often fall below thresholds for minimal clinically important differences (12 points for pain, 13 points for function, and 15 points for quality of life). This suggests that benefits may not be perceivable by all patients.
⛑︎ Safety:
Exercise does not significantly increase adverse events compared to attention control/placebo or no treatment/usual care. When combined with another intervention, exercise slightly increases the risk of adverse events.
⭕ Study Limitations:
The majority of included trials had a high or unclear risk of bias, especially regarding blinding.
The results may be influenced by contextual effects or placebo responses.
🔀 Subgroup and Sensitivity Analyses:
No significant differences were found between types of exercises or the frequency/intensity of sessions. The total number of sessions or healthcare provider interactions did not correlate strongly with outcomes.
✅ Overall Conclusion:
Exercise is a low- to moderate-certainty intervention for short-term improvements in pain, physical function, and quality of life for knee OA. However, the clinical significance of these improvements remains uncertain.
📷 Illustration: What Is Knee Osteoarthritis?, https://jamanetwork.com/journals/jama/fullarticle/2826225
