PLoS ONE (Jan 2022)

Effect of exercise and/or educational interventions on physical activity and pain in patients with hip/knee osteoarthritis: A systematic review with meta-analysis.

  • Ryo Sasaki,
  • Yuichiro Honda,
  • Satoshi Oga,
  • Takuya Fukushima,
  • Natsumi Tanaka,
  • Yasuhiro Kajiwara,
  • Koichi Nakagawa,
  • Ayumi Takahashi,
  • Yukinori Sakamoto,
  • Hinako Morita,
  • Yutaro Kondo,
  • Seima Okita,
  • Yasutaka Kondo,
  • Kyo Goto,
  • Hideki Kataoka,
  • Junya Sakamoto,
  • Minoru Okita

DOI
https://doi.org/10.1371/journal.pone.0275591
Journal volume & issue
Vol. 17, no. 11
p. e0275591

Abstract

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ObjectiveTo investigate the effectiveness of exercise and/or educational intervention on physical activity and pain in patients with hip/knee osteoarthritis (OA) using systematic review and meta-analysis.MethodsWe searched randomized controlled trials that investigated physical activity and pain and compared exercise and/or educational intervention with usual care in patients with hip/knee OA in MEDLINE (PubMed), ProQuest, Scopus, and the Physiotherapy Evidence Database (PEDro), including all those published by April 30, 2022 and written in English. Studies that newly applied analgesics after onset of the intervention were excluded. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the methodological qualities. The random-effects model was used for meta-analysis with standard mean differences using RevMan version 5.4. The body of evidence for each study was synthesized using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.ResultsTwenty studies including 2,350 patients were included (7 exercise studies, 8 educational intervention studies and 5 combination studies). The meta-analysis demonstrated that there is very low evidence that combination therapy of exercise and educational intervention improve the physical activity level at the endpoint (4 articles; SMD 0.33, 95% CI 0.04 to 0.51, P = 0.03). Low evidence was observed for combination therapy reducing pain (4 articles; SMD -0.15, 95% CI -0.29 to -0.02, P = 0.03).DiscussionThe current evidence indicated that combination therapy of exercise and educational intervention leads to improved physical activity and pain reduction in hip/knee OA patients, but the risk of bias in each study, especially in allocation concealment, downgraded the evidence level. These findings support the use of a combination therapy of exercise and educational intervention to promote physical activity levels in patients with hip/knee OA.Trail registrationThere was no financial support for this research. The protocol was registered at the International Prospective Register of Systematic Reviews (registration code: CRD42020205804).