[article] 
inAnnals of physical and rehabilitation medicine > Vol. 62, n°5 (Septembre 2019) . - p. 356-365

Titre :	Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: A systematic review and meta-analysis
Type de document :	texte imprimé
Auteurs :	Siew-Li Goh ; Monica S.M. Persson ; Joanne Stocks ; Yunfei Hou ; Jianhao Lin ; Michelle C. Hall ; Michael Doherty ; Weiya Zhang
Année de publication :	2019
Article en page(s) :	p. 356-365
Note générale :	doi.org/10.1016/j.rehab.2019.04.006
Langues :	Anglais (eng)
Mots-clés :	Knee osteoarthritis  Exercise  Meta-analysis  Determinants  Physical therapy  Pain  Function  Quality of Life
Résumé :	Background Exercise is an effective treatment for osteoarthritis. However, the effect may vary from one patient (or study) to another. Objective To evaluate the efficacy of exercise and its potential determinants for pain, function, performance, and quality of life (QoL) in knee and hip osteoarthritis (OA). Methods We searched 9 electronic databases (AMED, CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, PEDro, PubMed, SPORTDiscus and Google Scholar) for reports of randomised controlled trials (RCTs) comparing exercise-only interventions with usual care. The search was performed from inception up to December 2017 with no language restriction. The effect size (ES), with its 95% confidence interval (CI), was calculated on the basis of between-group standardised mean differences. The primary endpoint was at or nearest to 8 weeks. Other outcome time points were grouped into intervals, from < 1 month to ≥ 18 months, for time-dependent effects analysis. Potential determinants were explored by subgroup analyses. Level of significance was set at P ≤ 0.10. Results Data from 77 RCTs (6472 participants) confirmed statistically significant exercise benefits for pain (ES 0.56, 95% CI 0.44–0.68), function (0.50, 0.38–0.63), performance (0.46, 0.35–0.57), and QoL (0.21, 0.11–0.31) at or nearest to 8 weeks. Across all outcomes, the effects appeared to peak around 2 months and then gradually decreased and became no better than usual care after 9 months. Better pain relief was reported by trials investigating participants who were younger (mean age < 60 years), had knee OA, and were not awaiting joint replacement surgery. Conclusions Exercise significantly reduces pain and improves function, performance and QoL in people with knee and hip OA as compared with usual care at 8 weeks. The effects are maximal around 2 months and thereafter slowly diminish, being no better than usual care at 9 to 18 months. Participants with younger age, knee OA and not awaiting joint replacement may benefit more from exercise therapy. These potential determinants, identified by study-level analyses, may have implied ecological bias and need to be confirmed with individual patient data.
En ligne :	https://www.sciencedirect.com/science/article/pii/S1877065719300624
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[article] Efficacy and potential determinants of exercise therapy in knee and hip osteoarthritis: A systematic review and meta-analysis [texte imprimé] / Siew-Li Goh ; Monica S.M. Persson ; Joanne Stocks ; Yunfei Hou ; Jianhao Lin ; Michelle C. Hall ; Michael Doherty ; Weiya Zhang . - 2019 . - p. 356-365.
doi.org/10.1016/j.rehab.2019.04.006
Langues : Anglais (eng)
in Annals of physical and rehabilitation medicine > Vol. 62, n°5 (Septembre 2019) . - p. 356-365

Mots-clés :	Knee osteoarthritis  Exercise  Meta-analysis  Determinants  Physical therapy  Pain  Function  Quality of Life
Résumé :	Background Exercise is an effective treatment for osteoarthritis. However, the effect may vary from one patient (or study) to another. Objective To evaluate the efficacy of exercise and its potential determinants for pain, function, performance, and quality of life (QoL) in knee and hip osteoarthritis (OA). Methods We searched 9 electronic databases (AMED, CENTRAL, CINAHL, EMBASE, MEDLINE Ovid, PEDro, PubMed, SPORTDiscus and Google Scholar) for reports of randomised controlled trials (RCTs) comparing exercise-only interventions with usual care. The search was performed from inception up to December 2017 with no language restriction. The effect size (ES), with its 95% confidence interval (CI), was calculated on the basis of between-group standardised mean differences. The primary endpoint was at or nearest to 8 weeks. Other outcome time points were grouped into intervals, from < 1 month to ≥ 18 months, for time-dependent effects analysis. Potential determinants were explored by subgroup analyses. Level of significance was set at P ≤ 0.10. Results Data from 77 RCTs (6472 participants) confirmed statistically significant exercise benefits for pain (ES 0.56, 95% CI 0.44–0.68), function (0.50, 0.38–0.63), performance (0.46, 0.35–0.57), and QoL (0.21, 0.11–0.31) at or nearest to 8 weeks. Across all outcomes, the effects appeared to peak around 2 months and then gradually decreased and became no better than usual care after 9 months. Better pain relief was reported by trials investigating participants who were younger (mean age < 60 years), had knee OA, and were not awaiting joint replacement surgery. Conclusions Exercise significantly reduces pain and improves function, performance and QoL in people with knee and hip OA as compared with usual care at 8 weeks. The effects are maximal around 2 months and thereafter slowly diminish, being no better than usual care at 9 to 18 months. Participants with younger age, knee OA and not awaiting joint replacement may benefit more from exercise therapy. These potential determinants, identified by study-level analyses, may have implied ecological bias and need to be confirmed with individual patient data.
En ligne :	https://www.sciencedirect.com/science/article/pii/S1877065719300624
Permalink :	./index.php?lvl=notice_display&id=84153