Abstract
Background:
Osteoarthritis (OA) is a leading cause of disability worldwide. Currently, exercise is recognised to be one of the core treatments for OA (NICE, 2014). Convincing evidence shows that exercise can have positive effects on pain and function in people with OA (Fransen et al., 2015). However, a standardised exercise regimen may not suit all patients and adherence to exercise is always an issue. Therefore, several international guidelines recommended individualisation of the exercise regimen according to individual patient characteristics (e.g. pain severity, personal goals and co-morbidities), as this may enhance take up and adherence, hence treatment effect of the intervention (Fernandes et al., 2013).
Objectives:
The aims of this systematic review were: (1) to evaluate the current evidence for efficacy in randomised controlled trials (RCTs) of individualised exercise (IE) interventions for people with hip or knee OA; and (2) compare this to the efficacy of non-individualised exercise (NIE).
Methods:
A systematic search was carried out, up until March 6
th
2018, on the following databases: MEDLINE, CINAHL, AMED, PsycINFO and EMBASE. RCTs of IE interventions, or with subgroup analysis based on specific patient characteristics, were searched. Standardised mean difference and 95% confidence interval (CI) were calculated using random effects model. Risk of bias was evaluated using the modified Cochrane tool. Pain was the primary outcome of interest. Results of IE interventions were then compared to the NIE interventions identified from a previous systematic review (Goh et al., 2019).
Results:
We reviewed titles of 1,766 records in the systematic search. The screening process (Figure) identified 15 studies (1,826 participants) that met the inclusion criteria, of which 7 were included in a meta-analysis. Most included studies had high risk of bias. Blinding was a consistent problem due to the nature of the intervention. Within the trials exercise was individualised according to factors including severity of symptoms, exercise performance, lower limb muscle strength and presence of co-morbidities (e.g. heart failure, chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) type 2).
The analysis showed that IE significantly improved pain, physical function, performance and quality of life outcomes (Table). When compared to NIE interventions, IE showed greater effect size for all outcomes but their 95% CIs were overlapping.
Figure showing Summary of screening process
Table 1.
Summary of results
Outcome
Type of exercise program
ES
95% CI
Number of studies (Number of patients)
Pain
IE
1.04
0.32 - 1.77
7 (991)
NIE
0.57
0.44 - 0.69
65 (4,723)
Function
IE
1.37
0.50 - 2.24
7 (991)
NIE
0.51
0.38 - 0.64
63 (4,829)
Performance
IE
2.00
0.07 - 3.93
2 (291)
NIE
0.51
038 - 0.63
66 (4,889)
QoL
IE
1.30
-0.52 - 3.12
2 (226)
NIE
0.32
0.15 - 0.49
34 (2,545)
ES= Effect size. CI= Confidence Interval. IE= Individualised Exercise. NIE= Non-Individualised Exercise. QoL= Quality of Life
Conclusion:
The results of this review show that IE may have better outcomes on people with hip or knee OA compared to NIE. However, the small study effect may inflate the estimates of the individualised exercise group, and further head to head comparisons are required.
References:
[1] FERNANDES L., HAGEN K. B., BIJLSMA J. W., ANDREASSEN O., CHRISTENSEN P., CONAGHAN P. G., DOHERTY M., GEENEN R., HAMMOND A. & KJEKEN I. 2013. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis.
Annals of the rheumatic diseases,
72, 1125-1135.
[2] FRANSEN M., MCCONNELL S., HARMER A. R., VAN DER ESCH M., SIMIC M. & BENNELL K. L. 2015. Exercise for osteoarthritis of the knee.
The Cochrane Library
.
[3] GOH S.-L., PERSSON M. S., STOCKS J., HOU Y., WELTON N. J., LIN J., HALL M. C., DOHERTY M. & ZHANG, W. 2019. Relative efficacy of different exercises for pain, function, performance and quality of life in knee and hip osteoarthritis: Systematic review and network meta-analysis.
Sports Medicine,
49, 743-761.
[4] NICE 2014. Osteoarthritis: care and management in adults.
https://www.nice.org.uk/guidance/cg177/chapter/1-Recommendations#non-pharmacological-management-2
[Accessed 02/12 2019]
Disclosure of Interests:
Khalid Yaseen: None declared, Burak Kundakci: None declared, Siew Li Goh: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Weiya Zhang Consultant of: Grunenthal for advice on gout management, Speakers bureau: Bioiberica as an invited speaker for EULAR 2016 satellite symposium, Abhishek Abhishek Grant/research support from: AstraZeneca and OxfordImmunotech, Speakers bureau: Menarini pharmaceuticals, Michelle Hall: None declared