Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis.
To determine whether there is sufficient evidence to conclude that exercise interventions are more effective than no exercise control and to compare the effectiveness of different exercise interventions in relieving pain and improving function in patients with lower limb osteoarthritis, nine electronic databases were searched.
Randomised controlled trials comparing exercise interventions with each other or with no exercise control for adults with knee or hip osteoarthritis were included.
Two reviewers evaluated eligibility and methodological quality, with 60 trials (44 knee, two hip, 14 mixed) covering 12 exercise interventions and with 8218 patients meeting inclusion criteria. Sequential analysis showed that as of 2002 sufficient evidence had been accrued to show significant benefit of exercise interventions over no exercise control. For pain relief, strengthening, flexibility plus strengthening, flexibility plus strengthening plus aerobic, aquatic strengthening, and aquatic strengthening plus flexibility, exercises were significantly more effective than no exercise control. A combined intervention of strengthening, flexibility, and aerobic exercise was also significantly more effective than no exercise control for improving limitation in function.
There is sufficient evidence to show significant benefit of exercise over no exercise in patients with osteoarthritis, and further trials are unlikely to overturn this result. An approach combining exercises to increase strength, flexibility, and aerobic capacity is likely to be most effective in the management of lower limb osteoarthritis. The evidence is largely from trials in patients with knee osteoarthritis > From Uthman et al., BMJ 44 (2013) 347. All rights reserved to BMJ group.
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