Quicke, JG, Runhaar, J, van der Windt, DA ORCID: https://orcid.org/0000-0002-7248-6703, Healey, EL, Foster, NE ORCID: https://orcid.org/0000-0003-4429-9756 and Holden, MA (2020) Moderators of the effects of therapeutic exercise for people with knee and hip osteoarthritis: A systematic review of sub-group analyses from randomised controlled trials. Osteoarthritis and Cartilage Open, 2 (4). 100113 -100113.

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Abstract

Objective
1) To identify potential moderators of the effect of therapeutic exercise explored in randomised controlled trials (RCTs) of knee and hip osteoarthritis (OA); 2) summarise the extent, strength and quality of evidence reported for moderators.

Design
Systematic review (PROSPERO CRD42019148074). Inclusion criteria: a) RCTs with sub-group analyses investigating potential moderator variables; b) participants with knee and/or hip OA; c) therapeutic exercise interventions compared to either no exercise control or alternative exercise intervention(s), and; d) measuring pain or physical function outcomes. Included RCTs’ risk of bias and sub-group analysis quality were assessed. Data were extracted on sub-group analyses (methods and potential moderators), outcomes (pain and function) and sub-group findings (associated statistics of potential moderator∗intervention effects). Findings were analysed using narrative synthesis.

Results
14 RCTs were included; 13 knee OA RCTs (n = 2743 participants) explored 23 potential moderators and 1 hip OA RCT (n = 203) explored 6 potential moderators. Sub-group analysis quality was mixed. Knee varus malalignment was the only moderator of therapeutic exercise compared to non-exercise control in 1 RCT (WOMAC-pain adjusted difference 12.7 in the neutral alignment sub-group and 1.8 in the malaligned sub-group, interaction term: p = 0.02). Varus thrust, knee laxity/instability, obesity and cardiac problems all moderated the effect of therapeutic exercise on pain or function compared to different comparison exercise.

Conclusions
Therapeutic exercise may be effective for reducing pain in people with knee OA and neutral alignment but not for those with varus malalignment. The exercise moderator literature is limited. More robust evidence is required to inform sub-group exercise selection.

Item Type: Article
Additional Information: This is the final published version of the article (version of record). It was made available via Elsevier at https://doi.org/10.1016/j.ocarto.2020.100113 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Osteoarthritis, Knee pain, Hip pain, Exercise, Moderators, Systematic review
Subjects: R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Depositing User: Symplectic
Date Deposited: 28 Dec 2020 15:30
Last Modified: 16 Mar 2021 15:23
URI: https://eprints.keele.ac.uk/id/eprint/9041

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