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The Role of Physical Activity as Conservative Treatment for Hip and Knee Osteoarthritis in Older People: A Systematic Review and Meta-Analysis.

ABSTRACT: : The aim of this systematic review and meta-analysis is to determine the role of physical activity as a conservative treatment for older people with knee or hip osteoarthritis. The effect on pain, physical function, stiffness, quality of life, and dynamic balance of Aquatic Exercise, Land-based Exercise, and Sports were compared in a specific population composed of osteoarthritic patients aged 65 or over. A systematic search using Pubmed-Medline, Google Scholar, and the Cochrane Library was carried out to select randomized clinical trials, observational studies, or case series that evaluated outcome measures after physical activity. Twenty randomized controlled trials (RCTs) and two case series were included in this review. Four trials were at low risk of bias (A), 12 at unclear risk of bias (B), and four at high risk of bias (C). Compared to controls, Aquatic Exercise, Land-based Exercise, Tai Chi, and Yoga showed a small to high effect for improving pain, physical function, quality of life, and stiffness. Active exercise and sport are effective to improve pain and physical function in elderly people with osteoarthritis. Nevertheless, further studies are required to validate the use of land-based exercise, aquatic exercise, or sport to treat the symptoms of older adults that suffer from knee and hip osteoarthritis.

SUBMITTER: Zampogna B

PROVIDER: S-EPMC7230847 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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The Role of Physical Activity as Conservative Treatment for Hip and Knee Osteoarthritis in Older People: A Systematic Review and Meta-Analysis.

Zampogna Biagio B Papalia Rocco R Papalia Giuseppe Francesco GF Campi Stefano S Vasta Sebastiano S Vorini Ferruccio F Fossati Chiara C Torre Guglielmo G Denaro Vincenzo V

Journal of clinical medicine 20200418 4

<b>:</b> The aim of this systematic review and meta-analysis is to determine the role of physical activity as a conservative treatment for older people with knee or hip osteoarthritis. The effect on pain, physical function, stiffness, quality of life, and dynamic balance of Aquatic Exercise, Land-based Exercise, and Sports were compared in a specific population composed of osteoarthritic patients aged 65 or over. A systematic search using Pubmed-Medline, Google Scholar, and the Cochrane Library ...[more]

PMID: 32325775

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Project description:BACKGROUND:To evaluate the effectiveness and safety of technology-assisted rehabilitation following total hip/knee replacement (THR/TKR). METHODS:Six electronic databases were searched without language or time restrictions for relevant studies: MEDLINE, EMBASE, Cochrane Library, CINAHL, SPORTDiscus, Physiotherapy Evidence Database (PEDro); from inception to November 7th, 2018. Two reviewers independently applied inclusion criteria to select eligible randomised controlled trials (RCTs) that investigated the effectiveness of technology-based interventions, compared with usual care or no intervention for people undergoing THR/TKR. Two reviewers independently extracted trial details (e.g. patients' profile, intervention, outcomes, attrition and adverse events). Study methodological quality was assessed using the PEDro scale. Quality of evidence was critically appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS:We identified 21 eligible studies assessing telerehabilitation, game- or web-based therapy. There were 17 studies (N?=?2188) in post-TKR rehabilitation and 4 studies (N?=?783) in post-THR rehabilitation. Compared to usual care, technology-based intervention was more effective in reducing pain (mean difference (MD): -?0.25; 95% confidence interval (CI): -?0.48, -?0.02; moderate evidence) and improving function measured with the timed up-and-go test (MD: -7.03; 95% CI: -?11.18, -?2.88) in people undergoing TKR. No between-group differences were observed in rates of hospital readmissions or treatment-related adverse events (AEs) in those studies. CONCLUSION:There is moderate-quality of evidence showed technology-assisted rehabilitation, in particular, telerehabilitation, results in a statistically significant improvement in pain; and low-quality of evidence for the improvement in functional mobility in people undergoing TKR. The effects were however too small to be clinically significant. For THR, there is very limited low-quality evidence shows no significant effects.

Project description:ObjectiveTo identify risk factors for pain and functional deterioration in people with knee and hip osteoarthritis (OA) to form the basis of a future 'stratification tool' for OA development or progression.DesignSystematic review and meta-analysis.MethodsAn electronic search of the literature databases, Medline, Embase, CINAHL, and Web of Science (1990-February 2020), was conducted. Studies that identified risk factors for pain and functional deterioration to knee and hip OA were included. Where data and study heterogeneity permitted, meta-analyses presenting mean difference (MD) and ORs with corresponding 95% CIs were undertaken. Where this was not possible, a narrative analysis was undertaken. The Downs & Black tool assessed methodological quality of selected studies before data extraction. Pooled analysis outcomes were assessed and reported using the Grading of Reccomendation, Assessment, Development and Evaluation (GRADE) approach.Results82 studies (41 810 participants) were included. On meta-analysis: there was moderate quality evidence that knee OA pain was associated with factors including: Kellgren and Lawrence≥2 (MD: 2.04, 95% CI 1.48 to 2.81; p<0.01), increasing age (MD: 1.46, 95% CI 0.26 to 2.66; p=0.02) and whole-organ MRI scoring method (WORMS) knee effusion score ≥1 (OR: 1.35, 95% CI 0.99 to 1.83; p=0.05). On narrative analysis: knee OA pain was associated with factors including WORMS meniscal damage ≥1 (OR: 1.83). Predictors of joint pain in hip OA were large acetabular bone marrow lesions (BML; OR: 5.23), chronic widespread pain (OR: 5.02) and large hip BMLs (OR: 4.43).ConclusionsOur study identified risk factors for clinical pain in OA by imaging measures that can assist in predicting and stratifying people with knee/hip OA. A 'stratification tool' combining verified risk factors that we have identified would allow selective stratification based on pain and structural outcomes in OA.Prospero registration numberCRD42018117643.

Project description:Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions.The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA.The design was a prospective, single-blind, multicenter, superiority, cluster- randomized controlled trial.The setting included 143 primary care physical therapist practices.The participants were 208 people who had hip/knee OA and were 40 to 80 years of age.e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA.Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions.The e-Exercise group (n = 109) received, on average, 5 face-to-face sessions; the usual physical therapy group (n = 99) received 12. No significant differences in primary outcomes between the e-Exercise group and the usual physical therapy group were found. Within-group analyses for both groups showed a significant improvement in physical functioning. After 3 months, participants in the e-Exercise group reported an increase in physical activity; however, no objectively measured differences in physical activity were found. With respect to secondary outcomes, after 12 months, sedentary behavior significantly increased in the e-Exercise group compared with the usual physical therapy group. In both groups, there were significant improvements for pain, tiredness, quality of life, and self-efficacy.The response rate at 12 months was 65%.The blended intervention, e-Exercise, was not more effective than usual physical therapy in people with hip/knee OA.

Project description:BackgroundGlobally osteoarthritis of the knee is a leading cause of disability. Hip abductor strength and activation are essential for maintaining postural balance during transfers and are related to joint loading and progression during weight-bearing activities. Strength deficits in the hip abductors might cause a reduction in the lower extremity force generation, thereby causing stress on the medial tibiofemoral joint. The aim of this systematic review is to assess the effectiveness of hip abductor strengthening on knee joint loading, knee pain and functional outcome measures in patients with knee osteoarthritis.MethodsDatabase such as Scopus, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) database and PEDro were reviewed to recognize the trials published in English from inception to December 2020. Randomized controlled trials that studied the effectiveness of hip abductor strengthening in subjects with knee osteoarthritis and its impact on knee joint loading, knee pain and functional outcome measures were included. RevMan 5.4 was used for meta-analysis and forest plot construction. Quality assessment of the included studies was carried out using the PEDro scale.Results and discussionThe search yielded 260 results of which 29 full-text articles were screened. The review includes 7 randomized controlled trials and 3 studies with good methodological quality were included for meta-analysis. The meta-analysis of the articles favored hip abductor strengthening intervention over the control group. Hip abductor strengthening had significantly reduced the VAS [ SMD = -0.60[-0.88, -0.33] p < 0.0001]at 95% CI and improved the WOMAC scores [SMD - 0.75[-1.05,-0.45] p < 0.0001] at 95% CI. All of the included studies concluded that strengthening the hip abductor muscle had a positive impact on knee pain and functional outcomes.ConclusionThe current study found high-quality evidence to support the use of hip abductor muscle strengthening exercises as a rehabilitative treatment for subjects with knee osteoarthritis.Trial registrationCRD42021256251 .

Project description:Physical activity (PA), including engagement in structured exercise, has a key role in the management of hip and knee osteoarthritis (OA). However, maintaining a physically active lifestyle is a challenge for people with OA. PA determinants in this population need to be understood better so that they can be optimised by public health or healthcare interventions and social policy changes. OBJECTIVES:The primary aim of this study is to conduct a systematic review of the existing qualitative evidence on barriers and facilitators of PA for patients with hip or knee OA. Secondary objective is to explore differences in barriers and facilitators between (1) lifestyle PA and exercise and (2) PA uptake and maintenance. METHODS:Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Scopus, Grey literature and qualitative journals were searched. Critical Appraisal Skills Programme-Qualitative checklist and Lincoln and Guba's criteria were used for quality appraisal. Thematic synthesis was applied. FINDINGS:Ten studies were included, seven focusing on exercise regimes, three on overall PA. The findings showed a good fit with the biopsychosocial model of health. Aiming at symptom relief and mobility, positive exercise experiences and beliefs, knowledge, a 'keep going' attitude, adjusting and prioritising PA, having healthcare professionals' and social support emerged as PA facilitators. Pain and physical limitations; non-positive PA experiences, beliefs and information; OA-related distress; a resigned attitude; lack of motivation, behavioural regulation, professional support and negative social comparison with coexercisers were PA barriers. All themes were supported by high and medium quality studies. Paucity of data did not allow for the secondary objectives to be explored. CONCLUSION:Our findings reveal a complex interplay among physical, personal including psychological and social-environmental factors corresponding to the facilitation and hindrance of PA, particularly exercise, engagement. Further research on the efficacy of individualised patient education, psychological interventions or social policy change to promote exercise engagement and lifestyle PA in individuals with lower limb OA is required. TRIAL REGISTRATION NUMBER:CRD42016030024.

Project description: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).

Dataset Information

The Role of Physical Activity as Conservative Treatment for Hip and Knee Osteoarthritis in Older People: A Systematic Review and Meta-Analysis.

Publications

The Role of Physical Activity as Conservative Treatment for Hip and Knee Osteoarthritis in Older People: A Systematic Review and Meta-Analysis.

Similar Datasets

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