Background There is convincing evidence for the overall effectiveness of exercise in people with knee osteoarthritis (OA) . However, according to the EULAR recommendations , most trials found in the literature review used pain or physical function as the primary outcome and surprisingly few included quality of life outcome measures. Measurement of health-related quality of life (HRQOL) and utility is recommended .
Objectives The aim of this systematic review and meta-analysis was to examine the effects of exercise therapy on the HRQOL of people with knee OA.
Methods Data Sources: The electronic databases PubMed, CENTRAL, PEDro, and CINAHL were searched from the earliest date possible through January 2014.
Study Selection and eligibility criteria: Randomized controlled trials that evaluated the effects of exercise therapy on HRQOL as assessed with the SF-36 were included for review. Only studies with a control group that received either no intervention or a psychoeducational intervention were included.
Data Extraction and Data Synthesis The data were extracted using a predefined data extraction form by a single reviewer and checked for accuracy by another reviewer. The methodological qualities of the trials were assessed independently by two reviewers using the PEDro scale. Pooled analyses with a random-effects model or a fixed-effects model were used in the meta-analyses to calculate the standardized mean differences and 95% confidence intervals. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to each meta-analysis performed to determine the quality of the evidence.
Results Twelve studies met the inclusion criteria. Our meta-analysis provided high-quality evidence that exercise therapy increased the summary (SMD =0.47, 95% CI: 0.16 to 0.78, I2 =0%), physical functioning (SMD =0.28, 95% CI: 0.12 to 0.45, I2 =0%), and role-physical domain scores (SMD =0.26, 95% CI: 0.10 to 0.43, I2 =19%) of knee OA people. Our meta-analysis also provided moderate-quality evidence that the physical component summary (SMD =0.52, 95% CI: 0.21 to 0.83, I2 =76%) and mental component summary scores (SMD =0.44, 95% CI: 0.12 to 0.75, I2 =77%) improved to a greater extent by exercise therapy than by control interventions.
Conclusions Exercise therapy can improve HRQOL as assessed with the SF-36 in people with knee OA.
Tanaka R, Ozawa J, Kito N, Yamasaki T, Moriyama H. Evidence of improvement in various impairments by exercise interventions in patients with knee osteoarthritis: a systematic review and meta-analysis of randomized clinical trials. Journal of Japanese Physical Therapy Association. 2013; 16(1):7-21.
Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013 Jul; 72(7):1125-1135.
Maheu E, Altman RD, Bloch DA, Doherty M, Hochberg M, Mannoni A, et al. Design and conduct of clinical trials in patients with osteoarthritis of the hand: recommendations from a task force of the Osteoarthritis Research Society International. Osteoarthritis Cartilage. 2006 Apr; 14(4):303-322.
Disclosure of Interest None declared