Article Text

OP0227-HPR Does Exercise Therapy Improve Health-Related Quality of Life in People with Knee Osteoarthritis? A Systematic Review
  1. R. Tanaka1,
  2. J. Ozawa1,
  3. N. Kito1,
  4. H. Moriyama2
  1. 1Department of Rehabilitation, Hiroshima International University, Hiroshima
  2. 2Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Hyogo, Japan


Background There is convincing evidence for the overall effectiveness of exercise in people with knee osteoarthritis (OA) [1]. However, according to the EULAR recommendations [2], 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 [3].

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.


  1. 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.

  2. 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.

  3. 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

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.