Clinical question
How effective is land-based therapeutic exercise for people with osteoarthritis of the knee?
Bottom line
High-quality evidence indicated that, compared with no exercise or no treatment, land-based therapeutic exercise provided short-term benefit in terms of reduced knee pain (12% absolute improvement) that was sustained for at least 2–6 months after cessation of formal treatment. Moderate-quality evidence showed a 10% absolute improvement in physical function. The magnitude of the treatment effect was considered moderate to small (2–6 months), comparable with estimates reported for the use of non-steroidal anti-inflammatory drugs. Exercise programmes included traditional muscle strengthening, functional training, aerobic fitness and Tai Chi. Programmes that were individually provided appeared to be associated with greater improvements in knee pain and physical function.
Caveat
Marked variability was noted across studies in participants recruited, symptom duration, exercise interventions assessed and important aspects of study methodology, such as blinding.
Context
Knee osteoarthritis (OA) is a major public health issue because it causes chronic pain, reduces physical function and diminishes quality of life. Ageing of the population and increased global prevalence of obesity are anticipated to dramatically increase the prevalence of knee OA and its associated impairments. No cure for knee OA is known, but exercise therapy is among the dominant non-pharmacological interventions recommended by international guidelines.
Cochrane Systematic Review
Fransen M et al. Exercise for osteoarthritis of the knee. Cochrane Reviews, 2015, Issue 1. Art. No.: CD004376.DOI: 10.1002/14651858. CD004376.pub3. This review contains 54 studies involving 3913 participants.
Cochrane Systematic Reviews for primary care practitioners
Developed by the Cochrane Primary Care Field, New Zealand Branch of the Australasian Cochrane Centre at the Department of General Practice and Primary Health Care, University of Auckland and funded by the Ministry of Health and New Zealand Doctor. PEARLS are meant for educational use and not to guide clinical care. New Zealanders can access the Cochrane Library free via www.cochrane.org.nz
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