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Evidence synthesis of types and intensity of therapeutic land-based exercises to reduce pain in individuals with knee osteoarthritis

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Abstract

The objective of this study is to construct an evidence synthesis to identify the types of land-based exercises most investigated in the current literature, the intervention duration, frequency of the programs and the exercises which are most frequently implemented. A search was performed on the reference list of included and excluded studies of one systematic review, on land-based exercises for knee osteoarthritis and, an updated search of The Cochrane Library, Embase, CINAHL and PEDro was completed. Two authors independently selected the studies and a third author was consulted for an additional opinion. The inclusion criteria were male or female with tibiofemoral knee osteoarthritis, land-based exercises, non-exercise control group and randomized clinical trials. The exclusion criteria were mixed diagnosis or comparison to other types of exercise. The data were extracted by two authors. Fifty-five full-text articles were included. Strengthening, proprioception and aerobic exercises resulted in significant pain reduction. The intervention durations which were significant for pain reduction were either the period of 8–11 weeks or 12–15 weeks. The frequency of three times per week was found significant in comparison to a non-exercise control group. The results, which formed an evidence synthesis, demonstrate that there is substantial evidence regarding the benefits of strengthening exercises to reduce pain in knee osteoarthritis patients. Based on the included studies analysis, exercises should be performed three times weekly for a duration of 8–11 or 12–15 weeks. Health professionals working with knee osteoarthritis patients can use this evidence synthesis as a fast and pragmatic instrument to obtain information about several effective types of exercises for pain reduction.

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Abbreviations

OA:

Osteoarthritis

e.g.:

“For example”

RCTs:

Randomized clinical trials

ACSM:

American College of Sports Medicine

i.e.:

“That is”

PICOTS:

Population, intervention, comparator, outcomes, time, and study design

MDT:

Mechanical diagnosis and therapy

min:

Minutes

TIDieR:

Template for intervention description and replication

CONTENT:

Consensus on therapeutic exercise training

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The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this article was funded by the University of Ottawa Research Chair (salary support for graduate students).

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Authors and Affiliations

  1. Health Evidence Based Program, Federal University of Sao Paulo, School of Health Sciences (ESCS), Rua Napoleão de Barros, 865 - Vila Clementino, São Paulo, SP, 04024-002, Brazil

    Aline Mizusaki Imoto

  2. Cochrane Musculoskeletal Group, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada

    Jordi Pardo Pardo

  3. Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada

    Lucie Brosseau

  4. School of Medicine, University of Ottawa, Ottawa, Canada

    Jade Taki & Brigit Desjardins

  5. School of Human Kinetics, University of Ottawa, Ottawa, Canada

    Odette Thevenot

  6. Federal University of Sao Paulo, São Paulo, Brazil

    Eduardo Franco

  7. Physiotherapy Program, School of Rehabilitation, UNIFESP, São Paulo, Brazil

    Stella Peccin

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  1. Aline Mizusaki Imoto
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  2. Jordi Pardo Pardo
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  3. Lucie Brosseau
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  4. Jade Taki
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  5. Brigit Desjardins
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  7. Eduardo Franco
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AMI: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JPP: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LB: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JT: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. OT: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EF: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SP: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Author Aline Mizusaki Imoto declares that she has no conflict of interest with respect to the research, authorship, and/or publication of this article. Author Jordi Pardo Pardo declares that he has no conflict of interest with respect to the research, authorship, and/or publication of this article. Author Lucie Brosseau declares that she has no conflict of interest with respect to the research, authorship, and/or publication of this article. Author Jade Taki declares that he has no conflict of interest with respect to the research, authorship, and/or publication of this article. Author Brigit Desjardins declares that she has no conflict of interest with respect to the research, authorship, and/or publication of this article. Author Eduardo Franco declares that he has no conflict of interest with respect to the research, authorship, and/or publication of this article. Author Stella Peccin declares that she has no conflict of interest with respect to the research, authorship, and/or publication of this article.

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Imoto, A.M., Pardo, J.P., Brosseau, L. et al. Evidence synthesis of types and intensity of therapeutic land-based exercises to reduce pain in individuals with knee osteoarthritis. Rheumatol Int 39, 1159–1179 (2019). https://doi.org/10.1007/s00296-019-04289-6

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