Integrated exercise and self-management programmes in osteoarthritis of the hip and knee: a systematic review of effectiveness

Abstract

The aim of this systematic review was to investigate the clinical effects of integrated exercise and self-management programmes on pain and function in patients with hip and knee osteoarthritis, and to determine the cost-effectiveness of these interventions. A multiple database literature search identified randomised controlled trials reporting treatment regimens that combined exercise with interventions promoting self-management. A predetermined protocol was developed by the reviewers who then independently appraised the methodological quality of the studies, and extracted outcome data for pain and function. Of 109 abstracts identified, 10 studies met the inclusion criteria for this review. Outcome data suggested that interventions reduced pain and improved function, but many of the papers had methodological flaws, such as low statistical power, limited blinding and randomisation procedures, short follow-up and protracted treatment regimens. No associated cost analyses were included in any of the studies accepted within the review. Combining exercise and psychological interventions improves pain and function in hip and knee osteoarthritis, although methodological problems limit the ability to extrapolate the findings of these studies into clinical practice. Rigorously designed research studies of typical patients, using clinically applicable and practicable interventions with long-term follow-up and cost-benefit analyses are required to inform management guidelines and clinical practice.