Relative efficacy of different types of exercise for treatment of knee and hip osteoarthritis: protocol for network meta-analysis of randomised controlled trials.

Siew-Li Goh,Archan Bhattacharya,Weiya Zhang,Michael Doherty,Michelle Hall,Monica S M Persson

doi:10.1186/s13643-016-0321-6

Abstract

Background‘Exercise’ is universally recommended as a core treatment for knee and hip osteoarthritis (OA). However, there are very few head-to-head comparative trials to determine the relative efficacy between different types of exercise. The aim of this study is to benchmark different types of exercises against each other through the use of a common comparator in a network meta-analysis of randomised controlled trials (RCTs).MethodsThis study will include only RCTs published in peer-reviewed journals. A systematic search will be conducted in several electronic databases and other relevant online resources. No limitations are imposed on language or publication date. Participants must be explicitly identified by authors as having OA. Interventions that involved exercise or comparators in any form will be included. Pain is the primary outcome of interest; secondary outcomes will include function and quality of life measures. Quality assessment of studies will be based on the modified Cochrane’s risk of bias assessment tool. At least two investigators will be involved throughout all stages of screening and data acquisition. Conflicts will be resolved through discussion. Conventional meta-analysis will be performed based on random effects model and network meta-analysis on a Bayesian model. Subgroup analysis will also be conducted based on study, patient and disease characteristics.DiscussionThis study will provide for the first time comprehensive research evidence for the relative efficacy of different exercise regimens for treatment of OA. We will use network meta-analysis of existing RCT data to answer this question.Systematic review registrationPROSPERO CRD42016033865Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0321-6) contains supplementary material, which is available to authorized users.

Highlights

Osteoarthritis (OA) is the most common form of arthritis, characterised structurally by focal articular cartilage loss, subchondral bone remodelling and changes in the synovium, capsule and periarticular tissues [1]
In the absence of any definitive cure [6, 7], nonpharmacological therapy with adjunctive pharmacological analgesic use are the mainstay of management in knee and hip OA, with joint replacement surgery being reserved for severe disease that is resistant to conservative management [8, 9]
Exercise is the cornerstone of treatment for patients with lower-limb osteoarthritis

Summary

Introduction

Osteoarthritis (OA) is the most common form of arthritis, characterised structurally by focal articular cartilage loss, subchondral bone remodelling and changes in the synovium, capsule and periarticular tissues [1]. The knee joint appears to be more commonly affected than the hip [2]. It is a major health burden and has been ranked 11th out of all common causes of disability globally [3]. Patients with symptomatic OA may experience substantial reduction in quality of life (QoL), limitation in mobility and higher mortality and morbidity [4, 5]. In the absence of any definitive cure [6, 7], nonpharmacological therapy with adjunctive pharmacological analgesic use are the mainstay of management in knee and hip OA, with joint replacement surgery being reserved for severe disease that is resistant to conservative management [8, 9]. Exercise therapy is as effective as pharmacological agents in providing symptom relief and functional improvement, but without the serious side effects associated with systemic analgesics [10]

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