Quantitative analysis of effectiveness and associated factors of exercise on symptoms in osteoarthritis: a pharmacodynamic model-based meta-analysis
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Le résumé fourni par la source
OBJECTIVE: This study aims to evaluate the time point and magnitude of peak effectiveness of exercise and the effects of various exercise modalities for osteoarthritis (OA) symptoms and to identify factors that significantly affect the effectiveness of exercise. DESIGN: Pharmacodynamic model-based meta-analysis (MBMA). DATA SOURCES: Embase, PubMed, Cochrane Library, Web of Science and Scopus were searched for randomised controlled trials (RCTs) examining the effect of exercise for OA from inception to 20 November 2023. ELIGIBILITY CRITERIA: RCTs of exercise interventions in patients with knee, hip or hand OA, using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales or Visual Analogue Scale (VAS) pain scores as outcome measures, were included. The minimum clinically important difference (MCID) for WOMAC total, pain, stiffness, function and VAS pain was 9.0, 1.6, 0.8, 5.4 and 0.9, respectively. RESULTS: A total of 186 studies comprising 12 735 participants with symptomatic or radiographic knee, hip or hand OA were included. The effectiveness of exercise treatments peaked at 1.6-7.2 weeks after initiation of exercise interventions. Exercise was more effective than the control, but the differences in the effects of exercise compared with control on all outcomes were only marginally different with the MCID (7.5, 1.7, 1.0, 5.4 and 1.2 units for WOMAC total, pain, stiffness, function and VAS pain, respectively). During a 12-month treatment period, local exercise (strengthening muscles and improving mobilisations of certain joints) had the best effectiveness (WOMAC pain decreasing by 42.5% at 12 weeks compared with baseline), followed by whole-body plus local exercise. Adding local water-based exercise (eg, muscle strengthening in warm water) to muscle strengthening exercise and flexibility training resulted in 7.9, 0.5, 0.7 and 8.2 greater improvements in the WOMAC total score, pain, stiffness and function, respectively. The MBMA models revealed that treatment responses were better in participants with more severe baseline symptom scores for all scales, younger participants for the WOMAC total and pain scales, and participants with obesity for the WOMAC function. Subgroup analyses revealed participants with certain characteristics, such as female sex, younger age, knee OA or more severe baseline symptoms on the WOMAC pain scale, benefited more from exercise treatment. CONCLUSION: Exercise reaches peak effectiveness within 8 weeks and local exercise has the best effectiveness, especially if local water-based exercise is involved. Patients of female sex, younger age, obesity, knee OA or more severe baseline symptoms appear to benefit more from exercise treatment than their counterparts.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Quantitative analysis of effectiveness and associated factors of exercise on symptoms in osteoarthritis: a pharmacodynamic model-based meta-analysis
- Date Crossref
- 11/10/2024
- Éditeur
- BMJ
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Zhujiang Hospital Clinical Research Centre pays non établi dans la noticeÉtablissement de santé
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Southern Medical University Clinical Research Centre pays non établi dans la noticeUniversité ou école supérieure
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Shanghai Chest Hospital Department of Pharmacy pays non établi dans la noticeÉtablissement de santé
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Shanghai University of Traditional Chinese Medicine Center for Drug Clinical Research pays non établi dans la noticeUniversité ou école supérieure
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National Clinical Research Center for Digestive Diseases pays non établi dans la noticeÉtablissement de santé
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Beijing Tian Tan Hospital pays non établi dans la noticeÉtablissement de santé
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Hong Kong Polytechnic University Department of Rehabilitation Sciences pays non établi dans la noticeUniversité ou école supérieure
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The University of Melbourne pays non établi dans la noticeUniversité ou école supérieure
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Royal North Shore Hospital Department of Rheumatology pays non établi dans la noticeÉtablissement de santé
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University of Tasmania Menzies Institute for Medical Research pays non établi dans la noticeUniversité ou école supérieure
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National Clinical Research Center for Cancer Department of Etiology and Carcinogenesis pays non établi dans la noticeStructure de recherche
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Beijing Tiantan Hospital Department of Neurosurgery pays non établi dans la noticeÉtablissement de santé
Clinical Research Centre — Zhujiang Hospital, Clinical Research Centre — Southern Medical University et Department of Pharmacy — Shanghai Chest Hospital, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.