Effectiveness of exercise on pain intensity and physical function in patients with knee and hip osteoarthritis: an umbrella and mapping review with meta-meta-analysis

Abstract

Purpose

The aim of this review was to provide a qualitative and quantitative overview of the effects of exercise on pain, physical function, and quality of life for patients with knee and hip osteoarthritis.

Materials and methods

This study was an umbrella and mapping review with meta-meta-analysis. Meta-analyses of randomized controlled trials were included. The methodological quality and risk of bias were evaluated using the Modified Quality Assessment Scale for Systematic Reviews and the Risk of Bias in Systematic Reviews tool. The quality of evidence was evaluated using the Physical Activity Guidelines Advisory Committee Grading Criteria.

Results

41 meta-analyses were included, 43.9% of the studies had adequate methodological quality, and 56.1% of the studies had a low risk of bias. Moderate evidence was found that exercise decreases pain intensity (33 meta-analyses; SMD = −0.49; 95% CI −0.56 to −0.42), improves function (19 meta-analyses; SMD = −0.50; 95% CI −0.58 to −0.41), strength (6 meta-analyses; SMD = −0.57; 95% CI −0.70 to −0.44) and quality of life (SMD = −0.36; 95% CI −0.46 to −0.27) for patients with hip and knee osteoarthritis.

Conclusion

Exercise is an effective intervention to decrease pain intensity and improve function in patients with hip and knee osteoarthritis.

(PROSPERO, CRD42020221987)

IMPLICATIONS FOR REHABILITATION

1. Exercise in hip and knee osteoarthritis has shown improvement in pain, function, strength, and quality of life in different studies, but no differences have been observed in others.

2. The meta-meta-analysis of the present article find that exercise produces significant improvements in pain, function, strength, and quality of life of patients with knee and/or hip osteoarthritis with a small effect size and significant heterogeneity.

3. There is moderate evidence that exercise is effective in reducing pain and increasing function, strength, and quality of life of patients with knee and hip osteoarthritis.

Keywords:

• Knee osteoarthritis
• hip osteoarthritis
• exercise
• pain
• physical function

Acknowledgements

The authors would like to thank the Centro Superior de Estudios Universitarios CSEU La Salle for making this study possible and for its services in editing this manuscript.

Contributors

RL and AH conceptualized the study. AH wrote the study protocol. AH and FC conducted the literature searches. CV and LB conducted the study selection and data extraction. CV and LB conducted the study quality assessment. RL and AH assisted in solving discrepancies between duplicate study selections, data extractions and quality assessments. FC, AH and RL conducted the meta-meta-analysis. AH conducted the other meta-analyses and created directed acyclic graphs. AH, CV and LB drafted the Methods section of the manuscript. AP and RL performed the analysis and classification of the evidence with the PAGAC instrument. AP and RL drafted the Discussion, Conclusion and Summary box of the manuscript. All authors critically revised the draft manuscript and contributed to the subsequent revisions and the final version.

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.