What is the evidence for strength training and therapeutic exercise in the treatment of osteoarthritis of the knee?
AMSTAR Rating
Summary
Patient Population:
Mean age of participants ranged from 65-70 years in 11/12 studies included. In 10/12 studies the majority of participants were female (mean = 75%).
Intervention:
Exercise therapy, Strength training, exercise therapy + passive manual mobilization. 6 studies delivered treatment to individual participants; 6 delivered interventions in group settings. 5 studies included strength training conditions (vs. no treatment or placebo), 5 included exercise (strength + aerobic conditioning) and 2 examined exercise combined with passive manual manipulation.
Comparison:
Comparison conditions were most often education or home-based (non-supervised) exercise. There were 12 studies identified for inclusion in the present review. EBRO scores ranged from 2 – 7.
Outcome:
- Pain: exercise therapy vs. control – significant difference in favour of exercise (ES=0.34; 95% CI 0.19 to 0.49).
- Pain: exercise therapy + manual mobilization vs. control – significant difference in favour of exercise (ES=0.69; 95% CI 0.41 to 0.97).
- Pain: strengthening exercise vs. control – significant difference in favour of exercise (ES=0.38; 95% CI 0.22 to 0.54).
- Function: strengthening exercise vs. control – significant difference in favour of exercise (ES=0.37; 95% 0.15 to 0.59).
- Function: exercise therapy vs. control – significant difference in favour of exercise (ES=0.25; 95% 0.04 to 0.46).
- Function: exercise therapy + manual mobilization vs. control – significant difference in favour of exercise (ES=0.39; 95% CI 0.01 to 0.7).
Guideline Recommendations
| Source | Recommendation |
|---|---|
| ACR (2019) | Strongly recommended |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Exercise Therapy vs. Control
Pain
Function
Exercise Therapy + Manual Mobilization vs. Control
Pain
Function
Strengthening Exercise vs. Control
Pain
Function
