Effect of exercise therapy in patients with hip osteoarthritis: A systematic review and cumulative meta-analysis

Carolien H Teirlinck; Arianne P Verhagen; Leontien M van Ravesteyn; Elja A E Reijneveld-van de Vendel; Jos Runhaar; Marienke van Middelkoop; Manuela L Ferreira; Sita Ma Bierma-Zeinstra

doi:10.1016/j.ocarto.2023.100338

Effect of exercise therapy in patients with hip osteoarthritis: A systematic review and cumulative meta-analysis

Osteoarthr Cartil Open. 2023 Jan 19;5(1):100338. doi: 10.1016/j.ocarto.2023.100338. eCollection 2023 Mar.

Authors

Carolien H Teirlinck¹, Arianne P Verhagen^{1

2}, Leontien M van Ravesteyn², Elja A E Reijneveld-van de Vendel¹, Jos Runhaar¹, Marienke van Middelkoop¹, Manuela L Ferreira³, Sita Ma Bierma-Zeinstra¹

Affiliations

¹ Dept. General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands.
² Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Australia.
³ Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.

Abstract

Objective: To evaluate the existing evidence on the effect of exercise therapy in patients with hip osteoarthritis (OA) compared to no treatment and explore whether a further trial will change the current evidence.

Design: Systematic review and cumulative meta-analysis using randomized controlled trials (RCT) to determine the effect on pain and function post-treatment, and at 6-9 months after treatment. Standardized mean difference (SMD) ≤ -0.37 was considered clinically worthwhile. Extended funnel plots were used to simulate the impact of a new trial on the pooled effect size of pain and function.

Results: 18 RCTs were included. Post-treatment we found a beneficial effect of exercise therapy on pain (SMD -0.38, 95% Confidence Interval (CI): 0.55 to -0.22) and function (SMD -0.31, 95% CI -0.49 to -0.11). A beneficial effect of exercise therapy on pain (SMD -0.23, 95% CI: 0.41 to -0.05) and function (SMD -0.29, 95% CI: 0.45 to -0.12) was found 6-9 months after treatment. Most effect estimates were small, and it is unclear whether these are clinically meaningful. Extended funnel plots and a simulation of a new trial showed that only a new trial with a larger effect than the current pooled effect or a trial including 74,843 participants would change the pooled effect estimate from an unclear to a clearly clinically worthwhile effect.

Conclusions: We found a beneficial effect of exercise therapy on pain and function in hip OA. It is unlikely a new trial added to current evidence will change the conclusion.

Keywords: Clinical relevance; Cumulative meta-analysis; Exercise therapy; Osteoarthritis of the hip.

Publication types

Review