Mechanisms of action of therapeutic exercise for knee and hip OA remain a black box phenomenon: an individual patient data mediation study with the OA Trial Bank

Review written by Dr Anthony Teoli info

Key Points

  1. Of all potential mediators studied, only knee extension strength mediated ±2% of the effect of therapeutic exercise on pain and physical function in patients with knee osteoarthritis (OA).
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BACKGROUND & OBJECTIVE

Therapeutic exercise is recommended for the management of knee and hip osteoarthritis (OA) according to best practice guidelines (1). However, the mechanisms of action explaining the effect of therapeutic exercise are largely unknown. Knowledge about which mechanisms explain the effect of therapeutic exercise on pain and physical function in OA could help to better target future exercise programs and potentially lead to improvements in patient outcomes.

Therefore, the objective of this study was to evaluate mediating factors for the effect of therapeutic exercise on pain and physical function in people with knee and hip OA.

Therapeutic exercise is recommended for the management of knee and hip osteoarthritis according to best practice guidelines.
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The results of this study put into question the potential relevance of specific, local effects of therapeutic exercise in patients with knee osteoarthritis.

METHODS

The authors performed a mediation analysis using individual participant data (IPD) that was sought from all published randomized controlled trials (RCTs) comparing therapeutic exercise to non-exercise controls in people with knee and hip OA. For context, a mediator is a

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