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Long-term effectiveness of exercise therapy in patients with osteoarthritis of hip or knee: a systematic review.
Pisters, M.F., Veenhof, C., Meeteren, N.L.U. van, Ostelo, R.W., Bakker, D. de, Schellevis, F.G., Dekker, J. Long-term effectiveness of exercise therapy in patients with osteoarthritis of hip or knee: a systematic review. Arthritis and Rheumatism: 2007, 56(9 suppl.), p. S325. Abstract. ACR/ARHP Annual Scientific Meeting 2007, Boston, 6-11 november 2007.
PURPOSE: To determine the long-term effectiveness (= 6 months after treatment) of exercise therapy on pain, physical function and patient global assessment of effectiveness in patients with osteoarthritis (OA) of the hip and/or knee. METHODS: An extensive literature search in PubMed, Embase, CINAHL, SCISEARCH, PEDro and the Cochrane Controlled Trial Register was carried out. Both randomized clinical trials and controlled clinical trials investigating the long-term effectiveness of exercise therapy in patients with OA of the hip and/or knee were included, if follow-up assessments were at least 6 months after discharge. Additional booster sessions in the post-treatment period were only allowed if they either consisted of strategies that supported and/or stimulated long-term adherence to exercise, or consisted of advices considering physical activity behaviour and/or integration of exercises in patients daily life. Studies investigating exercise therapy including additional post-treatment booster sessions were reported separately. Methodological quality was independently assessed by two reviewers. Effect estimates were calculated and a best evidence synthesis was performed on basis of design, methodological quality, and statistical significance of findings. RESULTS: Five high quality and six low quality randomized clinical trials were included. Eight studies investigated the effectiveness of exercise therapy and three investigated the effectiveness of exercise therapy with additional booster sessions post-treatment. Strong evidence was found for no long-term effectiveness on pain and self-reported physical function, moderate evidence for long-term effectiveness on patient global assessment of effectiveness, and conflicting evidence on observed physical function. For exercise programs with additional booster sessions, moderate evidence was found for long-term effectiveness on pain, self-reported physical function and observed physical function. CONCLUSIONS: The positive post-treatment results of exercise therapy on pain and physical function in patients with OA of the hip and/or knee do not sustain in the long-term. Long-term beneficial effectiveness was only found for patient global assessment of effectiveness. However, additional booster sessions after the treatment period positively influence maintenance of beneficial post-treatment effects on pain and physical function in the long-term. (aut. ref.)
PURPOSE: To determine the long-term effectiveness (= 6 months after treatment) of exercise therapy on pain, physical function and patient global assessment of effectiveness in patients with osteoarthritis (OA) of the hip and/or knee. METHODS: An extensive literature search in PubMed, Embase, CINAHL, SCISEARCH, PEDro and the Cochrane Controlled Trial Register was carried out. Both randomized clinical trials and controlled clinical trials investigating the long-term effectiveness of exercise therapy in patients with OA of the hip and/or knee were included, if follow-up assessments were at least 6 months after discharge. Additional booster sessions in the post-treatment period were only allowed if they either consisted of strategies that supported and/or stimulated long-term adherence to exercise, or consisted of advices considering physical activity behaviour and/or integration of exercises in patients daily life. Studies investigating exercise therapy including additional post-treatment booster sessions were reported separately. Methodological quality was independently assessed by two reviewers. Effect estimates were calculated and a best evidence synthesis was performed on basis of design, methodological quality, and statistical significance of findings. RESULTS: Five high quality and six low quality randomized clinical trials were included. Eight studies investigated the effectiveness of exercise therapy and three investigated the effectiveness of exercise therapy with additional booster sessions post-treatment. Strong evidence was found for no long-term effectiveness on pain and self-reported physical function, moderate evidence for long-term effectiveness on patient global assessment of effectiveness, and conflicting evidence on observed physical function. For exercise programs with additional booster sessions, moderate evidence was found for long-term effectiveness on pain, self-reported physical function and observed physical function. CONCLUSIONS: The positive post-treatment results of exercise therapy on pain and physical function in patients with OA of the hip and/or knee do not sustain in the long-term. Long-term beneficial effectiveness was only found for patient global assessment of effectiveness. However, additional booster sessions after the treatment period positively influence maintenance of beneficial post-treatment effects on pain and physical function in the long-term. (aut. ref.)