Article Text

Exercise for osteoarthritis of the knee: a Cochrane systematic review
  1. Marlene Fransen1,
  2. Sara McConnell2,
  3. Alison R Harmer1,
  4. Martin Van der Esch3,
  5. Milena Simic1,
  6. Kim L Bennell4
  1. 1Faculty of Health Sciences, Clinical and Rehabilitation Sciences Research Group and Discipline of Physiotherapy, University of Sydney, Sydney, Australia
  2. 2Department of Medicine, St Joseph's Health Care Centre, Toronto, Canada
  3. 3Department of Rehabilitation, Reade, Centre for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
  4. 4Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
  1. Correspondence to Dr Martin Van der Esch, Department of Rehabilitation, Reade, Centre for Rehabilitation and Rheumatology, dr. J. van Breemenstraat 2, Amsterdam 1056AB, The Netherlands; m.vd.esch{at}


Objective To determine whether land-based therapeutic exercise is beneficial for people with knee osteoarthritis (OA) in terms of reduced joint pain or improved physical function and quality of life.

Methods Five electronic databases were searched, up until May 2013. Randomised clinical trials comparing some form of land-based therapeutic exercise with a non-exercise control were selected. Three teams of two review authors independently extracted data and assessed risk of bias for each study. Standardised mean differences immediately after treatment and 2–6 months after cessation of formal treatment were separately pooled using a random effects model.

Results In total, 54 studies were identified. Overall, 19 (35%) studies reported adequate random sequence generation, allocation concealment and adequately accounted for incomplete outcome data. However, research results may be vulnerable to selection, attrition and detection bias. Pooled results from 44 trials indicated that exercise significantly reduced pain (12 points/100; 95% CI 10 to 15) and improved physical function (10 points/100; 95% CI 8 to 13) to a moderate degree immediately after treatment, while evidence from 13 studies revealed that exercise significantly improved quality of life immediately after treatment with small effect (4 points/100; 95% CI 2 to 5). In addition, 12 studies provided 2-month to 6-month post-treatment sustainability data which showed significantly reduced knee pain (6 points/100; 95% CI 3 to 9) and 10 studies which showed improved physical function (3 points/100; 95% CI 1 to 5).

Conclusions Among people with knee osteoarthritis, land-based therapeutic exercise provides short-term benefit that is sustained for at least 2–6 months after cessation of formal treatment.

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