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Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis
  1. Andrew Craig Hislop1,2,
  2. Natalie J Collins2,
  3. Kylie Tucker3,
  4. Margaret Deasy2,
  5. Adam Ivan Semciw2,4,5,6
  1. 1 Physiotherapy Department, Prince Charles Hospital, Chermside, Queensland, Australia
  2. 2 School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
  3. 3 School of Biomedical Sciences, University of Queensland, St Lucia, Queensland, Australia
  4. 4 Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  5. 5 Centre for Functioning and Health Research, Brisbane, Queensland, Australia
  6. 6 Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Adam Ivan Semciw, Department of Rehabilitation, Nutrition and Sport, Latrobe University, Bundoora, VIC 3086, Australia; a.semciw{at}


Objectives To determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life.

Design Systematic review with meta-analysis.

Data sources Medline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018.

Eligibility criteria for selecting studies Randomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise.

Results Eight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference −1.06, 95% CI −2.01 to −0.12), but not for outcomes of pain (−0.09, 95% CI –0.96 to 0.79), patient-reported function (−0.74, 95% CI –1.56 to 0.08) or stair function (−0.7, 95% CI –1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI –0.31 to 0.56), patient-reported function (−0.15, 95% CI –0.58 to 0.29) or stair function (0.13, 95% CI –0.3 to 0.57).

Conclusion Walking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.

  • osteoarthritis
  • neuromuscular
  • strength
  • knee
  • hip

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  • Contributors The authors confirm that all named authors meet the Uniform Requirements for Manuscripts Submitted to Biomedical Journals criteria for authorship. The authors also confirm that the manuscript has not been submitted or is not simultaneously being submitted elsewhere, and that no portion of the data has been or will be published in proceedings or transactions of meetings or symposium volumes. The authors have no financial disclosures to declare.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.