TY - JOUR T1 - Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials JF - British Journal of Sports Medicine JO - Br J Sports Med DO - 10.1136/bjsports-2022-105898 SP - bjsports-2022-105898 AU - Qianlin Weng AU - Siew-Li Goh AU - Jing Wu AU - Monica S M Persson AU - Jie Wei AU - Aliya Sarmanova AU - Xiaoxiao Li AU - Michelle Hall AU - Michael Doherty AU - Ting Jiang AU - Chao Zeng AU - Guanghua Lei AU - Weiya Zhang Y1 - 2023/01/02 UR - http://bjsm.bmj.com/content/early/2023/01/02/bjsports-2022-105898.abstract N2 - Objective Clinical guidelines recommend exercise as a core treatment for knee or hip osteoarthritis (OA). However, how its analgesic effect compares to analgesics, for example, oral non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol—the most commonly used analgesics for OA, remains unknown.Design Network meta-analysis.Data sources PubMed, Embase, Scopus, Cochrane Library and Web of Science from database inception to January 2022.Eligibility criteria for selecting studies Randomised controlled trials (RCTs) comparing exercise therapy with oral NSAIDs and paracetamol directly or indirectly in knee or hip OA.Results A total of n=152 RCTs (17 431 participants) were included. For pain relief, there was no difference between exercise and oral NSAIDs and paracetamol at or nearest to 4 (standardised mean difference (SMD)=−0.12, 95% credibility interval (CrI) −1.74 to 1.50; n=47 RCTs), 8 (SMD=0.22, 95% CrI −0.05 to 0.49; n=2 RCTs) and 24 weeks (SMD=0.17, 95% CrI −0.77 to 1.12; n=9 RCTs). Similarly, there was no difference between exercise and oral NSAIDs and paracetamol in functional improvement at or nearest to 4 (SMD=0.09, 95% CrI −1.69 to 1.85; n=40 RCTs), 8 (SMD=0.06, 95% CrI −0.20 to 0.33; n=2 RCTs) and 24 weeks (SMD=0.05, 95% CrI −1.15 to 1.24; n=9 RCTs).Conclusions Exercise has similar effects on pain and function to that of oral NSAIDs and paracetamol. Given its excellent safety profile, exercise should be given more prominence in clinical care, especially in older people with comorbidity or at higher risk of adverse events related to NSAIDs and paracetamol.CRD42019135166 ER -