RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
SP bjsports-2022-105898
DO 10.1136/bjsports-2022-105898
A1 Qianlin Weng
A1 Siew-Li Goh
A1 Jing Wu
A1 Monica S M Persson
A1 Jie Wei
A1 Aliya Sarmanova
A1 Xiaoxiao Li
A1 Michelle Hall
A1 Michael Doherty
A1 Ting Jiang
A1 Chao Zeng
A1 Guanghua Lei
A1 Weiya Zhang
YR 2023
UL http://bjsm.bmj.com/content/early/2023/01/02/bjsports-2022-105898.abstract
AB 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