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Referencias

Abbott 2013 {published data only}

Abbott JH, Robertson MC, Chapple C, Pinto D, Wright AA, Leon de la Barras L, et al. Manual therapy, exercise therapy, or both, in addition to usual care for osteoarthritis of the hip or knee: a randomized controlled trial. I: Clinical effectiveness. Osteoarthritis and Cartilage 2013;21:525‐34.

An 2008 {published data only}

An B, Dai K, Zhu Z, Wang Y, Hao Y, Tang T, et al. Baduanjin alleviates the symptoms of knee osteoarthritis. Journal of Alternative & Complementary Medicine 2008;14(2):167‐74.

Baker 2001 {published data only}

Baker KR, Nelson ME, Felson DT, Layne JE, Sarno R, Roubenoff R. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. Journal of Rheumatology 2001;28:1655‐65.

Bautch 1997 {published data only}

Bautch JC, Malone DG, Vailas AC. Effects of exercise on knee joints with osteoarthritis: a pilot study of biologic markers. Arthritis Care & Research 1997;10:48‐55.

Bennell 2005 {published data only}

Bennell KL, Himan RS, Metcalf BR, Buchbinder R, McConnell J, McColl G, et al. Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial. Annals of the Rheumatic Diseases 2005;64:906‐12.

Bennell 2010 {published data only}

Bennell KL, Hunt MA, Wrigley TV, Hunter DJ, McManus FJ, Hodges PW, et al. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthritis and Cartilage 2010;18(5):621‐8.

Bezalel 2010 {published data only}

Bezalel T, Carmeli E, Katz‐Leurer M. The effect of a group education programme on pain and function through knowledge acquisition and home‐based exercise among patients with knee osteoarthritis: a parallel randomised single‐blind clinical trial. Physiotherapy 2010;96(2):137‐43.

Brismée 2007 {published data only}

Brismée J, Paige RL, Chyu M, Boatright JD, Hagar JM, McCaleb JA, et al. Group and home‐based Tai Chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Clinical Rehabilitation 2007;21(2):99‐111.

Bruce‐Brand 2012 {published data only}

Bruce‐Brand RA, Walls RJ, Ong JC, Emerson BS, O'Byrne JM, Moyna NM. Effects of home‐based resistance training and neuromuscular electrical stimulation in knee osteoarthritis: a randomized controlled trial. BMC Musculoskeletal Disorders 2012;13:118.

Chang 2012 {published data only}

Chang TF, Liou TH, Chen CH, Huang YC, Chang KH. Effects of elastic‐band exercise on lower‐extremity function among female patients with osteoarthritis of the knee. Disability and Rehabilitation 2012;34(20):1727‐35.

Deyle 2000 {published data only}

Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. Annals of Internal Medicine 2000;132(3):173‐81.

Doi 2008 {published data only}

Doi T, Akai M, Fujino K, Iwaya T, Kurosawa H, Hayashi K, et al. Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation 2008;87(4):258‐69.

Ettinger 1997a/b {published data only}

Ettinger WH, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA 1997;277:25‐31.

Foley 2003 {published data only}

Foley A, Halbert J, Hewitt T, Crotty M, Halbert J, Hewitt T, et al. Does hydrotherapy improve strength and physical function in patients with osteoarthritis—a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening program. Annals of the Rheumatic Diseases 2003;62:1162‐7.

Foroughi 2011 {published data only}

Foroughi N, Smith RM, Lange AK, Baker MK, Fiatarone Singh MA, Vanwanseele B. Lower limb muscle strengthening does not change frontal plane moments in women with knee osteoarthritis: a randomized controlled trial. Clinical Biomechanics 2011;26(2):167‐74.

Fransen 2001 {published data only}

Fransen M, Crosbie J, Edmonds J. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled trial. Journal of Rheumatology 2001;28:156‐64.

Fransen 2007 {published data only}

Fransen M, Nairn L, Winstanley J, Lam P, Edmonds J. The Physical Activity for Osteoarthritis Management (PAFORM) study. A randomised controlled clinical trial evaluating hydrotherapy and Tai Chi classes. Arthritis Care & Research 2007;57:407‐14.

Gur 2002 {published data only}

Gur H, Cakin N, Akova B, Okay E, Kucukoglu S. Concentric versus combined concentric‐eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee. Archives of Physical and Medical Rehabilitation 2003;83:308‐16.

Hay 2006 {published data only}

Hay EM, Foster NE, Thomas E, Peat G, Phelan M, Yates HE, et al. Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trial. BMJ 2006;333:995.

Hopman‐Rock 2000 {published data only}

Hopman‐Rock M, Westhoff M. The effects of a health educational and exercise program for older adults with osteoarthritis of the hip or knee. Journal of Rheumatology 2000;27:1947‐54.

Huang 2003 {published data only}

Huang M‐H, Lin Y‐S, Yang R‐C, Lee C‐L. A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Seminars in Arthritis and Rheumatism 2003;32:398‐406.

Huang 2005 {published data only}

Huang M‐H, Yang R‐C, Lee C‐L, Chen T‐W, Wang M‐C. Preliminary results of integrated therapy for patients with knee osteoarthritis. Arthritis Care & Research 2005;53:812‐20.

Hughes 2004 {published data only}

Hughes SL, Seymour RB, Campbell R, Pollak N, Huber G, Sharma L. Impact of the Fit and Strong intervention on older adults with osteoarthritis. The Gerontologist 2004;44:217‐28.

Hurley 2007 {published data only}

Hurley MV, Walsh NE, Mitchell HL, Pimm TJ, Patel A, Williamson E, et al. Clinical effectiveness of a rehabilitation program integrating exercise, self‐management, and active coping strategies for chronic knee pain: a cluster randomized trial. Arthritis & Rheumatism 2007;57(7):1211‐9.

Jan 2008 {published data only}

Jan M, Lin J, Liau J, Lin Y, Lin D. Investigation of clinical effects of high‐ and low‐resistance training for patients with knee osteoarthritis: a randomized controlled trial. Physical Therapy 2008;88(4):427‐36.

Jan 2009 {published data only}

Jan M, Lin C, Lin Y, Lin J, Lin D. Effects of weight‐bearing versus nonweight‐bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. Archives of Physical Medicine & Rehabilitation 2009;90(6):897‐904.

Jenkinson 2009 {published data only}

Jenkinson CM, Doherty M, Avery AJ, Read A, Taylor MA, Sach TH, et al. Effects of dietary intervention and quadriceps strengthening exercises on pain and function in overweight people with knee pain: randomised controlled trial. BMJ 2009;339:b3170.

Kao 2012 {published data only}

Kao MJ, Wu MP, Tsai MW, Chang WW, Wu SF. The effectiveness of a self‐management program on quality of life for knee osteoarthritis (OA) patients. Archives of Gerontology and Geriatrics 2012;54(2):317‐24.

Keefe 2004 {published data only}

Keefe FJ, Blumenthal J, Baucom D, Affleck G, Waugh R, Caldwell DS, et al. Effects of spouse‐assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study. Pain 2004;110:539‐49.

Kovar 1992 {published data only}

Kovar PA, Allegrante JP, MacKenzie CR, Peterson MGE, Gutin B, Charlson ME. Supervised fitness walking in patients with osteoarthritis of the knee. Annals of Internal Medicine 1992;116:529‐34.

Lee 2009 {published data only}

Lee H, Park H, Chae Y, Kim S, Kim J, Yin C. Tai Chi Qigong for the quality of life of patients with knee osteoarthritis: a pilot, randomized, waiting list controlled trial. Clinical Rehabilitation 2009;23(6):504‐11.

Lim 2008 {published data only}

Lim BW, Hinman RS, Wrigley TV, Sharma L, Bennell KL. Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis Care & Research 2008;59(7):943‐51.

Lin 2009 {published data only}

Lin D, Lin CJ, Lin Y, Jan M. Efficacy of 2 non‐weight‐bearing interventions, proprioception training versus strength training, for patients with knee osteoarthritis: a randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy 2009;39(6):450‐7.

Lund 2008 {published data only}

Lund H, Weile U, Christensen R, Rostock B, Downey A, Bartels EM, et al. A randomized controlled trial of aquatic and land‐based exercise in patients with knee osteoarthritis. Journal of Rehabilitation Medicine 2008;40(2):137‐44.

Maurer 1999 {published data only}

Maurer BT, Stern AG, Kinossian B, Cook KD, Schumacher HR. Osteoarthritis of the knee: isokinetic quadriceps exercise versus an educational intervention. Archives of Physical Medicine and Rehabilitation 1999;80:1293‐9.

Messier 2004 {published data only}

Messier SP, Loeser RF, Miller GD, Morgan TM, Rejeski WJ, Sevick MA, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis. Arthritis & Rheumatism 2004;50:1501‐10.

Mikesky 2006 {published data only}

Mikesky AE, Mazzuca SA, Brandt KD, Perkins SM, Damush T, Lane KA. Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis Care & Research 2006;55:690‐9.

Minor 1989 {published data only}

Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis & Rheumatism 1989;32:1396‐405.

O'Reilly 1999 {published data only}

O'Reilly SC, Muir KR, Doherty M. Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Annals of the Rheumatic Diseases 1999;58:15‐9.

Peloquin 1999 {published data only}

Peloquin L, Bravo G, Gauthier P, Lacombe G, Billiard J‐S. Effects of a cross‐training exercise program in persons with osteoarthritis of the knee. A randomized controlled trial. Journal of Clinical Rheumatology 1999;5:126‐36.

Quilty 2003 {published data only}

Quilty B, Tucker M, Campbell R, Dieppe P. Physiotherapy, including quadriceps exercises and patellar taping, for knee osteoarthritis with predominant patello‐femoral joint involvement: randomized controlled trial. Journal of Rheumatology 2003;30:1311‐7.

Rogind 1998 {published data only}

Rogind H, Bibow‐Nielsen B, Jensen B, Moller HC, Frimodt‐Moller H, Bliddal H. The effects of a physical training program on patients with osteoarthritis of the knees. Archives of Physical Medicine and Rehabilitation 1998;79:1421‐7.

Salacinski 2012 {published data only}

Salacinski AJ, Krohn K, Lewis SF, Holland ML, Ireland K, Marchetti G. The effects of group cycling on gait and pain‐related disability in individuals with mild‐to‐moderate knee osteoarthritis: a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy 2012;42(12):985‐95.

Salli 2010 {published data only}

Salli A, Sahin N, Baskent A, Ugurlu H. The effect of two exercise programs on various functional outcome measures in patients with osteoarthritis of the knee: a randomized controlled clinical trial. Isokinetics & Exercise Science 2010;18(4):201‐9.

Schilke 1996 {published data only}

Schilke JM, Johnson GO, Housh TJ, O'Dell JR. Effects of muscle‐strength training on the functional status of patients with osteoarthritis of the knee joint. Nursing Research 1996;45:68‐72.

Simao 2012 {published data only}

Simao AP, Avelar NC, Tossige‐Gomes R, Neves CD, Mendonca VA, Miranda AS, et al. Functional performance and inflammatory cytokines after squat exercises and whole‐body vibration in elderly individuals with knee osteoarthritis. Archives of Physical Medicine & Rehabilitation 2012;93(10):1692‐700.

Song 2003 {published data only}

Song R, Lee E‐O, Lam P, Bae S‐C. Effects of Tai Chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. Journal of Rheumatology 2003;30:2039‐44.

Talbot 2003 {published data only}

Talbot LA, Gaines JM, Huynh TN, Metter EJ. A home‐based pedometer‐driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. Journal of the American Geriatric Society 2003;51:387‐92.

Thomas 2002 {published data only}

Thomas KS, Muir KR, Doherty M, Jones AC, O'Reilly SC, Bassey EJ. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ 2002;325:752‐7.

Thorstensson 2005 {published data only}

Thorstensson CA, Roos EM, Petersson IF, Ekdahl C. Six‐week high‐intensity exercise program for middle‐aged patients with knee osteoarthritis: a randomized controlled trial. BMC Musculoskeletal Disorders 2005;6:27.

Topp 2002 {published data only}

Topp R, Woolley S, Horuyak J, Khuder S, Kahaleh B. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. Archives of Physical and Medical Rehabilitation 2002;83:1187‐95.

van Baar 1998 {published data only}

van Baar ME, Dekker J, Oostendorp RAB, Bijl D, Voorn TB, Lemmens JAM, et al. The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial. Journal of Rheumatology 1998;25:2432‐9.

Wang 2011 {published data only}

Wang TJ, Lee SC, Liang SY, Tung HH, Wu SF, Lin YP. Comparing the efficacy of aquatic exercises and land‐based exercises for patients with knee osteoarthritis. Journal of Clinical Nursing 2011;20(17‐18):2609‐22.

Yip 2007 {published data only}

Yip YB, Wit JW, Fung KKY, Wong DYS, Chong SYC, Chung LH, et al. Impact of an arthritis self‐management programme with an added exercise component for osteoarthritic knee sufferers on improving pain, functional outcomes, and use of health care services: an experimental study. Patient Education Counseling 2007;65:113‐21.

Ageberg 2010 {published data only}

Ageberg E, Link A, Roos EM. Feasibility of neuromuscular training in patients with severe hip or knee OA: the individualized goal‐based NEMEX‐TJR training program. BMC Musculoskeletal Disorders 2010;11:126.

Aglamis 2008 {published data only}

Aglamis B, Toraman NF, Yaman H. The effect of a 12‐week supervised multicomponent exercise program on knee OA in Turkish women. Journal of Back & Musculoskeletal Rehabilitation 2008;21(2):121‐8.

Aglamis 2009 {published data only}

Aglamis B, Toraman NF, Yaman H. Change of quality of life due to exercise training in knee osteoarthritis: SF‐36 and WOMAC. Journal of Back & Musculoskeletal Rehabilitation 2009;22(1):43‐8.

Akyol 2010 {published data only}

Akyol Y, Durmus D, Alayli G, Tander B, Bek Y, Canturk F, et al. Does short‐wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. European Journal of Physical & Rehabilitation Medicine 2010;46(3):325‐36.

Alfredo 2012 {published data only}

Alfredo PP, Bjordal JM, Dreyer SH, Ferreira, Zaguetti G, Ovanessian V, et al. Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double‐blind study. Clinical Rehabilitation 2012;26(6):523‐33.

Anwer 2011 {published data only}

Anwer S, Quddus N, Miraj M, Equebal A. Effectiveness of electromyographic biofeedback training on quadriceps muscle strength in osteoarthritis of knee. Hong Kong Physiotherapy Journal 2011;29(2):86‐93.

Aoki 2009 {published data only}

Aoki O, Tsumura N, Kimura A, Okuyama S, Takikawa S, Hirata S. Home stretching exercise is effective for improving knee range of motion and gait in patients with knee osteoarthritis. Journal of Physical Therapy Science 2009;21(2):113‐9.

Atamaz 2006 {published data only}

Atamaz F, Kirazli Y, Akkoc Y, Atamaz F, Kirazli Y, Akkoc Y. A comparison of two different intra‐articular hyaluronan drugs and physical therapy in the management of knee osteoarthritis. Rheumatology International 2006;26:873‐8.

Atamaz 2012 {published data only}

Atamaz FC, Durmaz B, Baydar M, Demircioglu OY, Iyiyapici A, Kuran B, et al. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double‐blind, randomized, controlled, multicenter study. Archives of Physical Medicine & Rehabilitation 2012;93(5):748‐56.

Boocock 2009 {published data only}

Boocock M, McNair P, Cicuttini F, Stuart A, Sinclair T. The short‐term effects of running on the deformation of knee articular cartilage and its relationship to biomechanical loads at the knee. Osteoarthritis and Cartilage 2009;17(7):883‐90.

Borjesson 1996 {published data only}

Borjesson M, Robertson E, Weidenhielm L, Mattsson E, Olsson E. Physiotherapy in knee osteoarthrosis effect on pain and walking. Physiotherapy Research International 1996;1:89‐97.

Brosseau 2012 {published data only}

Brosseau L, Wells GA, Kenny GP, Reid R, Maetzel A, Tugwell P, et al. The implementation of a community‐based aerobic walking program for mild to moderate knee osteoarthritis (OA): a knowledge translation (KT) randomized controlled trial (RCT): Part I: The Uptake of the Ottawa Panel clinical practice guidelines (CPGs). BMC Public Health 2012;12:871.

Bulthuis 2007 {published data only}

Bulthuis Y, Drossaers‐Bakker KW, Taal E, Rasker J, Oostveen J, van't Pad Bosch P, et al. Arthritis patients show long‐term benefits from 3 weeks intensive exercise training directly following hospital discharge. Rheumatology 2007;46(11):1712‐7.

Bulthuis 2008 {published data only}

Bulthuis Y, Mohammad S, Braakman‐Jansen LMA, Drossaers‐Bakker KW, van de Laar MAFJ. Cost‐effectiveness of intensive exercise therapy directly following hospital discharge in patients with arthritis: results of a randomized controlled clinical trial. Arthritis & Rheumatism 2008;59(2):247‐54.

Callaghan 1995 {published data only}

Callaghan MJ, Oldham JA, Hunt J. An evaluation of exercise regimes for patients with osteoarthritis of the knee: a single‐blind randomized controlled trial. Clinical Rehabilitation 1995;9:213‐8.

Cetin 2008 {published data only}

Cetin N, Aytar A, Atalay A, Akman MN. Comparing hot pack, short‐wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single‐blind, randomized, controlled trial. American Journal of Physical Medicine & Rehabilitation 2008;87(6):443‐51.

Chaipinyo 2009 {published data only}

Chaipinyo K, Karoonsupcharoen O. No difference between home‐based strength training and home‐based balance training on pain in patients with knee osteoarthritis: a randomised trial. Australian Journal of Physiotherapy 2009;55(1):25‐30.

Chamberlain 1982 {published data only}

Chamberlain MA, Care G, Harfield B. Physiotherapy in osteoarthrosis of the knees. A controlled trial of hospital versus home exercises. International Rehabilitation Medicine 1982;4:101‐6.

Cheing 2002 {published data only}

Cheing GLY, Hui‐Chan CWY, Chan KM. Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain?. Clinical Rehabilitation 2002;16:749‐60.

Cheing 2004 {published data only}

Cheing GLY, Hui‐Chan CWY. Would the addition of TENS to exercise training produce better physical performance outcomes in people with knee osteoarthritis than either intervention alone?. Clinical Rehabilitation 2004;18:487.

Ciolac 2011 {published data only}

Ciolac EG, Greve JMDA. Muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty. Clinics (Sao Paulo, Brazil) 2011;66(12):2079‐84.

Coupe 2007 {published data only}

Coupe VM, Veenhof C, van Tulder MW, Dekker J, Bijlsma JW, Van den Ende CH. The cost effectiveness of behavioural graded activity in patients with osteoarthritis of hip and/or knee. Annals of the Rheumatic Diseases 2007;66(2):215‐21.

Crotty 2009 {published data only}

Crotty M, Prendergast J, Battersby MW, Rowett D, Graves SE, Leach G, et al. Self‐management and peer support among people with arthritis on a hospital joint replacement waiting list: a randomised controlled trial. Osteoarthritis and Cartilage 2009;17(11):1428‐33.

Deyle 2005 {published data only}

Deyle GD, Allison SC, Matekel RL, Ryder MG, Stang JM, Gohdes DD, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Physical Therapy 2005;12:1301‐17.

Dias 2003 {published data only}

Dias RC, Ramos LR, Dias JM. Impact of an exercise and walking protocol on the quality of life of the elderly with osteoarthritis of the knee. Physiotherapy Research International 2003;8:121‐30.

Diracoglu 2005 {published data only}

Diracoglu D, Aydin R, Baskent A, Celik A, Diracoglu D, Aydin R, et al. Effects of kinesthesia and balance exercises in knee osteoarthritis. Journal of Clinical Rheumatology 2005;11:303‐10.

Duman 2012 {published data only}

Duman I, Taskaynatan MA, Mohur H, Tan AK. Assessment of the impact of proprioceptive exercises on balance and proprioception in patients with advanced knee osteoarthritis. Rheumatology international 2012;32(12):3793‐8.

Durmus 2007 {published data only}

Durmus D, Alayli G, Canturk F. Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis. Clinical Rheumatology 2007;26:674‐8.

Durmus 2012 {published data only}

Durmus D, Alayli G, Bayrak IK, Canturk F. Assessment of the effect of glucosamine sulfate and exercise on knee cartilage using magnetic resonance imaging in patients with knee osteoarthritis: a randomized controlled clinical trial. Journal of Back & Musculoskeletal Rehabilitation 2012;25(4):275‐84.

Ebnezar 2012 {published data only}

Ebnezar J, Nagarathna R, Yogitha B, Nagendra HR. Effects of an integrated approach of hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: a randomized controlled study. Journal of Alternative & Complementary Medicine 2012;18(5):463‐72.

Ebnezar 2012a {published data only}

Ebnezar J, Nagarathna R, Yogitha B, Nagendra HR. Effect of integrated yoga therapy on pain, morning stiffness and anxiety in osteoarthritis of the knee joint: a randomized control study. International Journal of Yoga 2012;5(1):28‐36.

Evcik 2002 {published data only}

Evcik D, Sonel B. Effectiveness of a home‐based exercise therapy and walking program on osteoarthritis of the knee. Rheumatology International 2002;22:103‐6.

Evgeniadis 2008 {published data only}

Evgeniadis G, Beneka A, Malliou P, Mavromoustakos S, Godolias G. Effects of pre‐ or postoperative therapeutic exercise on the quality of life, before and after total knee arthroplasty for osteoarthritis. Journal of Back & Musculoskeletal Rehabilitation 2008;21(3):161‐9.

Eyigor 2004 {published data only}

Eyigor S, Hepguler S, Capaci K. A comparison of muscle training methods in patients with knee osteoarthritis. Clinical Rheumatology 2004;23:109‐15.

Farr 2010 {published data only}

Farr JN, Going SB, McKnight PE, Kasle S, Cussler EC, Cornett M. Progressive resistance training improves overall physical activity levels in patients with early osteoarthritis of the knee: a randomized controlled trial. Physical Therapy 2010;90(3):356‐66.

Feinglass 2012 {published data only}

Feinglass J, Song J, Semanik P, Lee J, Manheim L, Dunlop D, et al. Association of functional status with changes in physical activity: insights from a behavioral intervention for participants with arthritis. Archives of Physical Medicine & Rehabilitation 2012;93(1):172‐5.

Fitzgerald 2011 {published data only}

Fitzgerald GK, Piva SR, Gil AB, Wisniewski SR, Oddis CV, Irrgang JJ. Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial. Physical Therapy 2011;91(4):452‐69.

Forestier 2010 {published data only}

Forestier R, Desfour H, Tessier JM, Francon A, Foote AM, Genty C, et al. Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial. Annals of the Rheumatic Diseases 2010;69(4):660‐5.

Foroughi 2011a {published data only}

Foroughi N, Smith RM, Lange AK, Singh MA, Vanwanseele B. Progressive resistance training and dynamic alignment in osteoarthritis: a single‐blind randomised controlled trial. Clinical Biomechanics (Bristol, Avon) 2011;26(1):71‐7.

Foster 2007 {published data only}

Foster NE, Thomas E, Barlas P, Hill JC, Young J, Mason E, et al. Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial. BMJ 2007;335(7617):436.

Gaal 2008 {published data only}

Gaal J, Varga J, Szekanecz Z, Kurko J, Ficzere A, Bodolay E, et al. Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life. Israel Medical Association Journal 2008;10(5):365‐9.

Gaudreault 2011 {published data only}

Gaudreault N, Mezghani N, Turcot K, Hagemeister N, Boivin K, de Guise JA. Effects of physiotherapy treatment on knee osteoarthritis gait data using principal component analysis. Clinical Biomechanics 2011;26(3):284‐91.

Gill 2009 {published data only}

Gill SD, McBurney H, Schulz DL. Land‐based versus pool‐based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial. Archives of Physical Medicine & Rehabilitation 2009;90(3):388‐94.

Green 1993 {published data only}

Green J, McKenna F, Redfern EJ, Chamberlain MA. Home exercises are as effective as outpatient hydrotherapy for osteoarthritis of the hip. British Journal of Rheumatology 1993;32:812‐5.

Gremion 2009 {published data only}

Gremion G, Gaillard D, Leyvraz PF, Jolles BM. Effect of biomagnetic therapy versus physiotherapy for treatment of knee osteoarthritis: a randomized controlled trial. Journal of Rehabilitation Medicine (Stiftelsen Rehabiliteringsinformation) 2009;41(13):1090‐5.

Haslam 2001 {published data only}

Haslam R. A comparison of acupuncture with advice and exercises on the symptomatic treatment of osteoarthritis of the hip—a randomised controlled trial. Acupuncture Medicine 2001;19:19‐26.

Helmark 2010 {published data only}

Helmark IC, Mikkelsen UR, Borglum J, Rothe A, Petersen MC, Andersen O, et al. Exercise increases interleukin‐10 levels both intraarticularly and peri‐synovially in patients with knee osteoarthritis: a randomized controlled trial. Arthritis Research & Therapy 2010;12(4):R126.

Helmark 2012 {published data only}

Helmark IC, Petersen MCH, Christensen HE, Kjaer M, Langberg H. Moderate loading of the human osteoarthritic knee joint leads to lowering of intraarticular cartilage oligomeric matrix protein. Rheumatology International 2012;32(4):1009‐14.

Hinman 2007 {published data only}

Hinman RS, Heywood SE, Day AR. Aquatic physical therapy for hip and knee osteoarthritis: results of a single‐blind randomized controlled trial. Physical Therapy 2007;87:32‐43.

Hiyama 2012 {published data only}

Hiyama Y, Yamada M, Kitagawa A, Tei N, Okada S. A four‐week walking exercise programme in patients with knee osteoarthritis improves the ability of dual‐task performance: a randomized controlled trial. Clinical Rehabilitation 2012;26(5):403‐12.

Hoeksma 2004 {published data only}

Hoeksma HL, Dekker J, Ronday HK, Heering A, van der Lubbe N, Vel C, et al. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis & Rheumatism 2004;51:722‐9.

Huang 2005b {published data only}

Huang M‐H, Lin Y‐H, Lee C‐L, Yang R‐C. Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis. Archives of Physical and Medical Rehabilitation 2005;86:1545‐51.

Hughes 2010 {published data only}

Hughes SL, Seymour RB, Campbell RT, Desai P, Huber G, Chang HJ. Fit and Strong!: bolstering maintenance of physical activity among older adults with lower‐extremity osteoarthritis. American Journal of Health Behavior 2010;34(6):750‐63.

Hurley 1998 {published data only}

Hurley MV, Scott DL. Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regime. British Journal of Rheumatology 1998;37:1181‐7.

Hurley 2007a {published data only}

Hurley MV, Walsh NE, Mitchell HL, Pimm TJ, Williamson E, Jones RH, et al. Economic evaluation of a rehabilitation program integrating exercise, self‐management, and active coping strategies for chronic knee pain. Arthritis & Rheumatism 2007;57(7):1220‐9.

Hurley 2012 {published data only}

Hurley MV, Walsh NE, Mitchell H, Nicholas J, Patel A. Long‐term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial. Arthritis Care & Research 2012;64(2):238‐47.

Jan 1991 {published data only}

Jan M‐H, Lai J‐S. The effects of physiotherapy on osteoarthritic knees of females. Journal of the Formosan Medical Association 1991;90:1008‐13.

Jan 2008a {published data only}

Jan M, Tang P, Lin J, Teng S, Lin Y, Lin D. Efficacy of a target‐matching foot‐stepping exercise on proprioception and function in patients with knee osteoarthritis. Journal of Orthopaedic & Sports Physical Therapy 2008;38(1):19‐25.

Jessep 2009 {published data only}

Jessep SA, Walsh NE, Ratcliffe J, Hurley MV. Long‐term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain. Physiotherapy 2009;95(2):94‐102.

Karagulle 2007 {published data only}

Karagulle M, Karagulle MZ, Karagulle O, Donmez A, Turan M. A 10‐day course of SPA therapy is beneficial for people with severe knee osteoarthritis. A 24‐week randomised, controlled pilot study. Clinical Rheumatology 2007;26(12):2063‐71.

Kawasaki 2008 {published data only}

Kawasaki T, Kurosawa H, Ikeda H, Kim SG, Osawa A, Takazawa Y, et al. Additive effects of glucosamine or risedronate for the treatment of osteoarthritis of the knee combined with home exercise: a prospective randomized 18‐month trial. Journal of Bone and Mineral Metabolism 2008;26(3):279‐87.

Kawasaki 2009 {published data only}

Kawasaki T, Kurosawa H, Ikeda H, Takazawa Y, Ishijima M, Kubota M, et al. Therapeutic home exercise versus intraarticular hyaluronate injection for osteoarthritis of the knee: 6‐month prospective randomized open‐labelled trial. Journal of Orthopaedic Science 2009;14(2):182‐91.

King 2008 {published data only}

King LK, Birmingham TB, Kean CO, Jones IC, Bryant DM, Giffin JR. Resistance training for medial compartment knee osteoarthritis and malalignment. Medicine & Science in Sports & Exercise 2008;40(8):1376‐84.

Konishi 2009 {published data only}

Konishi I, Tanabe N, Seki N, Suzuki H, Okamura T, Shinoda K, et al. Physiotherapy program through home visits for community‐dwelling elderly Japanese women with mild knee pain. Tohoku Journal of Experimental Medicine 2009;219(2):91‐9.

Kreindler 1989 {published data only}

Kreindler H, Lewis CB, Rush S, Schaefer K. Effects of three exercise protocols on strength of persons with osteoarthritis of the knee. Topics in Geriatriatric Rehabilitation 1989;4:32‐9.

Kuptniratsaikul 2002 {published data only}

Kuptniratsaikul V, Orchatara T, Nilganuwong S, Visanu T. The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis. Journal of the Medical Association of Thailand 2002;85:33‐9.

Lankhorst 1982 {published data only}

Lankhorst GJ, van de Stadt RJ, van der Korst JK, Hinlopen‐Bonrath E, Griffioen FM, de Boer W. Relationship of isometric knee extension torque and functional variables in osteoarthrosis of the knee. Scandinavian Journal of Rehabilitation Medicine 1982;14:7‐10.

Lim 2002 {published data only}

Lim BW. A comparative study of open and closed kinetic chain exercise regimes in patients with knee osteoarthritis. Physiotherapy Singapore 2002;5:34‐40.

Lim 2010 {published data only}

Lim JY, Tchai E, Jang SN. Effectiveness of aquatic exercise for obese patients with knee osteoarthritis: a randomized controlled trial. PM&R 2010;2(8):723‐31; quiz 93.

Lin 2004 {published data only}

Lin SY, Davey RC, Cochrane T. Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial. Clinical Rehabilitation 2004;18:92‐101.

Lin 2007 {published data only}

Lin DH, Lin YF, Chai HM, Han YC, Jan MH. Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis. Clinical Rheumatology 2007;26(4):520‐8.

Liu 2008 {published data only}

Liu Y, Guo L, Ma S. Treatment of 256 cases of osteoarthritis of knee joint with Guo Jianhua's four‐step therapy. Journal of Traditional Chinese Medicine 2008;28(2):114‐7.

Mangione 1999 {published data only}

Mangione KK, McCully K, Gloviak A, Lefebvre I, Hofmann M, Craik R. The effects of high‐intensity and low‐intensity cycle ergometry in older adults with knee osteoarthritis. Journal of Gerontology 1999;54A:M184‐90.

Marra 2012 {published data only}

Marra CA, Cibere J, Grubisic M, Grindrod KA, Gastonguay L, Thomas JM, et al. Pharmacist‐initiated intervention trial in osteoarthritis: a multidisciplinary intervention for knee osteoarthritis. Arthritis Care & Research 2012;64(12):1837‐45.

Mascarin 2012 {published data only}

Mascarin NC, Vancini RL, Andrade ML, Magalhaes Ede P, de Lira CA, Coimbra IB. Effects of kinesiotherapy, ultrasound and electrotherapy in management of bilateral knee osteoarthritis: prospective clinical trial. BMC Musculoskeletal Disorders 2012;13:182.

McCarthy 2004 {published data only}

McCarthy CJ, Mills PM, Pullen R, Roberts C, Silman A, Oldham JA. Supplementing a home exercise programme with a class‐based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis. Rheumatology 2004;43:880‐6.

McKnight 2010 {published data only}

McKnight PE, Kasle S, Going S, Villanueva I, Cornett M, Farr J, et al. A comparison of strength training, self‐management, and the combination for early osteoarthritis of the knee. Arthritis Care & Research 2010;62(1):45‐53.

McQuade 2011 {published data only}

McQuade KJ, De Oliveira AS. Effects of progressive resistance strength training on knee biomechanics during single leg step‐up in persons with mild knee osteoarthritis. Clinical Biomechanics 2011;26(7):741‐8.

Messier 1997 {published data only}

Messier SP, Thompson CD, Ettinger WH. Effects of long‐term aerobic or weight training regimes on gait in an older, osteoarthritic population. Journal of Applied Biomechanics 1997;13:205‐25.

Messier 2000a {published data only}

Messier SP, Loeser RF, Mitchell MN, Valle G, Morgan TP, Rejeski WJ, Ettinger WH. Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. Journal of the American Geriatric Society 2000;48:1062‐72.

Messier 2000b {published data only}

Messier SP, .Royer TD, Craven TE, O'Toole ML, Burns R, Ettinger WH. Long‐term exercise and its effect on balance in older, osteoarthritis adults: results from the Fitness, Arthritis and Seniors Trial (FAST). Journal of the American Geriatric Society 2000;48:131‐8.

Messier 2007 {published data only}

Messier SP, Mihalko S, Loeser RF, Legault C, Jolla J, Pfruender J, et al. Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study. Osteoarthritis and Cartilage 2007;15(11):1256‐66.

Messier 2008 {published data only}

Messier SP, Legault C, Lenz ME, Thonar EJ, Loeser RF. Effect of an exercise and dietary intervention on serum biomarkers in overweight and obese adults with osteoarthritis of the knee. Osteoarthritis and Cartilage 2008;16(9):1047‐53.

Miller 2012 {published data only}

Miller GD, Nicklas BJ, Davis CC, Legault C, Messier SP. Basal growth hormone concentration increased following a weight loss focused dietary intervention in older overweight and obese women. Journal of Nutrition, Health & Aging 2012;16(2):169‐74.

Moss 2007 {published data only}

Moss P, Sluka K, Wright A. The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Manual Therapy 2007;12:109‐18.

Murphy 2008 {published data only}

Murphy SL, Strasburg DM, Lyden AK, Smith DM, Koliba JF, Dadabhoy DP, et al. Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study. Arthritis & Rheumatism 2008;59(10):1480‐7.

Neves 2011 {published data only}

Neves M, Gualano B, Roschel H, Fuller R, Benatti FB, Pinto ALDS, et al. Beneficial effect of creatine supplementation in knee osteoarthritis. Medicine & Science in Sports & Exercise 2011;43(8):1538‐43.

Ng 2010 {published data only}

Ng NT, Heesch KC, Brown WJ. Efficacy of a progressive walking program and glucosamine sulphate supplementation on osteoarthritic symptoms of the hip and knee: a feasibility trial. Arthritis Research & Therapy 2010;12(1):R25.

Nicklas 2004 {published data only}

Nicklas BJ, Ambrosius W, Messier SP, Miller GD, Penninx BW, Loeser RF, et al. Diet‐induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. American Journal of Clinical Nutrition 2004;79:544‐51.

Ozdincler 2005 {published data only}

Ozdincler AR, Yeldan I, Kinali P. The effects of closed kinetic chain exercise on pain and functional performance of patients with knee osteoarthritis. The Pain Clinic 2005;1:107‐15.

Penninx 2001 {published data only}

Penninx B, Messier SP, Rejeski WJ, Williamson JD, DiBari M, Cavazzini C, et al. Physical exercise and prevention of disability in activities of daily living in older persons with osteoarthritis. Archives of Internal Medicine 2001;19:2309‐16.

Penninx 2002 {published data only}

Penninx BW, Rejeski WJ, Pandya J, Miller ME, Di Bari M, Applegate WB, et al. Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. Journal of Gerontology 2002;57B:P127‐32.

Pereira, 2011 {published data only}

Pereira Simão AP, Tossige‐Gomes R, Cunha N, Rocha‐Vieira E, Coimbra CC, et al. The effect of adding whole‐body vibration to squat training on the functional performance and self‐report of disease status in elderly patients with knee osteoarthritis: a randomized, controlled clinical study. Journal of Alternative & Complementary Medicine 2011;17(12):1149‐55.

Petersen 2010 {published data only}

Petersen SG, Saxne T, Heinegard D, Hansen M, Holm L, Koskinen S, et al. Glucosamine but not ibuprofen alters cartilage turnover in osteoarthritis patients in response to physical training. Osteoarthritis and Cartilage 2010;18(1):34‐40.

Petersen 2011 {published data only}

Petersen SG, Beyer N, Hansen M, Holm L, Aagaard P, Mackey AL, et al. Nonsteroidal anti‐inflammatory drug or glucosamine reduced pain and improved muscle strength with resistance training in a randomized controlled trial of knee osteoarthritis patients. Archives of Physical Medicine & Rehabilitation 2011;92(8):1185‐93.

Peterson 1993 {published data only}

Peterson MGE, Kovar‐Toledano PA, Otis JC, Allegrante JP, Mackenzie CR, Gutin B, Kross MA. Effect of a walking program on gait characteristics in patients with osteoarthritis. Arthritis Care & Research 1993;6:11‐6.

Petrella 2000 {published data only}

Petrella RJ, Bartha C. Home based exercise therapy for older patients with knee osteoarthritis: a randomized clinical trial. Journal of Rheumatology 2000;27:2215‐21.

Pietrosimone 2010 {published data only}

Pietrosimone BG, Saliba SA, Hart JM, Hertel J, Kerrigan DC, Ingersoll CD. Effects of disinhibitory transcutaneous electrical nerve stimulation and therapeutic exercise on sagittal plane peak knee kinematics and kinetics in people with knee osteoarthritis during gait: a randomized controlled trial. Clinical Rehabilitation 2010;24(12):1091‐101.

Pietrosimone 2012 {published data only}

Pietrosimone BG, Saliba SA. Changes in voluntary quadriceps activation predict changes in quadriceps strength after therapeutic exercise in patients with knee osteoarthritis. Knee 2012;19(6):939‐43.

Pisters 2010 {published data only}

Pisters MF, Veenhof C, de Bakker DH, Schellevis FG, Dekker J. Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis: a cluster‐randomised trial. Journal of Physiotherapy 2010;56(1):41‐7.

Pisters 2010a {published data only}

Pisters MF, Veenhof C, Schellevis FG, De Bakker DH, Dekker J. Long‐term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized controlled trial comparing two different physical therapy interventions. Osteoarthritis and Cartilage 2010;18(8):1019‐26.

Piva 2011 {published data only}

Piva SR, Fitzgerald GK. Effects of impairment‐based exercise on performance of specific self‐reported functional tasks in individuals with knee osteoarthritis. Physical Therapy 2011;91(12):1752‐65.

Piyakhachornrot 2011 {published data only}

Piyakhachornrot N, Aree‐Ue S, Putwatana P, Kawinwonggowit V. Impact of an integrated health education and exercise program in middle‐aged Thai adults with osteoarthritis of the knee. Orthopaedic Nursing 2011;30(2):134‐42.

Quirk 1985 {published data only}

Quirk AS, Newman RJ, Newman KJ. An evaluation of interferential therapy, shortwave diathermy and exercise in the treatment of osteoarthrosis of the knee. Physiotherapy 1985;71:55‐7.

Rattanachaiyanont 2008 {published data only}

Rattanachaiyanont M, Kuptniratsaikul V. No additional benefit of shortwave diathermy over exercise program for knee osteoarthritis in peri‐/post‐menopausal women: an equivalence trial. Osteoarthritis and Cartilage 2008;16(7):823‐8.

Ravaud 2004 {published data only}

Ravaud P, Giraudeau B, Logeart I, Larguier JS, Rolland D, et al. Management of osteoarthritis with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2x2 factorial design. Annals of the Rheumatic Diseases 2004;63:703‐8.

Reid 2010 {published data only}

Reid DA, McNair PJ. Effects of an acute hamstring stretch in people with and without osteoarthritis of the knee. Physiotherapy 2010;96(1):14‐21.

Reid 2011 {published data only}

Reid DA, McNair PJ. Effects of a six week lower limb stretching programme on range of motion, peak passive torque and stiffness in people and without osteoarthritis of the knee. New Zealand Journal of Physiotherapy 2011;39(1):5‐12.

Rejeski 1998 {published data only}

Rejeski WJ, Ettinger WH, Martin K, Morgan T. Treating disability in knee osteoarthritis with exercise therapy: a central role for self‐efficacy and pain. Arthritis Care & Research 1998;11:94‐101.

Sayers 2012 {published data only}

Sayers SP, Gibson K, Cook CR. Effect of high‐speed power training on muscle performance, function, and pain in older adults with knee osteoarthritis: a pilot investigation. Arthritis Care & Research 2012;64(1):46‐53.

Schlenk 2011 {published data only}

Schlenk EA, Lias JL, Sereika SM, Dunbar‐Jacob J, Kwoh CK. Improving physical activity and function in overweight and obese older adults with osteoarthritis of the knee: a feasibility study. Rehabilitation Nursing Journal 2011;36(1):32‐42.

Scopaz 2009 {published data only}

Scopaz KA, Piva SR, Gil AB, Woollard JD, Oddis CV, Fitzgerald GK. Effect of baseline quadriceps activation on changes in quadriceps strength after exercise therapy in subjects with knee osteoarthritis. Arthritis & Rheumatism: Arthritis Care & Research 2009;61(7):951‐7.

Selfe 2008 {published data only}

Selfe TK, Bourguignon C, Taylor AG. Effects of noninvasive interactive neurostimulation on symptoms of osteoarthritis of the knee: a randomized, sham‐controlled pilot study. Journal of Alternative & Complementary Medicine 2008;14(9):1075‐81.

Sen 2004 {published data only}

Sen A, Gocen Z, Unver B, Karatosun V, Gunal I. The frequency of visits by the physiotherapist of patients receiving home‐based exercise therapy for knee osteoarthritis. Knee 2004;11:151‐3.

Sevick 2009 {published data only}

Sevick MA, Miller GD, Loeser RF, Williamson JD, Messier SP. Cost‐effectiveness of exercise and diet in overweight and obese adults with knee osteoarthritis. Medicine & Science in Sports & Exercise 2009;41(6):1167‐74.

Shakoor 2007 {published data only}

Shakoor MA, Taslim MA, Hossain MS. Effects of activity modification on the patients with osteoarthritis of the knee. Bangladesh Medical Research Council Bulletin 2007;33(2):55‐9.

Shakoor 2010 {published data only}

Shakoor MA, Rahman MS, Azad AK, Islam MS. Effects of isometric quadriceps muscle strengthening exercise on chronic osteoarthritis of the knee. Bangladesh Medical Research Council Bulletin 2010;36(1):20‐2.

Shen 2008 {published data only}

Shen CL, James CR, Chyu MC, Bixby WR, Brismée JM, Zumwalt MA, et al. Effects of Tai Chi on gait kinematics, physical function, and pain in elderly with knee osteoarthritis—a pilot study. American Journal of Chinese Medicine 2008;36(2):219‐32.

Silva 2008 {published data only}

Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, et al. Hydrotherapy versus conventional land‐based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Physical Therapy 2008;88(1):12‐21.

Sled 2010 {published data only}

Sled EA, Khoja L, Deluzio KJ, Olney SJ, Culham EG. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: a clinical trial. Physical Therapy 2010;90(6):895‐904.

Song 2010 {published data only}

Song R, Roberts BL, Lee E, Lam P, Bae S. A randomized study of the effects of t'ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis. Journal of Alternative & Complementary Medicine 2010;16(3):227‐33.

Soni 2012 {published data only}

Soni A, Joshi A, Mudge N, Wyatt M, Williamson L. Supervised exercise plus acupuncture for moderate to severe knee osteoarthritis: a small randomised controlled trial. Acupuncture in Medicine 2012;30(3):176‐81.

Stitik 2007 {published data only}

Stitik TP, Blacksin MF, Stiskal DM, Kim JH, Foye PM, Schoenheer L, et al. Efficacy and safety of hyaluronan treatment in combination therapy with home exercise for knee osteoarthritis pain. Archives of Physical and Medical Rehabiltation 2007;88:135‐41.

Stitik 2007a {published data only}

Stitik TP, Blacksin MF, Stiskal DM, Kim JH, Foye PM, Schoenherr L, et al. Efficacy and safety of hyaluronan treatment in combination therapy with home exercise for knee osteoarthritis pain. Archives of Physical Medicine & Rehabilitation 2007;88(2):135‐41.

Sullivan 1998 {published data only}

Sullivan T, Allegrante JP, Peterson MG, Kovar PA, MacKenzie CR. One‐year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education. Arthritis Care & Research 1998;11:228‐33.

Swank 2011 {published data only}

Swank AM, Kachelman JB, Bibeau W, Quesada PM, Nyland J, Malkani A, et al. Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis. Journal of Strength & Conditioning Research 2011;25(2):318‐25.

Sylvester 1989 {published data only}

Sylvester KL. Investigation of the effect of hydrotherapy in the treatment of osteoarthritic hips. Clinical Rehabilitation 1989;4:223‐8.

Teixeira 2011 {published data only}

Teixeira PE, Piva SR, Fitzgerald GK. Effects of impairment‐based exercise on performance of specific self‐reported functional tasks in individuals with knee osteoarthritis. Physical Therapy 2011;91(12):1752‐65.

Thiengwittayaporn 2009 {published data only}

Thiengwittayaporn S, Wetpiryakul P, Foosakun Y, Ngamsom T, Vathanavit P, Pintongtun J. Comparison of the accuracy of quadriceps isometric exercise between using quadriceps education device (QED) and not using QED for osteoarthritic knee patients: a randomized controlled trial. Journal of the Medical Association of Thailand 2009;92 Suppl 6:S33‐8.

Toda 2001 {published data only}

Toda Y. The effect of energy restriction, walking and exercise on lower extremity lean body mass in obese women with osteoarthritis of the knee. Journal of Orthopaedic Science 2001;6:148‐54.

Tok 2011 {published data only}

Tok F, Aydemir K, Peker F, Safaz I, Taskaynatan MA, Ozgul A. The effects of electrical stimulation combined with continuous passive motion versus isometric exercise on symptoms, functional capacity, quality of life and balance in knee osteoarthritis: randomized clinical trial. Rheumatology International 2011;31(2):177‐81.

Topp 2009 {published data only}

Topp R, Swank AM, Quesada PM, Nyland J, Malkani A. The effect of prehabilitation exercise on strength and functioning after total knee arthroplasty. PM&R 2009;1(8):729‐35.

Tsauo 2008 {published data only}

Tsauo J, Cheng P, Yang R. The effects of sensorimotor training on knee proprioception and function for patients with knee osteoarthritis: a preliminary report. Clinical Rehabilitation 2008;22(5):448‐57.

Tunay 2010 {published data only}

Tunay VB, Baltaci G, Atay AO. Hospital‐based versus home‐based proprioceptive and strengthening exercise programs in knee osteoarthritis. Acta Orthopaedica et Traumatologica Turcica 2010;44(4):270‐7.

Tuzun 2004 {published data only}

Tuzun EH, Aytar A, Eker L, Daskapan A. Effectiveness of two different physical therapy programmes in the treatment of knee osteoarthritis. Pain Clinic 2004;16:379‐87.

van Baar 2001 {published data only}

van Baar ME, Dekker J, Oostendorp RA, Bijl D, Voorn TB, Bijlsma JW. Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months' follow up. Annals of the Rheumatic Diseases 2001;60:1123‐30.

Van Gool 2005 {published data only}

van Gool CH, Penninx BW, Kempen GI, Rejeski WJ, Miller GD, van Eijk JT, et al. Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis. Arthritis Care & Research 2005;53:24‐32.

Veenhof 2007 {published data only}

Veenhof C, Dekker J, Köke AJA, Oostendorp RA, Bijlsma JWJ. Which patients with osteoarthritis of hip and/or knee benefit most from behavioral graded activity?. International Journal of Behavioral Medicine 2007;14(2):86‐91.

Walls 2010 {published data only}

Walls RJ, McHugh G, O'Gorman DJ, Moyna N, O'Byrne JM. Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study. BMC Musculoskeletal Disorders 2010;11:119.

Wang 2006 {published data only}

Wang T‐J, Belza B, Thompson FE, Whitney JD, Bennett K. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Journal of Advanced Nursing 2006;57:141‐52.

Wang 2007 {published data only}

Wang T, Belza B, Elaine Thompson F, Whitney JD, Bennett K. Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Journal of Advanced Nursing 2007;57(2):141‐52.

Wang 2007a {published data only}

Wang X, Miller GD, Messier SP, Nicklas BJ. Knee strength maintained despite loss of lean body mass during weight loss in older obese adults with knee osteoarthritis. Journals of Gerontology Series A‐Biological Sciences & Medical Sciences 2007;62(8):866‐71.

Wang 2009 {published data only}

Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, et al. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis & Rheumatism 2009;61(11):1545‐53.

Weng 2009 {published data only}

Weng MC, Lee CL, Chen CH, Hsu JJ, Lee WD, Huang MH, et al. Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis. The Kaohsiung Journal of Medical Sciences 2009;25(6):306‐15.

Whitehurst 2011 {published data only}

Whitehurst DG, Bryan S, Hay EM, Thomas E, Young J, Foster NE. Cost‐effectiveness of acupuncture care as an adjunct to exercise‐based physical therapy for osteoarthritis of the knee. Physical Therapy 2011;91(5):630‐41.

Williamson 2007 {published data only}

Williamson L, Wyatt MR, Yein K, Melton JT. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology 2007;46:1445‐9.

Williamson 2007a {published data only}

Williamson L, Wyatt MR, Yein K, Melton JT. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology (Oxford, England) 2007;46(9):1445‐9.

Wyatt 2001 {published data only}

Wyatt FB, Milam S, Manske RC, Deere R. The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. Journal of Strengthening Research 2001;15:337‐40.

Yilmaz 2010 {published data only}

Yilmaz OO, Senocak O, Sahin E, Baydar M, Gulbahar S, Bircan C, et al. Efficacy of EMG‐biofeedback in knee osteoarthritis. Rheumatology International 2010;30(7):887‐92.

Yip 2007a {published data only}

Yip YB, Sit JW, Fung KK, Wong DY, Chong SY, Chung LH, et al. Effects of a self‐management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial. Journal of Advanced Nursing 2007;59(1):20‐8.

Yip 2008 {published data only}

Yip Y, Sit JW, Wong DYS, Chong SYC, Chung L. A 1‐year follow‐up of an experimental study of a self‐management arthritis programme with an added exercise component of clients with osteoarthritis of the knee. Psychology, Health & Medicine 2008;13(4):402‐14.

References to studies awaiting assessment

Carlos 2012 {published data only}

Carlos KP, Belli BdS, Alfredo PP. Effect of pulsed ultrasound and continuous ultrasound linked to exercise in patients with knee osteoarthritis: pilot study [Portuguese]. Fisioterapia e Pesquisa 2012;19(3):275‐81.

Eungpinichpong 1997 {published data only}

Eungpinichpong W. The efficacy of physical exercise programmes for patients with osteoarthritis of the knee as determined by clinical and gait parameters. New Zealand Journal of Physiotherapy 1998;26:5.

Ghroubi 2008 {published data only}

Ghroubi S, Elleuch H, Kaffel N, Echikh T, Abid M, Elleuch MH. [Contribution of exercise and diet in the management of knee osteoarthritis in the obese]. Annales de Readaptation et de Medecine Physique 2008;51(8):663‐70.

Keogan 2007 {published data only}

Keogan F, Gilsenan C, Hussey J, O'Connell P. Open or closed chain quadriceps exercises in treatment of osteoarthritis of the knee; which is more effective? A blinded randomised controlled trial. Physiotherapy Ireland 2007;28(1):47‐8.

Oida 2008 {published data only}

Oida Y, Morozumi K, Nakamura N, Kitabatake Y, Shiozawa S, Sato S, et al. [Effectiveness of a community health service program using exercise intervention for elderly people with osteoarthritis of the knees: a randomized controlled trial]. Nippon Koshu Eisei Zasshi ‐ Japanese Journal of Public Health 2008;55(4):228‐37.

Rosa 2012 {published data only}

Rosa UH, Velasquez Tlapanco J, Lara Maya C, Villarreal Rios E, Martinez Gonzalez L, Vargas Daza ER, et al. [Comparison of the effectiveness of isokinetic vs isometric therapeutic exercise in patients with osteoarthritis of knee]. Reumatologia Clinica 2012;8(1):10‐4.

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Altman RD. Criteria for the classification of clinical osteoarthritis. Journal of Rheumatology 1991;18 Suppl 27:10‐2.

Bellamy 1997

Bellamy N, Kirwan J, Boers M, Brooks P, Strand V, Tugwell P, et al. Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip and hand osteoarthritis. Consensus development at OMERACT III. Journal of Rheumatology 1997;24:799‐802.

Bennell 2008

Bennell KL, Hunt MA, Wrigley TV, Lim BW, Hinman RS. Role of muscle in the genesis and management of knee osteoarthritis. Rheumatic Disease Clinics of North America 2008;34:731‐54.

Brazier 1999

Brazier JE, Harper R, Munro J, Walters SJ, Snaith ML. Generic and condition‐specific outcome measures for people with osteoarthritis of the knee. Rheumatology 1999;38:870‐7.

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Buchner DM, Beresford SA, Larson EB, LaCroix AZ, Wagner EH. Effects of physical activity on health status in older adults II: Intervention studies. Annual Review of Public Health 1992;13:469‐88.

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Busija L, Bridgett L, Williams S, Osborne R, Buchbinder R, March L, et al. Burden of musculoskeletal conditions: osteoarthritis. Best Practice & Research Clinical Rheumatology 2010;24:757‐69.

Cohen 1977

Cohen J. Statistical Power Analysis for the Behavioural Sciences. New York: Academic, 1977.

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Cooper C. Occupational activity and the risk of osteoarthritis. Journal of Rheumatology 1995;22:10‐2.

Davis 1991

Davis MA, Ettinger WH, Neuhaus JM, Mallon KP. Knee osteoarthritis and physical functioning: evidence from the NHANES 1 epidemiologic followup study. Journal of Rheumatology 1991;18:591‐8.

Deeks 2011

Deeks JJ, Higgins JPT, Altman DG. Chapter 9: Analysing data and undertaking meta‐analyses In: Higgins J, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2: The Cochrane Collaboration. www.cochrane‐handbook.org. The Cochrane Collaboration, March 2011.

Dekker 2013

Dekker J. Exercise and Physical Functioning in Osteoarthritis; Medical, Neuromuscular and Behavioral Perspectives. Berlin: Springer‐Verlag, 2013.

Felson 1995

Felson DT. Weight and osteoarthritis. Journal of Rheumatology 1995;22:7‐9.

Fiatarone 1993

Fiatarone MA, Evans WJ. The etiology and reversibility of muscle dysfunction in the aged. Journal of Gerontology 1993;48:77‐83.

Guccione 1994

Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang Y, Wilson PW, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham study. American Journal of Public Health 1994;84:351‐8.

Hochberg 2008

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Abbott 2013

Methods

Low risk of bias

Participants

Hip and knee OA recruitment

116 community volunteers with knee OA

Mean age 66 years, 55% female

ACR criteria

Interventions

Clinic, individual:

1. Manual therapy: 9 sessions × 50 minutes (over 16 weeks) plus home programme (3 × per week)

2. Exercise (aerobic plus strengthening plus neuromuscular control): 9 sessions × 50 minutes plus home programme (3 × per week)

3. Exercise plus manual therapy: 9 sessions × 50 minutes plus home programme (3 × per week)

4. Usual care alone

Outcomes

At 1 year:

Pain (WOMAC)

Physical function (WOMAC)

No quality of life measure

Notes

Compared only allocation 2 with allocation 4

Outcomes measured only at 1 year

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Online randomisation service, stratified for hip or knee OA

Allocation concealment (selection bias)

Low risk

Varied block size randomisation, randomisation service kept schedule

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded participants/therapists

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participant self‐reported pain and physical function

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded outcome assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Loss to follow‐up balanced between allocation groups, intention‐to‐treat analysis

Selective reporting (reporting bias)

Low risk

Registered trial

An 2008

Methods

Moderate to high risk of bias

Participants

28 community volunteers, ACR clinical criteria

Mean age 65 years, all female, mean BMI 25

Interventions

Clinic, classes:

1. Baduanjin (type of Qigong, less physically demanding than Tai Chi), low‐level aerobics and strength, 8 weeks, 5 × 30 minutes

2. No intervention

Outcomes

At 8 weeks:

1. Pain (WOMAC)

2. Physical function (WOMAC)

No quality of life scale

Notes

Poor comparability at baseline for WOMAC pain and physical function. Post‐treatment scores indicate non‐normal distribution, i.e. mean (SD) not appropriate

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Nothing other than 'patients were randomised'

Allocation concealment (selection bias)

Unclear risk

No information provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Not disclosed

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Not disclosed

Incomplete outcome data (attrition bias)
All outcomes

High risk

HIgh loss to follow‐up: 3 (21%) and 4 (29%). No ITT analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Baker 2001

Methods

Unblinded assessor
Intention‐to‐treat analysis
Nutrition education control

Participants

46 volunteers, knee OA
74% female
Mean age 69 years
ACR criteria

Interventions

1. Home muscle strengthening programme (+ 12 visits)
2. Control: 7 × home visits, nutrition education

Outcomes

At 16 weeks:
Pain (WOMAC)
Function (WOMAC)

No QoL

Notes

Very closely monitored intensive strengthening programme with 12 home visits over 16 weeks (ankle weights, squats, etc)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Generated by independent statistician

Allocation concealment (selection bias)

Low risk

Central allocation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participant

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Unblinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Bautch 1997

Methods

Moderate to high risk of bias
Unblinded assessor
Efficacy analysis
Education control

Participants

34 participants/volunteers, knee OA
Mean age 68 years
ACR criteria

Interventions

Individual programme

1. 12 weeks: providing 36 sessions ROM/walking and education classes
2. Control: 12 weekly education classes

Outcomes

At 12 weeks:
Pain (VAS × 2)
Function (AIMS)

No QoL

Notes

Allocation groups very incomparable base pain/BMI/x‐ray with active treatment allocation, demonstrating more severe disease
Low‐intensity walking

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No information

Allocation concealment (selection bias)

Unclear risk

No information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Unblinded assessor

Incomplete outcome data (attrition bias)
All outcomes

High risk

Efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Bennell 2005

Methods

Low risk of bias

Participants

140 community volunteers, knee OA ACR criteria, pain > 3/10
68% female, mean age 68 years

Interventions

Individual programme:

1. Taping, knee massage, thoracic mobs and hip muscle strengthening; 12 weeks, 8 sessions
2. Control: 8 × sham ultrasound

Outcomes

At 12 weeks and 24 weeks:
VAS pain
WOMAC function

QoL

Notes

Novel intervention with little attention to knee strengthening. Taping, knee massage, thoracic mobs and hip strengthening

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random numbers

Allocation concealment (selection bias)

Low risk

Central allocation

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Participants blinded (sham US control)

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

Low risk

Participants blinded

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Bennell 2010

Methods

Low risk of bias

Participants

89 community volunteers, mean age 65 years, mean BMI 28

ACR criteria, KL Grade II+, medial tibiofemoral compartment disease

50% female, 33% KL Grade IV

Interventions

Clinic, individual:

1. Muscle strengthening (targeting hip abductors and adductors), 7 sessions of 15‐30 minutes over 2 months plus home exercise programme with cuff weights/Theraband (5× per week)

2. Waiting list

Outcomes

At 12 weeks:

1. Pain (WOMAC 0‐20)

2. Physical function (WOMAC 0‐68)

No quality of life measure

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random numbers, permuted block 4‐6

Allocation concealment (selection bias)

Low risk

Independent investigator, sealed opaque envelopes, central location

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participant

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

SBalanced loss to follow‐up (13% vs 16%), ITT analysis

Selective reporting (reporting bias)

Low risk

Registered trial

Bezalel 2010

Methods

Moderate risk of bias

Participants

50 community volunteers 65 years of age and over

70% female, mean age 75 years

Interventions

Clinic, classes:

1. Education + exercises, 4 weeks 1 × 45 minutes clinic classes, home‐based exercise programme strengthening and stretches

2. Short‐wave diathermy 6 sessions 20 minutes

Outcomes

At 4 weeks and 8 weeks:

1. Pain (WOMAC 0‐20)

2. Physical function (WOMAC 0‐68)

No quality of life

Notes

Scores estimated from graphs

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random numbers

Allocation concealment (selection bias)

Unclear risk

Not stated

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

24% dropout each allocation, intention‐to‐treat analysis LOCF

Selective reporting (reporting bias)

Unclear risk

Not registered

Brismée 2007

Methods

Moderate risk of bias

Participants

41 community volunteers 50 years of age and older

ACR criteria

85% female, mean age 70 years, mean BMI 28

Interventions

Clinic, classes:

1. Tai Chi (simplified Yang style) 6 weeks 3 × 40 minutes followed by 6‐week home programme (videotape)

2. Education programme, 6 weeks 3 × 40 minutes

Outcomes

At 6 weeks and 12 weeks:

1. Pain (WOMAC 7‐35)

2. Physical function (WOMAC 17‐85)

No quality of life measurement

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation table stratified by age and sex

Allocation concealment (selection bias)

Unclear risk

Not stated

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Loss to follow‐up 9% intervention, 27% control; apparent intention‐to‐treat (data from all participants who did not drop out in the first week)

Selective reporting (reporting bias)

Unclear risk

Not registered

Bruce‐Brand 2012

Methods

Moderate to high risk of bias (efficacy analysis)

Participants

41 community volunteers 55‐75 years of age

KL Grade III+

Interventions

Individual, home‐based:

1. Resistance training lower limb, 6 weeks 2 × 30 minutes supervised plus 1 × 30 minutes unsupervised

2. Neuromuscular electrical stimulation (not included in meta‐analysis)

3. Standard care

Outcomes

At week 8 and week 14:

1. Pain (WOMAC 0‐20)

2. Physical function (WOMAC 0‐68)

3. SF‐36 MCS

Notes

Standard care included OA education, weight loss, pharmacological therapy and physical therapy (no reporting of participation in any of these interventions)

Assumed available to the intervention group

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated random numbers, stratified for age and gender

Allocation concealment (selection bias)

Unclear risk

Investigator with no clinical role in the study

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unlinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

High risk

High loss to follow‐up (29% and 54%), no intention‐to‐treat analysis

Selective reporting (reporting bias)

Low risk

Registered trial

Chang 2012

Methods

Moderate to high risk of bias

Participants

41 women, KL Grade II or III, knee flexion > 90 degrees

Mean age 67 years, mean BMI 25

Interventions

Clinic, individual:

1. General physiotherapy (SWD, hot packs, TENS, IFC, etc) plus muscle strengthening (Theraband), 8 weeks 2 × 60 minutes

2. General physiotherapy alone, 8 weeks 2 × 30 minutes

Outcomes

At 8 weeks:

1. Pain (WOMAC 0‐20)

2. Physical function (WOMAC 0‐68)

No quality of life

Notes

All participants 'prohibited' from using Chinese medicine/alternative therapies and non‐habitual exercise during the study

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomly assigned but no description of procedure provided

Allocation concealment (selection bias)

Unclear risk

No indication

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Participants blinded/therapist unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

Low risk

Participants blinded

Blinding of outcome assessment (detection bias) ‐ other outcomes

Unclear risk

Assessed by lead study author, not clear whether lead study author was also a therapist or was blinded

Incomplete outcome data (attrition bias)
All outcomes

High risk

High loss to follow‐up, unbalanced (20% and 44% controls), no ITT analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Deyle 2000

Methods

Moderate to high risk of bias
Blinded assessor
Efficacy analysis
Subtherapeutic US control

Participants

83 military care patients, knee OA
60% female
Mean age 61 years
ACR criteria

Interventions

Individual, clinic programme:

1. Manual therapy/strengthening exercises/aerobic exercise, 4 weeks 2 × 60 minutes
Control: ultrasound (subtherapeutic)

Outcomes

At 8 weeks (delayed):
Pain + Function (WOMAC)

No QoL

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers generator

Allocation concealment (selection bias)

Unclear risk

No information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants/personnel unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Particpants unblinded

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

High risk

Imbalance in missing data between allocation groups, efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Doi 2008

Methods

Moderate risk of bias

Participants

142 participants with symptomatic knee OA, 50 years of age and older, osteophytes on x‐ray

76% female, mean age 70 years, mean BMI 25

Interventions

Home‐based (1 visit for instruction, no monitoring):

1. Quadriceps exercises in sitting or supine, 4 sets of 20 reps (knee extension in sitting) daily. Sandbags for weight, but almost all used just body weight.

2. NSAIDs 3× daily until 'no longer required'

Outcomes

At 8 weeks:

1. Pain (VAS 0‐100)

2. Physical function (total WOMAC score)

No quality of life. 1 undefined score reported for SF‐36 (PCS? MCS? One of the 8 domains?)

Notes

Both allocations could use analgesic patches

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated randomisation

Allocation concealment (selection bias)

Low risk

Performed by off‐site administrative office in Department of Public Health

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Participants unblinded

Blinding of outcome assessment (detection bias) ‐ other outcomes

Unclear risk

Unclear

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

13%‐17% loss to follow‐up at 8 weeks, no intention‐to‐treat

Selective reporting (reporting bias)

Low risk

Registered with Japanese Orthopaedic Association

Ettinger 1997a/b

Methods

Low risk of bias
Blinded assessor
Intention‐to‐treat
Education control

Participants

293 volunteers, knee OA
69% female
Mean age 69 years
ACR criteria

Interventions

Class‐based programme

Ettinger a: aerobic walking, 12 weeks 3 × 1 hour

Ettinger b: strengthening upper and lower limbs, 12 weeks 3 × 1 hour
Control: 3× monthly education classes, then monthly telephone calls

Outcomes

Mean score at 3, 9, 18 months:
Pain (FAST × 6)
Function (FAST × 23)

No quality of life

Notes

Large classes (10‐15 participants)
After cessation of classes, high level of regular telephone monitoring (monthly in past 9 months)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated

Allocation concealment (selection bias)

Low risk

Web‐based, central

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Particpants/personnel unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Participants unblinded

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Intention‐to‐treat analysis, missing data balanced between allocation groups

Selective reporting (reporting bias)

Unclear risk

Not registered

Foley 2003

Methods

Low risk of bias

Participants

*Hip and knee OA
70 patients, most from the clinic
Mean age 70 years
Radiographic criteria

Interventions

Class‐based programme (6 weeks); 18 sessions of muscle strengthening, range of motion
Control: waiting list, fortnightly telephone call

Outcomes

At 6 weeks:
WOMAC pain
WOMAC function

SF‐12 MCS

Notes

Separate analysis per knee OA only or hip OA, gym‐based group versus controls
About 40% on orthopaedic waiting list

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated

Allocation concealment (selection bias)

Low risk

Central allocation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants/personnel unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Participants unblinded

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Small numbers lost to follow‐up, balanced between allocation groups, intention‐to‐treat

Selective reporting (reporting bias)

Unclear risk

Not registered

Foroughi 2011

Methods

Moderate to high risk of bias

Participants

54 women 40 years of age and older, OA confirmed by MRI

Mean age 66 years, mean BMI 32

Interventions

Clinic, classes:

1. Progressive resistance training lower limb muscles using pneumatic Keiser machines, progressive to 80% 1RM (15‐18 Borg scale), 3 sets of 8 reps, 24 weeks 3 × 60 minutes

2, Sham exercise: as above, but minimal resistance and no progression, only 2 sets of 8 reps, no hip abduction/adduction, 24 weeks 3 × 60 minutes

Outcomes

At 6 months:

1. Pain (WOMAC 0‐20)

2. Physical function (WOMAC 0‐68)

No quality of life assessment

Notes

Exercise and sham exercise group trained together at same location

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated randomisation stratified for glucosamine/chondroitin use and WOMAC physical function subscale score

Allocation concealment (selection bias)

Low risk

Conducted by co‐investigator not involved in testing

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Most participants blinded/exercise physiologist supervising treatment unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

Low risk

Participants blinded

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Unblinded

Incomplete outcome data (attrition bias)
All outcomes

High risk

Loss to follow‐up: exercise (23%), sham exercise (11%), no intention‐to‐treat analysis

Selective reporting (reporting bias)

Low risk

Registered study

Fransen 2001

Methods

Low risk of bias

Participants

126 participants, knee OA, ACR criteria
70% female, mean age 66 years

Interventions

Individual or class‐based allocation (8 weeks), 16 sessions with muscle strengthening and aerobic components
Control: waiting list

Outcomes

At 8 weeks:
WOMAC pain
WOMAC function

SF‐36 MCS

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Low risk

Sealed opaque envelopes, sequentially numbered

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants/personnel unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Participants unblinded

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Fransen 2007

Methods

Low risk of bias

Participants

*Hip and knee OA, ACR criteria
97 community volunteers, 75% female, mean age 70 years

Interventions

Class‐based programme:

1. Tai Chi classes, modified style for OA: 12 weeks 2 × 60 minutes
2. Waiting list control

Outcomes

At 12 weeks:
1. WOMAC pain
2. WOMAC function

3. SF‐12 MCS

Notes

Disaggregated analysis (hip or knee OA) according to identified signal (most painful) joint

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Low risk

Central allocation by administrator

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants/personnel unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Intention‐to‐treat analysis

Selective reporting (reporting bias)

Low risk

Trial registered NCT00123994

Gur 2002

Methods

Moderate to high risk of bias

Participants

23 volunteers, knee OA
Gender?, mean age 56 years
Radiographic, bilateral KL Grade II‐III
Sedentary past 10 years, cardiovascular clearance

Interventions

Individual programme (8 weeks), 24 sessions of strengthening extensors/flexors (Cybex)
Control: no treatment, but 2 additional testing sessions during 8‐week period

Outcomes

At 8 weeks:
Pain (VAS: 7 items)
Fx (VAS: 5 items)

Notes

No medications allowed. Young sample
High intensity, maximal effort

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No information

Allocation concealment (selection bias)

Unclear risk

No information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants/personnel unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Participants unblinded

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Assessor unblinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No dropouts

Selective reporting (reporting bias)

Unclear risk

Not registered

Hay 2006

Methods

Moderate risk of bias

Participants

217 participants referred from general practice presenting with persistent knee pain and 55 years of age and older

Interventions

Exercise advice and access to 3‐6 sessions with physiotherapist over a 10‐week period

Control: advice/education leaflets with 1 follow‐up telephone call

Outcomes

At 3 months and 6 months:

1. WOMAC pain

2. WOMAC physical function

3. Hospital Anxiety and Depression Scale

Notes

Proportion with knee OA unknown

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers generator

Allocation concealment (selection bias)

Unclear risk

Small blocks of 6 per practice

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded particpants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Loss to follow‐up minimal and balanced, intention‐to‐treat analysis

Selective reporting (reporting bias)

Low risk

Registered trial

Hopman‐Rock 2000

Methods

Moderate to high risk of bias

Participants

*Hip and knee
91 volunteers with OA knee, 80% female, mean age 65 years

Interventions

Class, clinic:

1. Education + exercise, 6 weeks 1 × 60 minutes

2. Waiting list control

Outcomes

At 6 weeks:
1. VAS pain (2)
2. IRGL mobility

No quality of life measure

Notes

Only 6 treatment occasions
Separate analysis for OA knee provided

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No details

Allocation concealment (selection bias)

Unclear risk

No details

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

High risk

Efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Huang 2003

Methods

Moderate to high risk of bias

Participants

132 participants, bilateral knee OA

Interventions

Individual clinic:

1. Muscle strengthening (KinCom) extensor/flexor + hotpack/ROM, 8 weeks 3 × 60 minutes
2. Control: hotpack/ROM

Outcomes

At 8 weeks, 1 year:
1. VAS pain
2. Lequesne function

No quality of life measure

Notes

Combined the 3 muscle strengthening groups for meta‐analysis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Sequential numbers I‐IV (representing treatment allocation)

Allocation concealment (selection bias)

Unclear risk

No information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Unclear risk

Uncertain

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

8% loss to follow‐up, efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Huang 2005

Methods

Moderate to high risk of bias

Participants

70 participants, bilateral moderate knee OA
Lequesne score < 7, mean age 65 years, 80% female

Interventions

Individual, clinic:

1. Muscle strengthening (KinCom) + hotpack/ROM, 8 weeks 3 × 60 minutes
2. Control: hotpack/ROM

Outcomes

At 8 weeks, 1 year:
VAS pain
Lequesne fx

No quality of life measure

Notes

Analysed group 1 (exercise only) vs group 4 (control), allocation groups 2 and 3 received US and IA hyaluronan

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Sequential numbers I‐IV (representing treatment allocation)

Allocation concealment (selection bias)

Unclear risk

No information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded particpants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

9% loss to follow‐up, efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Hughes 2004

Methods

Moderate to high risk of bias

Participants

*Hip and knee (combined)
150 community volunteers, ACR criteria, mean age 74 years, 83% female

Interventions

Class, clinic:

1. Muscle strengthening plus aerobic walking (1 hour) plus education/discussion (30 minutes), 8 weeks 3 × 1.5 hours

2. Control: arthritis help book and list of available community exercise programmes

Outcomes

8 weeks, 6 months
WOMAC pain
WOMAC function

No quality of life measure

Notes

Large loss to follow‐up at 2 months in controls (40%)
Only simple exercise equipment used. Proportion of participants with knee vs hip OA unknown

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded particpants

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Unblinded assessors

Incomplete outcome data (attrition bias)
All outcomes

High risk

Imbalance in missing data, efficacy analysis, 40% loss to follow‐up

Selective reporting (reporting bias)

Unclear risk

Not registered

Hurley 2007

Methods

Moderate risk of bias

Participants

418 participants > 50 years of age who consulted a primary care physician for knee pain of > 6 months' duration

70% female, mean age 67 years, mean BMI 30

Interventions

Clinic, individual or classes (results combined):

1. Strengthening, balance, aerobic and motor control exercises, 6 weeks 2 × 45 minutes

2. Usual primary care (most given analgesics, very few participants referred for other interventions)

Outcomes

At 6 weeks and 6 months:

1. Pain (WOMAC 0‐20): only 6 months

2. Physical function (WOMAC 0‐68)

3. Quality of life (EQ5D 0‐1): only 6 months

Notes

Combined results of 2 exercise‐based interventions: individual and class‐based for all meta‐analyses apart from sensitivity analysis according to delivery mode (individual, class, home) for immediate post‐treatment physical function

WOMAC physical function was declared main outcome, with results provided for 6 weeks and 6 months

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Cluster randomisation: 54 primary care practices were randomly assigned, not participants. Randomisation list was generated by a study co‐author at an external location

Allocation concealment (selection bias)

Low risk

Randomisation list was generated by a study co‐author not involved in execution of the study

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded particpants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

18% lost to follow‐up, balanced between allocation groups, no intention‐to‐treat but effect of withdrawal was assessed

Selective reporting (reporting bias)

Low risk

Registered study

Jan 2008

Methods

Moderate to high risk of bias

Participants

102 participants, bilateral knee pain > 6 months, ACR criteria, KL Grade < IV

80% female, mean age 62 years, mean weight 62 kg

Interventions

Clinic, individual:

1. High resistance training (knee extensors and flexors), 60% 1RM, 3 × 8 reps, 8 weeks 3 × 30 minutes; 10 minutes cycling warmup, 10 minutes cold pack knee post session

2. Low resistance training (knee extensors and flexors), 10% 1RM, 10 × 15 reps, 8 weeks 3 × 50 minutes; 10 minutes cycling warmup, 10 minutes cold pack knee post session

3. Health education

Outcomes

At 8 weeks:

1. Pain (WOMAC 0‐20)

2. Physical function (WOMAC 0‐68)

No quality of life assessment

Notes

Participants did not take NSAIDs during study

Results for high resistance training and low resistance training identical, so combined in meta‐analysis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random integer generator used

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

High risk

Unbalanced loss to follow‐up: 4 (13%) in control group, 0 in exercise group, no intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Jan 2009

Methods

Low risk of bias

Participants

106 participants 50 years of age and older (not stated whether clinic or community‐based recruitment)

ACR criteria, KL Grade < IV (most KL II)

Bilateral knee pain > 6 months

70% female, mean age 62 years, mean weight 63 kg (BMI around 25 calculated)

Interventions

Clinic, individual:

1. Progressive weight bearing quadriceps strengthening (sitting, using EN‐Dynamic resistance device), 4 × 6 reps commencing at 50% RM, increasing to 70% RM, 8 weeks 3 × 30 minutes

2. Progressive non‐weight bearing quadriceps strengthening (sitting, using EN‐Tree resistance device), 4 × 6reps commencing at 50% RM, increasing to 70% RM, 8 weeks 3 × 30 minutes

3. No intervention control

Outcomes

At 8 weeks:

1. No pain assessment

2. Physical function (WOMAC 0‐68)

No quality of life assessment

Notes

Mean of physical function score taken for the 2 quadriceps strengthening allocations in the meta‐analysis, as no significant difference in physical function at 8 weeks

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

States random number tables

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No loss to follow‐up (5 discontinued treatment in the 2 exercise allocations)

Selective reporting (reporting bias)

Unclear risk

NCT 9100002377 not found

Jenkinson 2009

Methods

Low risk of bias

Participants

389 participants from 5 GP practices in Nottingham, 45 years of age and older

BMI > 28, knee pain on most days past month

66% female, mean age 61 years, mean BMI 34, 47% KL Grade II+

Interventions

Most at home, unmonitored (exercise/control)

1. Diet and exercise

2. Diet

3. Exercise: unsupervised home programme, predominantly strengthening with functional exercises introduced after 2 months and aerobic exercises (walking/stepping up) introduced after 6 months. 2 exercises/d, reps 5 (up to 20) daily for 24 months. Visited every 4 months by a dietitician and received a support telephone call between visits, but the calls were NOT used to reinforce the exercise programme

4. Control: education leaflet (but no information about weight loss or exercise)

Outcomes

At 24 months (delayed):

1. Pain (WOMAC 0‐20)

2, Physical function (WOMAC 0‐68), not estimable as no data for control group

No quality of life measure

Notes

Meta‐analysis included data from only 2 allocation groups: Exercise and Control

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer random sequence generator, 2 × 2 factorial design, blocks of 10 stratified by sex, age and BMI

Allocation concealment (selection bias)

Low risk

Prepared by trial researcher, kept in locked drawer, opened by co‐ordinator in sequential order

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded particpants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor (mailed questionnaires)

Incomplete outcome data (attrition bias)
All outcomes

Low risk

High loss to follow‐up at 24 months (26% exercise, 14% control), but intention‐to‐treat analysis using multiple imputation methods

Selective reporting (reporting bias)

Unclear risk

Study registered, but outcome measures not provided at time of registration. No justification for why only selected domains of SF‐36 (physical function, bodily pain)?

Kao 2012

Methods

Moderate to high risk of bias

Participants

259 community volunteers 50 years of age and older, morning stiffness < 30 minutes or crepitus, osteophytes on x‐ray

75% female (81% intervention group, 71% control group), mean age 68 years

Interventions

Clinic, classes:

1. Classes 10‐15 participants, education/discussion plus exercise. Stretching and strengthening 'whole body muscles, especially lower limbs,' 4 weeks 1 × 20 minutes

2. Control, no intervention

Outcomes

At 4 and 8 weeks:

1. No pain (only SF‐36 bodily pain)

2. Physical function (T‐WOMAC 0‐170)

3. Quality of life: SF‐36 MCS

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Cluster randomisation of 4 districts: 2 to intervention, 2 to control

Allocation concealment (selection bias)

Unclear risk

District allocation would have been known at time of participant screening/recruitment?

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Unclear risk

Not reported

Incomplete outcome data (attrition bias)
All outcomes

High risk

Unbalanced loss to follow‐up: 15% intervention, 27% controls. No intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Study not registered

Keefe 2004

Methods

Moderate to high risk of bias

Participants

34 volunteers and participants. Married
Persistent knee pain, mean age 59 years, 50% female

Interventions

Class, clinic:

1. 36 aerobic sessions, 24 strengthening sessions, 12 weeks 3 × 1 hour

2. Standard care

Outcomes

At 12 weeks:
Pain: AIMS pain subscales

QoL: AIMS psychological

Notes

Analysed group 3 (exercise only) vs standard care (no spouse intervention groups)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Only 'randomly allocated'

Allocation concealment (selection bias)

Unclear risk

No information provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded particpants

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Unblinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Only 6% loss to follow‐up, balanced between allocations. Efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Kovar 1992

Methods

Moderate to high risk of bias

Participants

103 participants, knee OA, 84% female, mean age 69 years
Pain and +x‐ray

Interventions

Class‐based, clinic:

1. Fitness walking/stretch/education, 8 weeks 3 × 60 minutes

2. Control: weekly telephone call regarding ADL function

Outcomes

At 8 weeks:
Pain (AIMS)
Function (AIMS)

No quality of life measure

Notes

Large classes (20‐30 participants)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Unclear risk

No information provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Unblinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Missing data balanced between allocation groups, efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Lee 2009

Methods

Low risk of bias

Participants

Participants and community volunteers, KL Grade II+, assessed at least 6 months before study entry, 50‐80 years of age

93% female, mean age 69 years, mean BMI 26, most KL Grade II‐III

Interventions

Clinic, classes:

1. Tai Chi Qigong (18 movements). Movements of mixed nature (motor control, ROM). Movements involved gentle body stretches, 8 weeks 2 × 45 minutes

2. No intervention control

Outcomes

At 8 weeks:

1. Pain (WOMAC 0‐35)

2. Physical function (WOMAC 0‐85)

3. Quality of life (SF‐36 MCS)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated balanced block randomisation (2:1)

Allocation concealment (selection bias)

Low risk

Sealed envelopes with identification number. Opened in order

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblilnded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Loss to follow‐up low (n = 3), included in analysis

Selective reporting (reporting bias)

Unclear risk

Study not registered

Lim 2008

Methods

Low risk of bias

Participants

107 community volunteers, tibiofemoral knee OA, ACR criteria, medial knee pain, medial compartment osteophytes and medial joint space narrowing > lateral joint space narrowing. < 5 degrees valgus malalignment on x‐ray

55% female, mean age 66 years, mean BMI 29

Interventions

Most in home programme:

1. Quadriceps strengthening in varus knee alignment group, 2 × 10 reps (weeks 1‐2), 3 × 10 reps (weeks 3‐12), 5 days a week. Exercise loads progressed frequently, monitored by 7 home visits by physiotherapist

2. Quadriceps strengthening exercise in neutral knee alignment group, as above

3. No intervention control varus knee alignment group

4. No intervention control neutral knee alignment group

Outcomes

At week 13:

1. Pain (WOMAC 0‐100)

2. Physical function (WOMAC 0‐100)

No quality of life measure

Notes

Average results for exercise allocations (1,2) vs average results for control allocations (3,4) used in meta‐analysis. Study did demonstrate clearly that effects of quadriceps strengthening greater in neutral alignment group

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table used, stratified by alignment in blocks of 6

Allocation concealment (selection bias)

Low risk

Independent researcher randomly assigned participants

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Loss to follow‐up 4%‐18%, but intention‐to‐treat analysis using last observation carried forward

Selective reporting (reporting bias)

Low risk

Registered study

Lin 2009

Methods

Low risk of bias

Participants

108 participants 50 years of age and older, KL Grade < IV, history of knee pain > 6 months

70% female, mean age 62 years, mean weight 62 kg

Interventions

Clinic, individual:

1. Proprioception exercises, stepping in multiple directions at various speeds, ROM exercises, 8 weeks 3 × 50 minutes

2. Quadriceps strengthening, 50% 1RM 4 × 6 reps. 1RM tested every 2 weeks and a 5% increase in 1RM implemented to training weight, 8 weeks 3 × 50 minutes

3. No intervention control

Outcomes

At 8 weeks:

1. Pain (WOMAC 0‐20)

2. Physical function (WOMAC 0‐68)

No quality of life measure

Notes

Only allocations 2 and 3 included in meta‐analysis

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Low risk

Sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

6%‐8% loss to follow‐up, intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Study not registered

Lund 2008

Methods

Low risk of bias

Participants

79 community volunteers, ACR criteria

75% female, mean age 69 years, mean weight 68‐77 kg

Interventions

Clinic, classes:

1. Aquatic exercise

2. Land‐based exercise, mixed strengthening, endurance, balance, stretching, 8 weeks 2 × 50 minutes

3. No intervention control

Outcomes

At 8 weeks and 20 weeks:

1. Pain (KOOS, 100‐0)

2. Physical function (KOOS ADL, 100‐0)

3. Quality of life (KOOS QoL, 100‐0)

Notes

Needed to reverse score KOOS pain and physical function outcomes (KOOS lower score is worse score) and to calculate SD from provided SE

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Envelope method with blocks of 18

Allocation concealment (selection bias)

Low risk

Envelope method, so screener unaware which will be chosen

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

7%‐20% loss to follow‐up at 20 weeks; however intention‐to‐treat analysis using LOCF

Selective reporting (reporting bias)

Unclear risk

Study not registered

Maurer 1999

Methods

Moderate risk of bias

Participants

113 participants, knee OA, ACR criteria
42% female, mean age 64 years

Interventions

Individual, clinic:

1. Unilateral quadriceps strengthening only, 8 weeks 3 × 30 minutes

2. 4 education classes

Outcomes

At 8 weeks:
Pain (WOMAC)
Function (WOMAC)

No quality of life measure

Notes

Only unilateral exercise but many(?) with bilateral symptoms

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers generator

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Missing data balanced between groups, not study‐related, efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Messier 2004

Methods

Low risk of bias

Participants

158 obese community volunteers
70% female, mean age 69 years

Interventions

Class, clinic (4 months + optional additional 2 months clinic or home)

Four allocations:

1. Exercise

2. Exercise + diet

3. Diet

4. Control

Exercise: strengthening and aerobic walking (4 months), then telephone monitored home programme (with weights)
Control: healthy lifestyle: 3‐monthly education meetings re weight loss and exercise with follow‐up telephone monitoring (about 8 calls)

Outcomes

At 6 and 18 months (delayed):
1. WOMAC pain
2. WOMAC function

No quality of life measure

Notes

Analysis of exercise only vs healthy lifestyle control group
Physical function assessed at 18 months, SD of baseline used. Very obese sample

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated

Allocation concealment (selection bias)

Low risk

Web‐based

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Mikesky 2006

Methods

Moderate to high risk of bias

Participants

37 community volunteers in OA/pain strata
60% female
Mean age 69 years
Pain and +x‐ray

Interventions

Clinic (0‐12 months), then home programme thereafter (12‐30 months):
1. Lower and upper limb strengthening (KinCom) 0‐12 months, 45 clinic sessions: 12‐30 months, home programme strengthening (Theraband)

2. ROM control

Outcomes

30 months (delayed):
1. WOMAC pain
2. WOMAC function

3. SF‐36 MCS

Notes

Analysis only of participants with knee OA/pain. Twice‐weekly clinic‐based classes in the first 12 weeks

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No information apart from 'randomized'

Allocation concealment (selection bias)

Unclear risk

No information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

21% loss to follow‐up at 30 months but intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Minor 1989

Methods

Moderate to high risk of bias

Participants

80 participants/volunteers, knee OA, 80% female, mean age 64 years
Pain and +x‐ray

Interventions

Class, clinic:

1. Aerobic walking, 12 weeks 3 × 1 hour
2. Control: ROM/relaxation, 12 weeks 3 × 1 hour

Outcomes

At 12 weeks and 1 year:
Pain (AIMS)

QoL (AIMS depression)

Notes

Large classes (max 12 participants)
Aim of treatment was to increase aerobic capacity without exacerbating symptoms

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No information provided

Allocation concealment (selection bias)

Unclear risk

No information provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Unclear risk

Uncertain blinding assessors

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Efficacy analysis, 7% loss to follow‐up

Selective reporting (reporting bias)

Unclear risk

Not registered

O'Reilly 1999

Methods

Moderate to high risk of bias

Participants

180 volunteers, knee OA, 66% female, mean age 62 years
Knee pain past week

Interventions

Home programme:

1. Lower limb strengthening (4 home visits to monitor) + lifestyle advice

2. Lifestyle advice only

Outcomes

At 6 months (delayed):
1, Pain (WOMAC)
2. Function (WOMAC)

3. Quality of life (HADS depression)

Notes

Community sample, most with mild radiographic/symptomatic disease (only 41% > KL Grade I)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Unclear risk

Not reported whether sealed envelopes were opaque with sequential numbers for audit trail

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded partcipants

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Unblinded assessors

Incomplete outcome data (attrition bias)
All outcomes

Low risk

6% loss to follow‐up, intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Peloquin 1999

Methods

Moderate to high risk of bias

Participants

137 volunteers, knee OA, 70% female, mean age 66 years
+x‐ray (< Grade IV)

Interventions

Class‐based, clinic:

1. Aerobic and strengthening/stretching exercise, 12 weeks 3 × 1 hour
2. Control: 12× education classes

Outcomes

At 12 weeks:
Pain (AIMS)
Function (AIMS)

No quality of life measure

Notes

Excluded people with severe disease:
> 10 degrees varum, KL Grade IV, > 15 degrees of flexion deformity

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Unclear risk

No information provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

High risk

Imbalance in missing data between allocation groups, efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Quilty 2003

Methods

Low risk of bias

Participants

87 community volunteers with patellofemoral pain
Mean age 67 years

Interventions

1. 9 physiotherapy sessions over 10 weeks

2. Standard care

Outcomes

At 5 and 12 months:
VAS pain
WOMAC function

No quality of life measure

Notes

Zelen randomisation
Treatment directed at patellofemoral joint

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated

Allocation concealment (selection bias)

Low risk

Sealed opaque envelopes, sequentially numbered for audit trail

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Unblinded to intervention, but Zelen randomisation resulted in blinded control group

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

Low risk

Blinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Rogind 1998

Methods

Moderate to high risk of bias

Participants

25 participants, knee OA ACR criteria and +x‐ray (> KL Grade II)
92% female, mean age 72 years

Interventions

Class‐based programme:

1. Complex mix of exercises, 12 weeks 2 × 1 hour
2. Control: no intervention

Outcomes

At 12 weeks and 1 year:
Pain (VAS × 3)
Function (AFI × 10)

No quality of life measure

Notes

Moderate to severe disease. Only median (IQR) provided. Baseline differences in pain scores
Very complex exercise programme (including venous, truncal muscles, balance)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Unclear risk

No information provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Missing data minimal and balanced between allocation groups, efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Salacinski 2012

Methods

Moderate to high risk of bias

Participants

37 participants/community volunteers, KL Grades I‐III

> 90 degrees knee flexion and exclude patellofemoral pain precluding stationary cycling

77%‐60% female, mean age 53‐61 years, mean BMI 22‐27, experimental/control

Interventions

Clinic, classes:

1. Aerobic cycling (modified 'spinning,' 70% maximum heart rate) 12 weeks 2 × 60 minutes

2. Wait list control

Outcomes

At 12 weeks:

Pain (WOMAC): reverse score

Physical function (WOMAC): reverse score

KOOS QoL

Notes

Baseline incomparability between groups for BMI and age

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Preset randomisation scheme with computer assignment

Allocation concealment (selection bias)

Unclear risk

No information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Unblinded assessor

Incomplete outcome data (attrition bias)
All outcomes

High risk

17% (control)‐32%(intervention) lost to follow‐up and not included in analysis

Selective reporting (reporting bias)

Low risk

Registered

Salli 2010

Methods

Moderate to high risk of bias

Participants

75 community volunteers 45‐65 years of age, leading sedentary life

ACR criteria, KL Grade I or II, mean age 57 years, 83% female, mean BMI 32

Interventions

Clinic, individual:

1. Concentric‐eccentric exercise programme (8 weeks 3 × 60 minutes individual, used isokinetic dynamometer) + PRN paracetamol to max 2 grams per day

2. Isometric exercise programme (8 weeks 3 × 60 minutes individual, used isokinetic dynamometer) + PRN paracetamol to max 2 grams per day

3. Control (PRN paracetamol to max 2 grams per day)

Outcomes

At week 8 and week 20:

Pain (VAS motion)

Physical function (WOMAC)

No quality of life

Notes

Early radiographic disease, SF‐36 MCS scores appear extremely high (70.1)

Participants assigned to concentric‐eccentric experienced a short period of difficulty in adaptation, but no later adverse effects were observed

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No information provided, major differences between allocation groups in physical function/SF‐36 MCS at baseline

Allocation concealment (selection bias)

Unclear risk

No information provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Only 4/75 lost fo follow‐up (5%), balanced between allocation groups

Selective reporting (reporting bias)

Unclear risk

Not registered

Schilke 1996

Methods

Moderate to high risk of bias

Participants

20 participants, knee OA, 85% female, mean age 66 years
Rheumatology clinic attendees

Interventions

Individual, clinic:

1. Strengthening bilateral knee extensors and flexors, 8 weeks 3 × 1 hour

2. No intervention control

Outcomes

At 8 weeks:
Pain (OASI)
Function (OASI)

No quality of life measure

Notes

All training on Cybex
Intensive, maximal effort

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Unclear risk

Not reported

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Unclear risk

Uncertain

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No missing data

Selective reporting (reporting bias)

Unclear risk

Not registered

Simao 2012

Methods

Moderate risk of bias

Participants

35 participants, ACR criteria, KL Grade II+

90% female, mean age 70 years, mean BMI 27‐30

Interventions

Clinic classes:

1. Squat exercises on a vibratory platform

2. Cycle (70% maximum heart rate) and squatting exercises (progressive 20 × 6 reps), 12 weeks 3 × 30 minutes

3. Telephone calls to confirm adherence to routine activities, i.e. not starting exercise programme (control)

Outcomes

At 12 weeks (median, IQR provided):

1. Pain (WOMAC 0‐500)

2. Physical function (WOMAC 0‐1700)

No QoL

Notes

The 2 allocation groups were incomparable at baseline for BMI (27 vs 30) WOMAC pain and function

Large proportion same KL 4 (27%‐40%)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No procedure described

Allocation concealment (selection bias)

Low risk

Serial numbered opaque envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Only 1 participant in each allocation lost to follow‐up at 12 weeks

Selective reporting (reporting bias)

Low risk

Registered

Song 2003

Methods

Moderate risk of bias

Participants

72 sedentary female participants, knee OA (confirmed by email), clinical and radiographic criteria
Mean age 65 years

Interventions

Class‐based programme, clinic:

1. Tai Chi classes, 16 1‐hour sessions

2. Control: weekly telephone call

Outcomes

At 12 weeks:
Pain and function: Korean WOMAC

No quality of life measure

Notes

About 40% dropout

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Low risk

Central allocation

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

High risk

43% missing data, efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Talbot 2003

Methods

Moderate to high risk of bias

Participants

34 participants, knee OA, ACR criteria
Mean age 70 years, 78% female

Interventions

Home programme:

1. 12 ASMP classes plus home‐based pedometer walking programme
2. Control: 12 weekly ASMP classes

Outcomes

At 12 week and 24 weeks:
Pain (McGill Pain Questionnaire)

No physical function measure

No quality of life measure

Notes

Evaluating the addition of a home‐based pedometer monitored walking programme to the Arthritis Self‐Management Programme (ASMP)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Unclear risk

No information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

High risk

Unblinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Minimal missing data, balanced between allocation groups, efficacy analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Thomas 2002

Methods

Low risk of bias

Participants

786 participants, knee pain
65% female, mean age 62 years

Interventions

Home programme:

1. Daily muscle strength training, bilateral, with Theraband plus 4 home visits during first 2 months, then 1 visit per 6 months (8, 14, 20 months?)
2. Control: short (2‐minute) monthly telephone call

Outcomes

At 24 months (delayed):
Pain (WOMAC)
Function (WOMAC)

No quality of life measure

Notes

Participants with knee pain, all may not be OA

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated

Allocation concealment (selection bias)

Low risk

Central administration, sequential list audit trail

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Thorstensson 2005

Methods

Low risk of bias

Participants

65 participants (identified by radiologists/orthopaedic surgeons) with radiographic knee OA (KL Grade III or higher) and long‐standing knee pain

Between 35 and 65 years of age

Interventions

Clinic‐based classes:

1. Intensive muscle strengthening programme, 6 weeks 2 × 1 hour

2. Control: waiting list for 6 months

Outcomes

At 6 weeks and 6 months:

1. KOOS pain

2. KOOS ADL

3. SF‐36 MCS

Notes

Younger sample and more severe radiographic disease than most RCTs evaluating exercise for OA

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

No sequence generation, sealed envelopes produced before randomisation

Allocation concealment (selection bias)

Low risk

Participants selected sealed envelope

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Unclear risk

Uncertain

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Only 7%‐10% loss to follow‐up, no intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Topp 2002

Methods

Moderate to high risk of bias

Participants

102 volunteers, ACR clinical criteria
74% female, mean age 63 years

Interventions

Class‐based, clinic:

1. Muscle strengthening (dynamic or isometric) with Theraband, 15 weeks 1 × 1 hour (clinic), home 16 weeks 2 × 1 hour

2. Control: no intervention

Outcomes

At 16 weeks:
Pain (WOMAC)
Function (WOMAC)

No quality of life measure

Notes

Clinic‐based classes 1× per week
Home programme 2× per week

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No information

Allocation concealment (selection bias)

Unclear risk

No information

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Unclear risk

Uncertain

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

No information

Selective reporting (reporting bias)

Unclear risk

Not registered

van Baar 1998

Methods

Low risk of bias

Participants

113 participants, knee OA, ACR criteria
79% female, mean age 68 years

Interventions

Individual, clinic:

1. Physiotherapy + GP education, 12 weeks, 17 sessions total

2. GP education

Outcomes

At 12 weeks:
Pain (VAS × 1)
Function IRGL

No quality of life measure

Notes

Recruited participants with hip and knee OA. Separate results provided for knee OA. Most with early disease, as approximately 50% of sample had symptom duration < 1 year

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random numbers table

Allocation concealment (selection bias)

Low risk

Sealed opaque envelopes, sequential numbering for audit trail

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Wang 2011

Methods

Low risk of bias

Participants

84 community volunteers, 55 years of age and older

Physician diagnosis of OA

Not currently exercising > 60 minutes per week, past 2 months

Interventions

Clinic, classes:

1. Land‐based exercise, PACE programme (flexibility and aerobic), 12 weeks 3 × 60 minutes

2. Aquatic exercise programme

3. Control (no intervention)

Outcomes

At 12 weeks:

1. KOOS pain (0‐100), reverse scored

2. KOOS ADL (0‐100), reverse scored

3. KOOS quality of life (0‐100)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated

Allocation concealment (selection bias)

Low risk

External, researcher not recruiting participants

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Low risk

Blinded assessor

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Only 7% loss to follow‐up, 2/28 in each allocation, no intention‐to‐treat analysis

Selective reporting (reporting bias)

Unclear risk

Not registered

Yip 2007

Methods

Moderate to high risk of bias

Participants

182 participants 50 years of age and older, ACR clinical criteria

Mean age 65 years, 84% female

Interventions

Clinic, classes:

1. ASMP + stretching/walking/Tai Chi (8 movements), 6 weeks 1 × 120 minutes (15 minutes for exercise)

2. No intervention

Outcomes

At week 7 and week 23:

1. Current pain (0‐100)

No physical function (HAQ score inappropriate: most upper limb function; scores inaccurate: outside 0‐3 range)

No quality of life

Notes

Large loss to follow‐up due to SARS (Hong Kong): discouraged from attending hospital clinics

Health Assessment Questionnaire for rheumatoid arthritis developed (not specific to lower limb disability)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random number table

Allocation concealment (selection bias)

Unclear risk

No information provided

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Unblinded

Blinding of outcome assessment (detection bias) ‐ subjective self‐reported outcomes (pain, function, quality of life)

High risk

Unblinded participants

Blinding of outcome assessment (detection bias) ‐ other outcomes

Unclear risk

No indication that outcomes assessors blinded

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

High loss to follow‐up post treatment due to SARS: 25% control, 10% intervention; 16 weeks: 44% control, 24% intervention. ITT analysis conducted but method not clarified

Selective reporting (reporting bias)

Unclear risk

Not registered

1RM: One‐repetition maximum.
ACR: American College of Rheumatology.
ADL: Activity of daily living.
AFI: Arthritis Function Index.
AIMS: Arthritis Impact Measurement Scales.
ASMP: Arthritis Self‐Management Programme.
BMI: Body mass index.
EQ5D: Standardised measure of health outcome.
FAST: Fitness Arthritis and Seniors Trial.
GP: General practitioner.
HADS: Hospital Anxiety Depression Scale.
IFC: International Functional Classification.
IQR: Interquartile range.
IRGL: Influence of Rheumatic Disease on Health and Lifestyle scale.
ITT: Intention‐to‐treat.
KL: Kellgren and Lawrence.
KOOS: Knee Osteoarthritis Outcome Scale.
LOCF: Last observation carried forward.
MCS: Mental Component Summary.
MRI: Magnetic resonance imaging.
NSAIDs: Non‐steroidal anti‐inflammatory drugs.
OA: Osteoarthritis.
OASI: Osteoarthritis Screening Index.
PACE: Patient‐centered Assessment and Counseling for Exercise.
PCS: Physical Component Summary.
QoL: Quality of life.
RCT: Randomised controlled trial.
ROM: Range of motion.
SARS: Severe acute respiratory syndrome.
SD: Standard deviation.
SF: Short Form.
SWD: Short Wave Diathermy.
TENS: Transcutaneous electrical nerve stimulation.
US: Ultrasound.
VAS: Visual analogue scale.
WOMAC: Western Ontario and McMasters Universities Osteoarthritis Index.

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Ageberg 2010

No non‐exercise control, not randomised

Aglamis 2008

Large baseline differences between 2 small comparator groups in pain and physical function scores

Aglamis 2009

Secondary analysis (Aglamis 2009)

Akyol 2010

No non‐exercise control

Alfredo 2012

No non‐exercise control

Anwer 2011

No non‐exercise control

Aoki 2009

Prehabilitation (home stretching programme)

Atamaz 2006

Physical therapy did not include an exercise programme (IR, short‐wave diathermy, interferential)

Atamaz 2012

No non‐exercise control

Boocock 2009

No non‐exercise control, not randomised, no self‐report measures

Borjesson 1996

Patients scheduled for joint replacement surgery

Brosseau 2012

No pain/physical function/quality of life measures

Bulthuis 2007

All non‐arthroplasty patients had RA

Bulthuis 2008

Secondary analysis (Bulthuis 2007)

Callaghan 1995

Unable to ascertain effect size, as only provided with median % improvements without baseline scores and with extremely wide confidence intervals because of small sample size

Cetin 2008

No non‐exercise control

Chaipinyo 2009

No non‐exercise control

Chamberlain 1982

No appropriate control. Assessed benefit of SWD added to exercise

Cheing 2002

No control group. Control group used extremely effective sham TENS

Cheing 2004

Secondary analysis of Cheing 2002. Only gait and muscle strength evaluated

Ciolac 2011

No non‐exercise control, not randomised

Coupe 2007

Secondary analysis (Veenhof 2007)

Crotty 2009

Prehabilitation

Deyle 2005

No non‐exercise control

Dias 2003

Unable to extract change (SD) or post‐treatment (SD) scores from published manuscript. Unusually, published manuscript provided only median/test statistic/degrees of freedom data

Diracoglu 2005

No non‐exercise control

Duman 2012

All study patients taking fixed‐dose NSAIDs (meloxicam 15 mg daily)

Durmus 2007

No non‐exercise control

Durmus 2012

No non‐exercise control

Ebnezar 2012

No non‐exercise control

Ebnezar 2012a

No non‐exercise control

Evcik 2002

Not a randomised trial. Patients were 'separated' into 3 groups

Evgeniadis 2008

Prehabilitation

Eyigor 2004

No non‐exercise control

Farr 2010

No self‐reported pain/physical function/quality of life

Feinglass 2012

No non‐exercise control

Fitzgerald 2011

No non‐exercise control

Forestier 2010

Aquatic exercise

Foroughi 2011a

Secondary analysis (Foroughi 2011)

Foster 2007

No non‐exercise control

Gaal 2008

Aquatic exercise

Gaudreault 2011

No randomly assigned allocation

Gill 2009

No non‐exercise control

Green 1993

No appropriate control. Assessed benefit of hydrotherapy added to home exercise

Gremion 2009

Inappropriate control group (biomagnetic therapy)

Haslam 2001

Advice and exercise given in control group. Evaluated treatment was acupuncture

Helmark 2010

No self‐reported pain/function outcomes

Helmark 2012

No randomly assigned allocation

Hinman 2007

Aquatic exercise

Hiyama 2012

No non‐exercise control

Hoeksma 2004

No non‐exercise control. Manual therapy vs exercise

Huang 2005b

Earlier version of Huang 2005 (1)

Hughes 2010

Secondary analysis

Hurley 1998

Not even quasi‐randomised

Hurley 2007a

Secondary analysis

Hurley 2012

18‐ and 30‐month outcomes for a 6‐week intervention (Hurley 2007). Already submitted 6‐month outcomes for sustainability evaluation

Jan 1991

Not even quasi‐randomised

Jan 2008a

Preliminary analysis for Lin 2009

Jessep 2009

No non‐exercise control

Karagulle 2007

Aquatic exercise

Kawasaki 2008

No non‐exercise control

Kawasaki 2009

Inappropriate control: weekly intra‐articular hyaluronate injections

King 2008

No randomly assigned allocation

Konishi 2009

No randomly assigned allocation

Kreindler 1989

No pain/function/patient global outcome assessment. Only outcome is muscle strength

Kuptniratsaikul 2002

Cluster random sampling

Lankhorst 1982

No control group in analysis of results. No pain/function/patient global outcome assessment

Lim 2002

No non‐exercise control

Lim 2010

No non‐exercise control

Lin 2004

Water exercise programme

Lin 2007

Preliminary analysis (Lin 2009)

Liu 2008

No non‐exercise control

Mangione 1999

No appropriate control group. Both allocations on stationary cycling, high vs low intensity

Marra 2012

Exercise only a small component of the experimental allocation (pharmacist‐led education programme)

Mascarin 2012

No non‐exercise control

McCarthy 2004

No non‐exercise control

McKnight 2010

No appropriate control group (comprehensive and well‐monitored self‐management programme, including exercise component)

McQuade 2011

No randomly assigned allocation

Messier 1997

Secondary analysis (Ettinger 1997). Gait assessment

Messier 2000a

No appropriate control group. Assessed benefit of dietary therapy added to an exercise programme

Messier 2000b

Secondary analysis (Ettinger 1997a/b). Balance assessment

Messier 2007

No non‐exercise control

Messier 2008

No pain, physical function, quality of life outcomes

Miller 2012

Secondary analysis (ADAPT study)

Moss 2007

No exercise group; patients passive for mobilisation

Murphy 2008

No non‐exercise control

Neves 2011

No non‐exercise control

Ng 2010

No non‐exercise control

Nicklas 2004

Secondary analysis (Messier 2004). Outcomes limited to markers of chronic inflammation

Ozdincler 2005

No non‐exercise control

Penninx 2001

Secondary analysis (Ettinger 1997a/b)

Penninx 2002

Secondary analysis (Ettinger 1997a/b)

Pereira, 2011

No non‐exercise allocation

Petersen 2010

No non‐exercise allocation, no pain/physical function measures

Petersen 2011

No non‐exercise allocation

Peterson 1993

Secondary analysis (Kovar 1992). Gait assessment

Petrella 2000

All study patients taking fixed‐dose NSAIDs (oxaprozin 1200 mg daily)

Pietrosimone 2010

No non‐exercise allocation

Pietrosimone 2012

No non‐exercise allocation, no pain/function/quality of life outcomes

Pisters 2010

No non‐exercise allocation

Pisters 2010a

Secondary analyses

Piva 2011

Secondary analysis

Piyakhachornrot 2011

No non‐exercise allocation

Quirk 1985

No appropriate control group. Assessed benefit of interferential therapy or SWD added to exercise

Rattanachaiyanont 2008

No non‐exercise allocation

Ravaud 2004

Cluster‐randomised trial

Reid 2010

No non‐exercise allocation

Reid 2011

No self‐report pain/physical function/quality of life outcomes

Rejeski 1998

Secondary analysis (Ettinger 1997a/b)

Sayers 2012

No non‐exercise control

Schlenk 2011

Not randomised

Scopaz 2009

Not randomised

Selfe 2008

No non‐exercise allocation

Sen 2004

No non‐exercise control

Sevick 2009

Secondary analysis ADAPT study

Shakoor 2007

No non‐exercise allocation

Shakoor 2010

Not randomised, no specific pain/function/quality of life outcomes

Shen 2008

Not randomised

Silva 2008

No non‐exercise allocation

Sled 2010

Not randomised

Song 2010

No pain/function/quality of life outcomes

Soni 2012

No non‐exercise allocation

Stitik 2007

Not randomised or quasi‐randomised—sequentially assigned. In addition, all patients received hyaluronan (5 or 3 weekly injections)

Stitik 2007a

Not randomised

Sullivan 1998

Secondary analysis (1‐year follow‐up) (Kovar 1992)

Swank 2011

Secondary analysis (Topp)

Sylvester 1989

No appropriate control. Hydrotherapy compared with exercise plus SWD (N = 14)

Teixeira 2011

Secondary analysis (Fitzgerald 2011), no non‐exercise control

Thiengwittayaporn 2009

No non‐exercise allocation

Toda 2001

Not randomised

Tok 2011

No non‐exercise allocation

Topp 2009

Prehabilitation

Tsauo 2008

No non‐exercise allocation

Tunay 2010

No non‐exercise allocation

Tuzun 2004

No non‐exercise control

van Baar 2001

Secondary analysis (van Baar 1998) (follow‐up study)

Van Gool 2005

Secondary analysis ADAPT study

Veenhof 2007

No non‐exercise allocation

Walls 2010

Prehabilitation

Wang 2006

No land‐based exercise group

Wang 2007

Aquatic exercise only

Wang 2007a

No pain/function/quality of life outcomes

Wang 2009

No non‐exercise control

Weng 2009

No non‐exercise control

Whitehurst 2011

No non‐exercise allocation

Williamson 2007

Patients awaiting knee replacement surgery

Williamson 2007a

Prehabilitation

Wyatt 2001

No non‐exercise control

Yilmaz 2010

No non‐exercise allocation

Yip 2007a

Secondary analysis

Yip 2008

Secondary analysis

ADAPT: Arthritis Diet and Activity Promotion Trial

IR: Infra‐Red

NSAIDs: Non‐steroidal anti‐inflammatory drugsav

RA: Rheumatoid Arthritis

SD: standard deviation

SWD: Short Wave Diathermy

TENS: Transcutaneous electrical nerve stimulation

Data and analyses

Open in table viewer
Comparison 1. Post treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

44

3537

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐0.59, ‐0.39]

Analysis 1.1

Comparison 1 Post treatment, Outcome 1 Pain.

Comparison 1 Post treatment, Outcome 1 Pain.

1.1 Change scores

28

2136

Std. Mean Difference (IV, Random, 95% CI)

‐0.50 [‐0.62, ‐0.38]

1.2 End of treatment scores

16

1401

Std. Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.65, ‐0.29]

2 Physical function Show forest plot

44

3913

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.64, ‐0.39]

Analysis 1.2

Comparison 1 Post treatment, Outcome 2 Physical function.

Comparison 1 Post treatment, Outcome 2 Physical function.

2.1 Change scores

28

2253

Std. Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.63, ‐0.31]

2.2 End of treatment scores

16

1660

Std. Mean Difference (IV, Random, 95% CI)

‐0.59 [‐0.78, ‐0.40]

3 Quality of Life Show forest plot

13

1073

Std. Mean Difference (IV, Random, 95% CI)

0.28 [0.15, 0.40]

Analysis 1.3

Comparison 1 Post treatment, Outcome 3 Quality of Life.

Comparison 1 Post treatment, Outcome 3 Quality of Life.

3.1 Change scores

8

848

Std. Mean Difference (IV, Random, 95% CI)

0.27 [0.13, 0.42]

3.2 End of treatment scores

5

225

Std. Mean Difference (IV, Random, 95% CI)

0.30 [0.04, 0.57]

4 Study withdrawals Show forest plot

45

4607

Odds Ratio (M‐H, Random, 95% CI)

0.93 [0.75, 1.15]

Analysis 1.4

Comparison 1 Post treatment, Outcome 4 Study withdrawals.

Comparison 1 Post treatment, Outcome 4 Study withdrawals.

Open in table viewer
Comparison 2. Treatment sustainability 2‐6 months

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

12

1468

Std. Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.35, ‐0.14]

Analysis 2.1

Comparison 2 Treatment sustainability 2‐6 months, Outcome 1 Pain.

Comparison 2 Treatment sustainability 2‐6 months, Outcome 1 Pain.

1.1 Change

4

563

Std. Mean Difference (IV, Random, 95% CI)

‐0.19 [‐0.36, ‐0.02]

1.2 End of follow‐up

8

905

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.42, ‐0.15]

2 Physical function Show forest plot

10

1279

Std. Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.26, ‐0.04]

Analysis 2.2

Comparison 2 Treatment sustainability 2‐6 months, Outcome 2 Physical function.

Comparison 2 Treatment sustainability 2‐6 months, Outcome 2 Physical function.

2.1 Change scores

4

566

Std. Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.31, 0.02]

2.2 End of follow‐up

6

713

Std. Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.32, 0.02]

Open in table viewer
Comparison 3. Treatment sustainability > 6 months

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

8

1272

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐1.01, ‐0.03]

Analysis 3.1

Comparison 3 Treatment sustainability > 6 months, Outcome 1 Pain.

Comparison 3 Treatment sustainability > 6 months, Outcome 1 Pain.

1.1 Change

4

1024

Std. Mean Difference (IV, Random, 95% CI)

‐0.05 [‐0.35, 0.26]

1.2 End of follow‐up

4

248

Std. Mean Difference (IV, Random, 95% CI)

‐1.03 [‐2.02, ‐0.04]

2 Physical function Show forest plot

8

1266

Std. Mean Difference (IV, Random, 95% CI)

‐0.57 [‐1.05, ‐0.10]

Analysis 3.2

Comparison 3 Treatment sustainability > 6 months, Outcome 2 Physical function.

Comparison 3 Treatment sustainability > 6 months, Outcome 2 Physical function.

2.1 Change

4

1024

Std. Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.32, ‐0.07]

2.2 End of follow‐up

4

242

Std. Mean Difference (IV, Random, 95% CI)

‐1.03 [‐2.07, 0.02]

Open in table viewer
Comparison 4. Treatment content

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

44

3487

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.60, ‐0.41]

Analysis 4.1

Comparison 4 Treatment content, Outcome 1 Pain.

Comparison 4 Treatment content, Outcome 1 Pain.

1.1 Quads strengthening only

9

620

Std. Mean Difference (IV, Random, 95% CI)

‐0.64 [‐0.95, ‐0.33]

1.2 Lower limb strengthening

12

863

Std. Mean Difference (IV, Random, 95% CI)

‐0.53 [‐0.78, ‐0.28]

1.3 Strengthening and aerobics

10

920

Std. Mean Difference (IV, Random, 95% CI)

‐0.50 [‐0.64, ‐0.37]

1.4 Walking programmes

4

351

Std. Mean Difference (IV, Random, 95% CI)

‐0.48 [‐0.83, ‐0.13]

1.5 Other programmes

10

733

Std. Mean Difference (IV, Random, 95% CI)

‐0.35 [‐0.49, ‐0.20]

2 Physical function Show forest plot

44

4255

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.62, ‐0.39]

Analysis 4.2

Comparison 4 Treatment content, Outcome 2 Physical function.

Comparison 4 Treatment content, Outcome 2 Physical function.

2.1 Quadriceps strengthening only

10

726

Std. Mean Difference (IV, Random, 95% CI)

‐0.74 [‐1.07, ‐0.41]

2.2 Lower limb strengthening

13

1066

Std. Mean Difference (IV, Random, 95% CI)

‐0.54 [‐0.83, ‐0.26]

2.3 Strengthening and aerobics

10

1231

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.67, ‐0.36]

2.4 Walking programmes

3

317

Std. Mean Difference (IV, Random, 95% CI)

‐0.35 [‐0.58, ‐0.11]

2.5 Other programmes

10

915

Std. Mean Difference (IV, Random, 95% CI)

‐0.27 [‐0.47, ‐0.07]

Open in table viewer
Comparison 5. Treatment delivery mode

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

44

3588

Std. Mean Difference (IV, Random, 95% CI)

‐0.50 [‐0.60, ‐0.41]

Analysis 5.1

Comparison 5 Treatment delivery mode, Outcome 1 Pain.

Comparison 5 Treatment delivery mode, Outcome 1 Pain.

1.1 Individual treatments

14

1133

Std. Mean Difference (IV, Random, 95% CI)

‐0.76 [‐1.01, ‐0.52]

1.2 Class‐based programmes

24

1905

Std. Mean Difference (IV, Random, 95% CI)

‐0.42 [‐0.51, ‐0.33]

1.3 Home programmes

7

550

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.55, ‐0.21]

2 Physical Function Show forest plot

45

4344

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐0.61, ‐0.38]

Analysis 5.2

Comparison 5 Treatment delivery mode, Outcome 2 Physical Function.

Comparison 5 Treatment delivery mode, Outcome 2 Physical Function.

2.1 Individual treatments

16

1493

Std. Mean Difference (IV, Random, 95% CI)

‐0.76 [‐1.03, ‐0.50]

2.2 Class‐based programmes

24

2152

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.49, ‐0.26]

2.3 Home programmes

7

699

Std. Mean Difference (IV, Random, 95% CI)

‐0.37 [‐0.53, ‐0.21]

Open in table viewer
Comparison 6. Number of contact occasions

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

44

3487

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.60, ‐0.41]

Analysis 6.1

Comparison 6 Number of contact occasions, Outcome 1 Pain.

Comparison 6 Number of contact occasions, Outcome 1 Pain.

1.1 Fewer than 12 occasions

10

1019

Std. Mean Difference (IV, Random, 95% CI)

‐0.40 [‐0.56, ‐0.24]

1.2 12 or more occasions

34

2468

Std. Mean Difference (IV, Random, 95% CI)

‐0.55 [‐0.66, ‐0.43]

2 Physical function Show forest plot

44

3913

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.64, ‐0.39]

Analysis 6.2

Comparison 6 Number of contact occasions, Outcome 2 Physical function.

Comparison 6 Number of contact occasions, Outcome 2 Physical function.

2.1 Fewer than 12 occasions

9

1033

Std. Mean Difference (IV, Random, 95% CI)

‐0.33 [‐0.57, ‐0.09]

2.2 12 or more occasions

35

2880

Std. Mean Difference (IV, Random, 95% CI)

‐0.57 [‐0.71, ‐0.43]

Open in table viewer
Comparison 7. Sensitivity Analyses

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Selection and attrition bias: pain Show forest plot

44

3487

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.60, ‐0.41]

Analysis 7.1

Comparison 7 Sensitivity Analyses, Outcome 1 Selection and attrition bias: pain.

Comparison 7 Sensitivity Analyses, Outcome 1 Selection and attrition bias: pain.

1.1 Low risk

14

1458

Std. Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.59, ‐0.36]

1.2 Unclear or high risk

30

2029

Std. Mean Difference (IV, Random, 95% CI)

‐0.53 [‐0.67, ‐0.39]

2 Selection and attrition bias: physical function Show forest plot

44

3913

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.64, ‐0.39]

Analysis 7.2

Comparison 7 Sensitivity Analyses, Outcome 2 Selection and attrition bias: physical function.

Comparison 7 Sensitivity Analyses, Outcome 2 Selection and attrition bias: physical function.

2.1 Low risk

14

1456

Std. Mean Difference (IV, Random, 95% CI)

‐0.45 [‐0.63, ‐0.28]

2.2 Unclear or high risk

30

2457

Std. Mean Difference (IV, Random, 95% CI)

‐0.55 [‐0.72, ‐0.38]

3 Detection bias: pain Show forest plot

44

3487

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.60, ‐0.41]

Analysis 7.3

Comparison 7 Sensitivity Analyses, Outcome 3 Detection bias: pain.

Comparison 7 Sensitivity Analyses, Outcome 3 Detection bias: pain.

3.1 Low risk

3

226

Std. Mean Difference (IV, Random, 95% CI)

‐0.37 [‐0.87, 0.13]

3.2 Unclear or high risk

41

3261

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.61, ‐0.42]

4 Detection bias: physical function Show forest plot

44

3913

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.64, ‐0.39]

Analysis 7.4

Comparison 7 Sensitivity Analyses, Outcome 4 Detection bias: physical function.

Comparison 7 Sensitivity Analyses, Outcome 4 Detection bias: physical function.

4.1 Low risk

3

226

Std. Mean Difference (IV, Random, 95% CI)

‐0.46 [‐1.14, 0.22]

4.2 Unclear or high risk

41

3687

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.65, ‐0.40]

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Post treatment, outcome: 1.1 Pain.
Figuras y tablas -
Figure 2

Forest plot of comparison: 1 Post treatment, outcome: 1.1 Pain.

Forest plot of comparison: 1 Post treatment, outcome: 1.2 Physical function.
Figuras y tablas -
Figure 3

Forest plot of comparison: 1 Post treatment, outcome: 1.2 Physical function.

Forest plot of comparison: 1 Post treatment, outcome: 1.3 Quality of life.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Post treatment, outcome: 1.3 Quality of life.

Comparison 1 Post treatment, Outcome 1 Pain.
Figuras y tablas -
Analysis 1.1

Comparison 1 Post treatment, Outcome 1 Pain.

Comparison 1 Post treatment, Outcome 2 Physical function.
Figuras y tablas -
Analysis 1.2

Comparison 1 Post treatment, Outcome 2 Physical function.

Comparison 1 Post treatment, Outcome 3 Quality of Life.
Figuras y tablas -
Analysis 1.3

Comparison 1 Post treatment, Outcome 3 Quality of Life.

Comparison 1 Post treatment, Outcome 4 Study withdrawals.
Figuras y tablas -
Analysis 1.4

Comparison 1 Post treatment, Outcome 4 Study withdrawals.

Comparison 2 Treatment sustainability 2‐6 months, Outcome 1 Pain.
Figuras y tablas -
Analysis 2.1

Comparison 2 Treatment sustainability 2‐6 months, Outcome 1 Pain.

Comparison 2 Treatment sustainability 2‐6 months, Outcome 2 Physical function.
Figuras y tablas -
Analysis 2.2

Comparison 2 Treatment sustainability 2‐6 months, Outcome 2 Physical function.

Comparison 3 Treatment sustainability > 6 months, Outcome 1 Pain.
Figuras y tablas -
Analysis 3.1

Comparison 3 Treatment sustainability > 6 months, Outcome 1 Pain.

Comparison 3 Treatment sustainability > 6 months, Outcome 2 Physical function.
Figuras y tablas -
Analysis 3.2

Comparison 3 Treatment sustainability > 6 months, Outcome 2 Physical function.

Comparison 4 Treatment content, Outcome 1 Pain.
Figuras y tablas -
Analysis 4.1

Comparison 4 Treatment content, Outcome 1 Pain.

Comparison 4 Treatment content, Outcome 2 Physical function.
Figuras y tablas -
Analysis 4.2

Comparison 4 Treatment content, Outcome 2 Physical function.

Comparison 5 Treatment delivery mode, Outcome 1 Pain.
Figuras y tablas -
Analysis 5.1

Comparison 5 Treatment delivery mode, Outcome 1 Pain.

Comparison 5 Treatment delivery mode, Outcome 2 Physical Function.
Figuras y tablas -
Analysis 5.2

Comparison 5 Treatment delivery mode, Outcome 2 Physical Function.

Comparison 6 Number of contact occasions, Outcome 1 Pain.
Figuras y tablas -
Analysis 6.1

Comparison 6 Number of contact occasions, Outcome 1 Pain.

Comparison 6 Number of contact occasions, Outcome 2 Physical function.
Figuras y tablas -
Analysis 6.2

Comparison 6 Number of contact occasions, Outcome 2 Physical function.

Comparison 7 Sensitivity Analyses, Outcome 1 Selection and attrition bias: pain.
Figuras y tablas -
Analysis 7.1

Comparison 7 Sensitivity Analyses, Outcome 1 Selection and attrition bias: pain.

Comparison 7 Sensitivity Analyses, Outcome 2 Selection and attrition bias: physical function.
Figuras y tablas -
Analysis 7.2

Comparison 7 Sensitivity Analyses, Outcome 2 Selection and attrition bias: physical function.

Comparison 7 Sensitivity Analyses, Outcome 3 Detection bias: pain.
Figuras y tablas -
Analysis 7.3

Comparison 7 Sensitivity Analyses, Outcome 3 Detection bias: pain.

Comparison 7 Sensitivity Analyses, Outcome 4 Detection bias: physical function.
Figuras y tablas -
Analysis 7.4

Comparison 7 Sensitivity Analyses, Outcome 4 Detection bias: physical function.

Summary of findings for the main comparison. Immediate post‐treatment effects of exercise for osteoarthritis of the knee

Immediate post‐treatment effects of exercise for osteoarthritis of the knee

Patient or population: patients with knee OA
Settings: clinic or community
Intervention: land‐based exercise
Comparison: no exercise

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

No exercise

Land‐based exercise

Pain
Self‐report questionnaires. Scale from 0‐100 (0 represents no pain)

Mean pain in the control groups was
44 points

Mean pain in intervention groups was
0.49 standard deviations lower
(0.39‐0.59 lower)

This translates to an absolute mean reduction of 12 (10‐15) points compared with control group on a 0‐100 scalea

3537
(44 studies)

⊕⊕⊕⊕
High

SMD ‐0.49 (‐0.39 to ‐0.59)

Absolute reduction in pain 12% (10%‐15%); relative change 27% (21%‐32%)a

NNTB 4 (3‐5)b

Physical function
Self‐report questionnaire. Scale from 0‐100 (0 represents no physical disability)

Mean physical function in control groups was
38 points

Mean physical function in intervention groups was
0.52 standard deviations lower
(0.39‐0.64 lower)

This translates to an absolute mean improvement of 10 (8‐13) points on a 0‐100 scalec

3913
(44 studies)

⊕⊕⊕⊝
Moderated

SMD ‐0.52 (‐0.39 to ‐0.64)

Absolute improvement 10% (8%‐13%); relative improvement 26% (20%‐32%)c

NNTB 4 (3‐5)b

Quality of life
Self‐report questionnaire. Scale from 0‐100 (100 is maximum quality of life)

Mean quality of life in control groups was
43 points

Mean quality of life in intervention groups was
0.28 standard deviations higher
(0.15‐0.4 higher)

This translates to an absolute improvement of 4 (2‐5) points on a 0‐100 scalee

1073
(13 studies)

⊕⊕⊕⊕
High

SMD 0.28 (0.15‐0.40)

Absolute improvement 4% (2%‐5%); relative improvement 9% (5%‐13%)e

NNTB 8 (5‐14)b

Study withdrawals or dropouts

153 per 1000

137 per 1000

4607

(44 studies)

⊕⊕⊕⊕
High

OR 0.93 (0.75‐1.15)

Absolute risk reduction: 1% fewer events with exercise (2% fewer‐2% more); relative risk reduction 6% fewer events with exercise (21% fewer‐12% more)

NNTH n/ab

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; GRADE: Grades of Recommendation, Assessment, Development and Evaluation; KOOS: Knee Osteoarthritis Outcome Scale; NNTB: Number needed to treat for an additional beneficial outcome; NNTH: Number needed to treat for an additional harmful outcome; SMD: Standardised mean difference.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aCalculations based on the control group baseline mean (SD) pain: 44.3 (24.4) points on 0‐100 scale (from Yip 2007).

bNumber needed to treat for an additional beneficial outcome (NNTB) or harmful outcome (NNTH) not applicable (n/a) when result was not statistically significant. Number needed to treat (NNT) for continuous outcomes calculated using the Wells calculator (from the CMSG Editorial office; http://musculoskeletal.cochrane.org/), and for dichotomous outcomes using the Cates NNT calculator (www.nntonline.net/visualrx/).

cCalculations based on the control group baseline mean (SD) function: 40.0 (20.0) points on 0‐100 scale (from Hurley 2007).

dPhysical function downgraded for inconsistency (heterogeneity, I2 = 68%).

eCalculated on the basis of the control group baseline mean (SD): 39.2 (13.1) points on 0‐100 KOOS subscale (from Lund 2008).

Figuras y tablas -
Summary of findings for the main comparison. Immediate post‐treatment effects of exercise for osteoarthritis of the knee
Comparison 1. Post treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

44

3537

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐0.59, ‐0.39]

1.1 Change scores

28

2136

Std. Mean Difference (IV, Random, 95% CI)

‐0.50 [‐0.62, ‐0.38]

1.2 End of treatment scores

16

1401

Std. Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.65, ‐0.29]

2 Physical function Show forest plot

44

3913

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.64, ‐0.39]

2.1 Change scores

28

2253

Std. Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.63, ‐0.31]

2.2 End of treatment scores

16

1660

Std. Mean Difference (IV, Random, 95% CI)

‐0.59 [‐0.78, ‐0.40]

3 Quality of Life Show forest plot

13

1073

Std. Mean Difference (IV, Random, 95% CI)

0.28 [0.15, 0.40]

3.1 Change scores

8

848

Std. Mean Difference (IV, Random, 95% CI)

0.27 [0.13, 0.42]

3.2 End of treatment scores

5

225

Std. Mean Difference (IV, Random, 95% CI)

0.30 [0.04, 0.57]

4 Study withdrawals Show forest plot

45

4607

Odds Ratio (M‐H, Random, 95% CI)

0.93 [0.75, 1.15]

Figuras y tablas -
Comparison 1. Post treatment
Comparison 2. Treatment sustainability 2‐6 months

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

12

1468

Std. Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.35, ‐0.14]

1.1 Change

4

563

Std. Mean Difference (IV, Random, 95% CI)

‐0.19 [‐0.36, ‐0.02]

1.2 End of follow‐up

8

905

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.42, ‐0.15]

2 Physical function Show forest plot

10

1279

Std. Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.26, ‐0.04]

2.1 Change scores

4

566

Std. Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.31, 0.02]

2.2 End of follow‐up

6

713

Std. Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.32, 0.02]

Figuras y tablas -
Comparison 2. Treatment sustainability 2‐6 months
Comparison 3. Treatment sustainability > 6 months

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

8

1272

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐1.01, ‐0.03]

1.1 Change

4

1024

Std. Mean Difference (IV, Random, 95% CI)

‐0.05 [‐0.35, 0.26]

1.2 End of follow‐up

4

248

Std. Mean Difference (IV, Random, 95% CI)

‐1.03 [‐2.02, ‐0.04]

2 Physical function Show forest plot

8

1266

Std. Mean Difference (IV, Random, 95% CI)

‐0.57 [‐1.05, ‐0.10]

2.1 Change

4

1024

Std. Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.32, ‐0.07]

2.2 End of follow‐up

4

242

Std. Mean Difference (IV, Random, 95% CI)

‐1.03 [‐2.07, 0.02]

Figuras y tablas -
Comparison 3. Treatment sustainability > 6 months
Comparison 4. Treatment content

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

44

3487

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.60, ‐0.41]

1.1 Quads strengthening only

9

620

Std. Mean Difference (IV, Random, 95% CI)

‐0.64 [‐0.95, ‐0.33]

1.2 Lower limb strengthening

12

863

Std. Mean Difference (IV, Random, 95% CI)

‐0.53 [‐0.78, ‐0.28]

1.3 Strengthening and aerobics

10

920

Std. Mean Difference (IV, Random, 95% CI)

‐0.50 [‐0.64, ‐0.37]

1.4 Walking programmes

4

351

Std. Mean Difference (IV, Random, 95% CI)

‐0.48 [‐0.83, ‐0.13]

1.5 Other programmes

10

733

Std. Mean Difference (IV, Random, 95% CI)

‐0.35 [‐0.49, ‐0.20]

2 Physical function Show forest plot

44

4255

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.62, ‐0.39]

2.1 Quadriceps strengthening only

10

726

Std. Mean Difference (IV, Random, 95% CI)

‐0.74 [‐1.07, ‐0.41]

2.2 Lower limb strengthening

13

1066

Std. Mean Difference (IV, Random, 95% CI)

‐0.54 [‐0.83, ‐0.26]

2.3 Strengthening and aerobics

10

1231

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.67, ‐0.36]

2.4 Walking programmes

3

317

Std. Mean Difference (IV, Random, 95% CI)

‐0.35 [‐0.58, ‐0.11]

2.5 Other programmes

10

915

Std. Mean Difference (IV, Random, 95% CI)

‐0.27 [‐0.47, ‐0.07]

Figuras y tablas -
Comparison 4. Treatment content
Comparison 5. Treatment delivery mode

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

44

3588

Std. Mean Difference (IV, Random, 95% CI)

‐0.50 [‐0.60, ‐0.41]

1.1 Individual treatments

14

1133

Std. Mean Difference (IV, Random, 95% CI)

‐0.76 [‐1.01, ‐0.52]

1.2 Class‐based programmes

24

1905

Std. Mean Difference (IV, Random, 95% CI)

‐0.42 [‐0.51, ‐0.33]

1.3 Home programmes

7

550

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.55, ‐0.21]

2 Physical Function Show forest plot

45

4344

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐0.61, ‐0.38]

2.1 Individual treatments

16

1493

Std. Mean Difference (IV, Random, 95% CI)

‐0.76 [‐1.03, ‐0.50]

2.2 Class‐based programmes

24

2152

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐0.49, ‐0.26]

2.3 Home programmes

7

699

Std. Mean Difference (IV, Random, 95% CI)

‐0.37 [‐0.53, ‐0.21]

Figuras y tablas -
Comparison 5. Treatment delivery mode
Comparison 6. Number of contact occasions

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

44

3487

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.60, ‐0.41]

1.1 Fewer than 12 occasions

10

1019

Std. Mean Difference (IV, Random, 95% CI)

‐0.40 [‐0.56, ‐0.24]

1.2 12 or more occasions

34

2468

Std. Mean Difference (IV, Random, 95% CI)

‐0.55 [‐0.66, ‐0.43]

2 Physical function Show forest plot

44

3913

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.64, ‐0.39]

2.1 Fewer than 12 occasions

9

1033

Std. Mean Difference (IV, Random, 95% CI)

‐0.33 [‐0.57, ‐0.09]

2.2 12 or more occasions

35

2880

Std. Mean Difference (IV, Random, 95% CI)

‐0.57 [‐0.71, ‐0.43]

Figuras y tablas -
Comparison 6. Number of contact occasions
Comparison 7. Sensitivity Analyses

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Selection and attrition bias: pain Show forest plot

44

3487

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.60, ‐0.41]

1.1 Low risk

14

1458

Std. Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.59, ‐0.36]

1.2 Unclear or high risk

30

2029

Std. Mean Difference (IV, Random, 95% CI)

‐0.53 [‐0.67, ‐0.39]

2 Selection and attrition bias: physical function Show forest plot

44

3913

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.64, ‐0.39]

2.1 Low risk

14

1456

Std. Mean Difference (IV, Random, 95% CI)

‐0.45 [‐0.63, ‐0.28]

2.2 Unclear or high risk

30

2457

Std. Mean Difference (IV, Random, 95% CI)

‐0.55 [‐0.72, ‐0.38]

3 Detection bias: pain Show forest plot

44

3487

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.60, ‐0.41]

3.1 Low risk

3

226

Std. Mean Difference (IV, Random, 95% CI)

‐0.37 [‐0.87, 0.13]

3.2 Unclear or high risk

41

3261

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.61, ‐0.42]

4 Detection bias: physical function Show forest plot

44

3913

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.64, ‐0.39]

4.1 Low risk

3

226

Std. Mean Difference (IV, Random, 95% CI)

‐0.46 [‐1.14, 0.22]

4.2 Unclear or high risk

41

3687

Std. Mean Difference (IV, Random, 95% CI)

‐0.52 [‐0.65, ‐0.40]

Figuras y tablas -
Comparison 7. Sensitivity Analyses