| Aquatic exercise for treating people with knee and hip osteoarthritis |
| Participants: people with knee and hip osteoarthritis. Settings: outpatient.
Intervention: aquatic exercise programme. Comparison: control treatment (e.g. usual care, information). |
| Pain on a 0 to 100 scale.
Various pain scales. (lower score is better) | Weighted mean pain in control groups was 46 points (95% CI 32 points up to 73) on a 0 to 100 scale | The mean pain in the aquatic exercise groups was 5 points lower (95% CI 3 to 8 points lower) compared with the control group.1 | SMD −0.31 (95% CI −0.47 to −0.15). | 1135
(12 trials) | ⊕⊕⊕⊝2 moderate | Absolute change: 5% (95% CI 3% to 8%)
Relative change: 9.0.% (95% CI 4.3% to 13.6%).1 NNTB: 9 (95% CI 6 to 16).3 |
| Disability on a 0 to 100 scale. Various disability scales (lower score is better) | Weighted mean disability in control groups was 44 points (95% CI 33 points up to 63) on a 0 to 100 scale | The mean disability in the aquatic exercise groups was 5 points lower (95% CI 3 to 8 points lower) compared with control group.1 | SMD −0.32 (95% CI −0.47 to −0.17). | 1116
(12 trials) | ⊕⊕⊕⊝2 moderate | Absolute change: 5% (95% CI 3% to 8%) Relative change: 12.4% (95% CI 6.6% to 18.2%) NNTB: 11 (95% CI 8 to 19).3 |
| Quality of life on a 0 to 100 scale. Various quality of life scales. (higher score is better) | Weighted mean quality of life in control groups was 50 points (95% CI 24 points up to 67 points) on a 0 to 100 scale | The mean quality of life in the aquatic exercise groups was 7 points higher (95% CI 0 to 13 points higher) compared with the control group.4 | SMD −0.25 (95% CI −0.49 to −0.01). | 1027 (10 trials) | ⊕⊕⊕⊝2 moderate | Absolute change: 7% (0 to 13%) Relative change 13.2% (95% CI 0.5% to 25.9%). NNTB: 13 (95% CI 8 to 288).5 |
| Withdrawals | 15 per 100 | 18 per 100 (14 to 23) | RR 1.25 (95% CI 0.98 to 1.60) | 1190
(13 trials) | ⊕⊕⊕⊝2 moderate | Absolute change: 3% (95% CI ‐1% to 9%) Relative percent change 22% (95% CI 6% fewer withdrawals % to 57 more withdrawals%) NNTH: 31 (95%CI 14 to ∞)6 |
| Radiographic evaluation | see comments | see comments | see comments | see comments | see comments | The included trials did not perform any radiographic evaluation. |
| Short term serious adverse effects from trials | see comments | see comments | see comments | see comments | see comments | None reported. |
| Long term adverse effects or toxicity from observational studies | see comments | see comments | see comments | see comments | see comments | None reported. |
| 1Estimated from the SMD into percent improvement based on Bliddal 2009. 2Downgraded by one level due to high risk of bias. 3We estimated the NNTB (Number Needed to Treat for an additional beneficial outcome) from the OR. We transformed the SMD value to the OR using the equation of Chinn 2000. We set the patient expected event rate (PEER) to 0.4 for pain and to 0.26 for disability, based on Tubach 2005. 4The SD value from the largest trial (Cochrane 2005; SD in control group = 27.17) was multiplied with the SMD value of QoL (SMD −0.25, 95% CI −0.49 to −0.01). 5We estimated the NNTB from the OR. We transformed the SMD value to the OR using the equation of Chinn 2000. Since we assumed a strong relation between QoL and disability, we chose the PEER of 0.26 for disability based on Tubach 2005. 6 We estimated the NNTH (Number Needed to Treat for an additional harmful outcome) from the RR, where the assumed control risk is the number of withdrawals in the control group. |
| 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. |
