Proprioception is significantly impaired in knee osteoarthritis (KOA), contributing to reduced functionality. Strength training (ST) is essential in KOA by improving muscle strength, although it may also be effective in improving proprioception. The purpose was to determine the effect of ST on knee proprioception in KOA patients. Pubmed, CINAHL, Scopus, WOS, and PEDro were searched for randomized controlled trials (RCTs) (inception to March 2023). Comparisons for ST were physical exercise different from ST, non-exercise-based interventions, and no intervention. Methodological quality was assessed using the PEDro scale, and risk of bias (RoB) using the Cochrane tool. Meta-analyses were performed by comparison groups using the standardized mean difference (SMD) (Hedge's g) with random effects models, also considering subgroups by proprioception tests. Finally, six RCTs were included. The mean PEDro score was 6.3, and the highest proportion of biases corresponds to performance, selection, and detection. The meta-analysis indicated that only when compared with non-intervention, ST significantly improved knee proprioception for the joint position sense (JPS) (active + passive), JPS (passive), and threshold to detect passive motion (TTDPM) subgroups (g = -1.33 [-2.33, -0.32], g = -2.29 [-2.82, -1.75] and g = -2.40 [-4.23, -0.58], respectively). However, in the knee JPS (active) subgroup, ST was not significant (g = -0.72 [-1.84, 0.40]). In conclusion, ST improves knee proprioception compared to non-intervention. However, due to the paucity of studies and diversity of interventions, more evidence is needed to support the effectiveness of ST. Future RCTs may address the limitations of this review to advance knowledge about proprioceptive responses to ST and contribute to clinical practice.
PURPOSE: While strengthening exercises are recommended for knee osteoarthritis (KOA) treatment, the optimal type of muscle contraction remains unclear, with current research showing conflicting results. This network meta-analysis (NMA) aims to evaluate the efficacy of lower limb strengthening exercises based on different muscle contraction characteristics for KOA patients and provide clinical references.
METHODS: We conducted the NMA following the PRISMA-NMA. A comprehensive search of five databases (PubMed, Web of Science, CENTRAL, Embase, and SPORTDiscus) up to August 2024 identified randomized controlled trials (RCTs) investigating lower limb strengthening exercises in KOA patients. Control groups included receiving usual care, only providing health education, or no intervention at all. Outcomes analyzed included pain, physical function, quality of life, and muscle strength.
RESULTS: Forty-one studies (2,251 participants) were included. Twenty-eight studies used rigorous randomization; eighteen reported allocation concealment. All had high performance bias risk due to exercise interventions. Regarding efficacy, isokinetic exercise ranked highest in pain relief (SMD = 0.70, 95% CI: 0.50-0.91, SUCRA = 82.6%), function improvement (SMD = 0.75, 95% CI: 0.57-0.92, SUCRA = 96.1%), and enhancement in muscle strength (SMD = 0.56, 95% CI: 0.34-0.78, SUCRA = 90.1%). Isometric exercise ranked highest in improving quality of life (SMD = 0.80, 95% CI: 0.28-1.31, SUCRA = 90.5%). Mixed strengthening exercise ranked lowest across all outcomes. High-frequency interventions (≥5 times/week) showed superior pain relief compared with low-frequency (≤3 times/week) for isotonic, isometric, and isokinetic exercise.
CONCLUSION: This NMA suggests isokinetic exercise may be most effective for pain, function, and muscle strength in KOA patients, while isometric exercise benefits quality of life most. Mixed strengthening exercise ranked lowest across all outcomes. High-frequency interventions appear more effective than low-frequency ones. These findings support personalized KOA treatment, considering efficacy, accessibility, and patient-specific factors. Study biases, heterogeneity, and other limitations may affect result reliability. Future research should focus on high-quality studies with standardized protocols and analyze dose-response relationships to refine KOA treatment strategies.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024582525, identifier: CRD42024582525.
BACKGROUND: Osteoarthritis (OA) is a common and debilitating musculoskeletal condition that significantly impacts the quality of life of affected individuals. Various interventions, including weight training and exercise (WTE), have been explored to alleviate pain and improve mobility in knee OA patients. This study aimed to comprehensively analyze the existing literature to evaluate the effects of different WTE interventions on pain, mobility, knee function, and quality of life in individuals with knee OA. METHODS: A systematic review and meta-analysis was conducted, with clinical trials being the primary type of studies included in accordance with the PRISMA guidelines. The primary outcomes of interest were pain reduction and improvements in mobility, assessed through various validated measures. RESULTS: A total of 15 clinical trials were included in this review. The meta-analysis revealed mixed findings regarding the effects of WTE on pain and mobility in knee OA patients. While some interventions, such as high-intensity resistance training, demonstrated significant reductions in pain and improvements in mobility, others showed no substantial differences compared to control groups. The diversity of exercise modalities and intervention durations across studies contributed to this variability. Nevertheless, the overall analysis indicated that WTE interventions have the potential to positively impact pain and mobility in knee OA, with variations depending on the specific exercise type and duration. CONCLUSION: The findings underscore the importance of tailoring exercise programs to individual patient needs and preferences. While certain exercise modalities yielded significant improvements, future research should focus on optimizing exercise protocols, conducting long-term follow-up assessments, and evaluating cost-effectiveness. These insights hold significant implications for healthcare providers seeking evidence-based strategies to enhance the well-being of knee OA patients.
Globally, knee osteoarthritis (KOA) is the leading cause of disability. The most prevalent complaints associated with KOA are knee pain, joint stiffness, and weakness in the muscles of the lower limbs. These symptoms impede movement and result in functional limitations. As a result, people with KOA have a lower quality of life. For all patient groups with knee OA, an effective rehabilitation program focuses on improving knee range of motion, isometric quadriceps strength, and productivity level while reducing discomfort. The American College of Rheumatology (ACR) categorization criteria for KOA, research on KOA physiotherapy, and reviews covering various physical therapy interventions, including exercise, physical modalities, and patient education, were used to narrow down the pool of 180 systematic reviews to 15 articles. Google Scholar, PubMed, the Cochrane Library, and EMBASE were the databases that were used. The following keyword combinations were included in our search: KOA and physiotherapy or interventions or exercises, strengthening and stretching, concentric and eccentric training. Through our analysis, we identified a few methods that, in addition to standard therapy, could be used in clinical settings for people with osteoarthritis in the knee. It has been shown that Mulligan, Pilates, Kinesiotaping, Aquatic Therapy, and other current therapies are effective. The study employed a broad range of results. This review concludes that rather than relying solely on conventional therapy, it is preferable to combine a number of the most current physiotherapy techniques with it.
Background/Objectives: Pain is the most common symptom of osteoarthritis (OA), and it leads to functional decline, such as decreased mobility and limitations in activities of daily living, which leads to difficulties in social participation, increased social isolation, and economic burden. Muscle weakness can be a cause of OA symptoms. The purpose was to analyze the effects of resistance training on improving pain, strength, and function in OA and to analyze the effects by intervention duration and joint. Methods: The study search was conducted on 14 September 2024, and the period of study inclusion covered studies available in the databases from their inception to the search date. The databases used were PubMed, CHINAL, Cochrane Library, and Embase. Inclusion criteria were studies that targeted OA and compared a resistance training intervention with a no resistance training intervention group and measured pain, strength, and function. Subgroup analysis was used to analyze the effects by intervention duration (4 weeks or less, 5 to 8 weeks, 9 weeks or more) and joint (knee, hip). Results: A total of 27 studies included 1712 subjects, and significant improvements were observed in pain (SMD: -0.48, CI: -0.58~-0.37, I2: 45%), strength (SMD: 0.4, CI: 0.32~0.47, I2: 0%), and function (SMD: -0.56, CI: -0.65~-0.47, I2: 30%). In the effects by intervention duration, both pain and strength showed significant improvements, but no effect on function was observed for less than 4 weeks. For effects by joint, both the knee and hip showed significant improvements. Conclusions: Resistance training was effective in improving pain, strength, and function in patients with knee and hip OA.
Background: Knee osteoarthritis (OA) is a musculoskeletal disorder that causes pain and increasing loss of function, resulting in reduced proprioceptive accuracy and balance. Therefore, the goal of this systematic review and meta-analysis is to evaluate the effectiveness of balance training on pain and functional outcomes in knee OA. Methods: "PubMed", "Scopus", "Web of Science", "Cochrane", and "Physiotherapy Evidence Database" were searched for studies conducted between January 2000 and December 2021. Randomized controlled trials (RCTs) that investigated the effectiveness of balance training in knee OA, as well as its effects on pain and functional outcome measures, were included. Conference abstracts, case reports, observational studies, and clinical commentaries were not included. Meta-analysis was conducted for the common outcomes, i.e., Visual Analog Scale (VAS), The Timed Up and Go (TUG), Western Ontario and McMaster Universities Arthritis Index (WOMAC). The PEDro scale was used to determine the quality of the included studies. Results: This review includes 22 RCTs of which 17 articles were included for meta-analysis. The included articles had 1456 participants. The meta-analysis showed improvement in the VAS scores in the experimental group compared to the control group [ I 2= 92%; mean difference= -0.79; 95% CI= -1.59 to 0.01; p<0.05] and for the WOMAC scores the heterogeneity ( I 2) was 81% with a mean difference of -0.02 [95% CI= -0.44 to 0.40; p<0.0001]. The TUG score was analyzed, the I 2 was 95% with a mean difference of -1.71 [95% CI= -3.09 to -0.33; p<0.0001] for the intervention against the control group. Conclusions: Balance training significantly reduced knee pain and improved functional outcomes measured with TUG. However, there was no difference observed in WOMAC. Although due to the heterogeneity of the included articles the treatment impact may be overestimated. Registration: The current systematic review was registered in PROSPERO on 7th October 2021 (registration number CRD42021276674).
The main clinical manifestations of knee osteoarthritis are pain, swelling, stiffness, and limited activity, which have a serious impact on the life of patients. Exercise therapy can effectively improve the related symptoms of patients with knee osteoarthritis. This paper uses the method of network meta-analysis to compare the efficacy of different exercise types in the treatment of knee osteoarthritis.
METHODS:
CNKI, WanFang, PubMed, Embase, Cochrane Library, Web of Science, Scopus, Ebsco, SinoMed, and UpToDate were searched with Chinese search terms “knee osteoarthritis, exercise therapy” and English search terms “knee osteoarthritis, exercise”. Randomized controlled trials on the application of different exercise types in patients with knee osteoarthritis from October 2013 to October 2023 were collected. The outcome measures included visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index score, Timed Up and Go test, and 36-item short form health survey. Literature quality analysis was performed using the Cochrane Manual recommended tool for risk assessment of bias in randomized controlled trials. Two researchers independently completed the data collection, collation, extraction and analysis. RevMan 5.4 and Stata 18.0 software were used to analyze and plot the obtained data.
RESULTS:
A total of 29 articles with acceptable quality were included, involving 1 633 patients with knee osteoarthritis. The studies involved four types of exercise: aerobic training, strength training, flexibility/skill training, and mindfulness relaxation training. (1) The results of network meta-analysis showed that compared with routine care/health education, aerobic training could significantly improve pain symptoms (SMD=-3.26, 95%CI:-6.33 to-0.19, P < 0.05); strength training (SMD=-0.79, 95%CI:-1.34 to-0.23, P < 0.05) and mindfulness relaxation training (SMD=-0.79, 95%CI:-1.23 to-0.34, P < 0.05) could significantly improve the function of patients. Aerobic training (SMD=-1.37, 95%CI:-2.24 to-0.51, P < 0.05) and mindfulness relaxation training (SMD=-0.41, 95%CI:-0.80 to-0.02, P < 0.05) could significantly improve the functional mobility of patients. Mindfulness relaxation training (SMD=0.70, 95%CI: 0.21-1.18, P < 0.05) and strength training (SMD=0.42, 95%CI: 0.03-0.81, P < 0.05) could significantly improve the quality of life of patients. (2) The cumulative probability ranking results were as follows: pain: aerobic training (86.6%) > flexibility/skill training (60.1%) > strength training (56.8%) > mindfulness relaxation training (34.7%) > routine care/health education (11.7%); Knee function: strength training (73.7%) > mindfulness relaxation training (73.1%) > flexibility/skill training (56.1%) > aerobic training (39.9%) > usual care/health education (7.6%); Functional mobility: aerobic training (94.7%) > mindfulness relaxation training (65.5%) > strength training (45.1%) > flexibility/skill training (41.6%) > routine care/health education (3.2%); Quality of life: mindfulness relaxation training (91.3%) > strength training (68.0%) > flexibility/skill training (44.3%) > aerobic training (34.0%) > usual care/health education (12.3%).
