The effectiveness of exercise with behavior change techniques in people with knee osteoarthritis: A systematic review with meta‐analysis

• Published in: PM & R Vol. 15; no. 8; pp. 1012 - 1025
• Main Authors: Ariie, Takashi, Takasaki, Hiroshi, Okoba, Ryota, Chiba, Hiroki, Handa, Yusuke, Miki, Takahiro, Taito, Shunsuke, Tsutsumi, Yusuke, Morita, Masaharu
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.08.2023
• ISSN: 1934-1482; 1934-1563
• DOI: 10.1002/pmrj.12898

Objective The purpose of this systematic review with meta‐analysis was to examine the effectiveness of exercise with behavior change techniques (BCTs) on core outcome sets in people with knee osteoarthritis. Literature Survey We searched randomized controlled trials (RCTs) in eight databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, ICTRP, and ClinicalTrials.gov) up to November 4, 2021. Methodology Eligible participants were people with knee osteoarthritis. The intervention was exercise with BCTs. Primary outcomes included physical function, quality of life (QOL) 6 to 12 months after intervention, and adverse events. Secondary outcomes were knee pain, exercise adherence, mobility, and self‐efficacy 3 months or more after intervention. The bias risk was assessed using the Risk of Bias 2 tool. The random‐effects model was used for the meta‐analysis. Synthesis We found 16 individual BCTs, and 37.7% of trials used a single BCT. For meta‐analysis, we included 21 RCTs (n = 1623). Most outcomes had a very low certainty of evidence, and the risk of bias was the consistent reason for downgrading evidence levels. The standardized mean difference (SMD) with 95% confidence interval (95% CI) was 0.00 (−0.24, 0.24) in physical function, 0.33 (−0.51, 1.17) in exercise adherence, and 0.04 (−0.39, 0.47) in self‐efficacy. The risk ratio (95% CI) of adverse events was 3.6 (0.79, 16.45). QOL was not pooled due to insufficient data (very low certainty of evidence). In contrast, the SMD (95% CI) for knee pain reduction and mobility improvement was −0.33 (−0.53, −0.13) and 0.21 (−0.05, 0.47) with moderate and low certainty of evidence, respectively. Conclusion The evidence is inconclusive regarding the effectiveness of BCTs with exercises on core outcome sets. Further research should explore the effectiveness of BCTs with valid design. Protocol Registration PROSPERO (CRD42020212904).