. 2017 Dec 22;7(12):e018971.

doi: 10.1136/bmjopen-2017-018971.

Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol

Melanie A Holden¹, Danielle L Burke¹, Jos Runhaar², Danielle van Der Windt¹, Richard D Riley¹, Krysia Dziedzic¹, Amardeep Legha¹, Amy L Evans¹, J Haxby Abbott³, Kristin Baker⁴, Jenny Brown⁵, Kim L Bennell⁶, Daniël Bossen^{7

8}, Lucie Brosseau⁹, Kanda Chaipinyo¹⁰, Robin Christensen¹¹, Tom Cochrane¹², Mariette de Rooij¹³, Michael Doherty¹⁴, Helen P French¹⁵, Sheila Hickson⁵, Rana S Hinman⁶, Marijke Hopman-Rock^{16

17}, Michael V Hurley^{18

19}, Carol Ingram⁵, Jesper Knoop¹³, Inga Krauss²⁰, Chris McCarthy²¹, Stephen P Messier²², Donald L Patrick²³, Nilay Sahin²⁴, Laura A Talbot²⁵, Robert Taylor⁵, Carolien H Teirlinck², Marienke van Middelkoop², Christine Walker⁵, Nadine E Foster¹; OA Trial Bank

Affiliations

¹ Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK.
² Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
³ Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Orthopaedic Surgery Section, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
⁴ Sargent College, Boston University, Boston, Massachusetts, USA.
⁵ Research User Group, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK.
⁶ Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Faculty of Health, ACHIEVE Centre of Expertise, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
⁸ Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁹ Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada.
¹⁰ Division of Physical Therapy, Faculty of Health Science, Srinakharinwirot University, Bangkok, Thailand.
¹¹ Musculoskeletal Statistics Unit, The Parker Institute, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark.
¹² Centre for Research Action in Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia.
¹³ Amsterdam Rehabilitation Research Centre, Centre for Rehabilitation and Rheumatology, Reade, Amsterdam, The Netherlands.
¹⁴ Academic Rheumatology, University of Nottingham, Nottingham, Nottinghamshire, UK.
¹⁵ School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
¹⁶ TNO Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.
¹⁷ Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
¹⁸ Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK.
¹⁹ Health Innovation Network South London, London, UK.
²⁰ Department of Sports Medicine, Medical Clinic, University Hospital of Tübingen, Tübingen, Germany.
²¹ Manchester Movement Unit, Manchester School of Physiotherapy, Manchester Metropolitan University, Manchester, UK.
²² J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Worrell Professional Center, Wake Forest University, Winston Salem, USA.
²³ Department of Health Services, University of Washington, Seattle, Washington, USA.
²⁴ Department of Physical Medicine and Rehabilitation, Medical Faculty, Balikesir University, Balikesir, Turkey.
²⁵ Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA.

PMID: 29275348
PMCID: PMC5770908
DOI: 10.1136/bmjopen-2017-018971

Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol

Melanie A Holden et al. BMJ Open. 2017.

. 2017 Dec 22;7(12):e018971.

doi: 10.1136/bmjopen-2017-018971.

Authors

Affiliations

¹ Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK.
² Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
³ Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Orthopaedic Surgery Section, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
⁴ Sargent College, Boston University, Boston, Massachusetts, USA.
⁵ Research User Group, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK.
⁶ Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Faculty of Health, ACHIEVE Centre of Expertise, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
⁸ Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁹ Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada.
¹⁰ Division of Physical Therapy, Faculty of Health Science, Srinakharinwirot University, Bangkok, Thailand.
¹¹ Musculoskeletal Statistics Unit, The Parker Institute, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark.
¹² Centre for Research Action in Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia.
¹³ Amsterdam Rehabilitation Research Centre, Centre for Rehabilitation and Rheumatology, Reade, Amsterdam, The Netherlands.
¹⁴ Academic Rheumatology, University of Nottingham, Nottingham, Nottinghamshire, UK.
¹⁵ School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
¹⁶ TNO Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.
¹⁷ Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
¹⁸ Faculty of Health, Social Care and Education, St George's University of London and Kingston University, London, UK.
¹⁹ Health Innovation Network South London, London, UK.
²⁰ Department of Sports Medicine, Medical Clinic, University Hospital of Tübingen, Tübingen, Germany.
²¹ Manchester Movement Unit, Manchester School of Physiotherapy, Manchester Metropolitan University, Manchester, UK.
²² J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Worrell Professional Center, Wake Forest University, Winston Salem, USA.
²³ Department of Health Services, University of Washington, Seattle, Washington, USA.
²⁴ Department of Physical Medicine and Rehabilitation, Medical Faculty, Balikesir University, Balikesir, Turkey.
²⁵ Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA.

PMID: 29275348
PMCID: PMC5770908
DOI: 10.1136/bmjopen-2017-018971

Abstract

Introduction: Knee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/do not respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions.

Methods and analysis: Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI.

Ethics and dissemination: Research ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians.

Prospero registration number: CRD42017054049.

Keywords: exercise; hip; knee; musculoskeletal disorders; osteoarthritis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Causal pathway of potential mediators: (A) single mediator and (B) multiple mediators.

See this image and copyright information in PMC

References

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1. Lawrence RC, Felson DT, Helmick CG, et al. National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008;58:26–35. 10.1002/art.23176 - DOI - PMC - PubMed
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Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol

Affiliations

Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Molecular Biology Databases