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. 2023 Aug;57(15):990-996.
doi: 10.1136/bjsports-2022-105898. Epub 2023 Jan 2.

Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials

Qianlin Weng #  1 , Siew-Li Goh #  2   3 , Jing Wu  4 , Monica S M Persson  5   6 , Jie Wei  4   7 , Aliya Sarmanova  5   6 , Xiaoxiao Li  4 , Michelle Hall  6   8   9 , Michael Doherty  5   6   9 , Ting Jiang  1   5   6   10 , Chao Zeng  11   4   12 , Guanghua Lei  11   4   12   13 , Weiya Zhang  14   6   9
Affiliations

Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials

Qianlin Weng et al. Br J Sports Med. 2023 Aug.

Abstract

Objective: Clinical guidelines recommend exercise as a core treatment for knee or hip osteoarthritis (OA). However, how its analgesic effect compares to analgesics, for example, oral non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol-the most commonly used analgesics for OA, remains unknown.

Design: Network meta-analysis.

Data sources: PubMed, Embase, Scopus, Cochrane Library and Web of Science from database inception to January 2022.

Eligibility criteria for selecting studies: Randomised controlled trials (RCTs) comparing exercise therapy with oral NSAIDs and paracetamol directly or indirectly in knee or hip OA.

Results: A total of n=152 RCTs (17 431 participants) were included. For pain relief, there was no difference between exercise and oral NSAIDs and paracetamol at or nearest to 4 (standardised mean difference (SMD)=-0.12, 95% credibility interval (CrI) -1.74 to 1.50; n=47 RCTs), 8 (SMD=0.22, 95% CrI -0.05 to 0.49; n=2 RCTs) and 24 weeks (SMD=0.17, 95% CrI -0.77 to 1.12; n=9 RCTs). Similarly, there was no difference between exercise and oral NSAIDs and paracetamol in functional improvement at or nearest to 4 (SMD=0.09, 95% CrI -1.69 to 1.85; n=40 RCTs), 8 (SMD=0.06, 95% CrI -0.20 to 0.33; n=2 RCTs) and 24 weeks (SMD=0.05, 95% CrI -1.15 to 1.24; n=9 RCTs).

Conclusions: Exercise has similar effects on pain and function to that of oral NSAIDs and paracetamol. Given its excellent safety profile, exercise should be given more prominence in clinical care, especially in older people with comorbidity or at higher risk of adverse events related to NSAIDs and paracetamol.CRD42019135166.

Keywords: Exercise; Medicine; Meta-analysis; Osteoarthritis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Summary of studies identification and selection according to the PRISMA flow diagram. NSAIDs, non-steroidal anti-inflammatory drugs; OA, osteoarthritis; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Structure of network formed by interventions (A) pain relief at or nearest to 4 weeks; (B) functional improvement at or nearest to 4 weeks. NSAIDs, non-steroidal anti-inflammatory drugs; IAHA, intra-articular hyaluronic acid.
Figure 3
Figure 3
Forest plots depicting estimates from direct and indirect comparison for exercise to oral NSAIDs and paracetamol. CrI, credible interval; NSAIDs, non-steroidal anti-inflammatory drugs; SMD, standardised mean difference.
See this image and copyright information in PMC

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