Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 9;6(1):100431.
doi: 10.1016/j.ocarto.2023.100431. eCollection 2024 Mar.

Mediators of the effects of exercise and manual therapy for people with knee and hip osteoarthritis: A secondary, exploratory analysis of the MOA trial

Daniel Cury Ribeiro  1 , Sarah E Lamb  2 , J Haxby Abbott  3
Affiliations

Mediators of the effects of exercise and manual therapy for people with knee and hip osteoarthritis: A secondary, exploratory analysis of the MOA trial

Daniel Cury Ribeiro et al. Osteoarthr Cartil Open. .

Abstract

Objective: To explore whether pain beliefs and functional strength mediate the treatment effect of manual therapy (MT) and exercise therapy (ET) on the Western Ontario and McMaster Osteoarthritis Index (WOMAC) composite scores and its subscales in individuals with hip and/or knee osteoarthritis in the MOA trial.

Design: Secondary analysis of a randomised controlled trial that compared the incremental effects of supervised MT and ET in addition to usual care in patients with osteoarthritis of the hip or knee. 206 participants enrolled in the MOA trial were analysed. The primary outcome measure was the WOMAC composite score after 1 year.

Results: Pain belief mediated the effect of MT (b: -10.7, 95 ​% CI: -22.3, -0.9), ET (b: -14.5 95%CI: -26.0, -4.4). Functional strength did not mediate the effect of MT, ET, or MT ​+ ​ET. Mediation sensitivity analyses suggest findings are likely to change if small confounding between those mediators and WOMAC composite score is present.

Conclusions: We identified possible mediators of MT and ET. Future confirmatory studies could be designed to assess the mechanisms through which manual therapy and exercise cause improvements in pain and function scores in patients with hip or knee osteoarthritis.

Keywords: Function; Mediation; Musculoskeletal diseases; Osteoarthritis; Pain; Randomized controlled trial.

PubMed Disclaimer

Conflict of interest statement

At the end of the text, under a subheading “Conflict of interest statement” all authors must disclose any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and research grants or other funding.

Figures

Fig. 1
Fig. 1
Directed acyclic graph representing the causal model with mediator of treatment effect on clinical outcomes (WOMAC composite, pain or function score at 1 year follow-up).
See this image and copyright information in PMC

References

    1. Brosseau L., Taki J., Desjardins B., Thevenot O., Fransen M., Wells G.A., et al. The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs. Clin. Rehabil. 2017;31:596–611. - PubMed
    1. Fransen M., McConnell S., Harmer A.R., Van der Esch M., Simic M., Bennell K.L. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br. J. Sports Med. 2015;49:1554–1557. - PubMed
    1. Quicke J.G., Runhaar J., van der Windt D., Healey E.L., Foster N.E., Holden M.A. Moderators of the effects of therapeutic exercise for people with knee and hip osteoarthritis: a systematic review of sub-group analyses from randomised controlled trials. Osteoarthritis Cartilage Open. 2020;2 - PMC - PubMed
    1. Kraemer H.C., Wilson G.T., Fairburn C.G., Agras W.S. Mediators and moderators of treatment effects in randomized clinical trials. Arch. Gen. Psychiatr. 2002;59:877–883. - PubMed
    1. Fernandes L., Hagen K.B., Bijlsma J.W., Andreassen O., Christensen P., Conaghan P.G., et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann. Rheum. Dis. 2013;72:1125–1135. - PubMed

LinkOut - more resources