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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
  1. Melanie A Holden1,
  2. Danielle L Burke1,
  3. Jos Runhaar2,
  4. Danielle van Der Windt1,
  5. Richard D Riley1,
  6. Krysia Dziedzic1,
  7. Amardeep Legha1,
  8. Amy L Evans1,
  9. J Haxby Abbott3,
  10. Kristin Baker4,
  11. Jenny Brown5,
  12. Kim L Bennell6,
  13. Daniël Bossen7,8,
  14. Lucie Brosseau9,
  15. Kanda Chaipinyo10,
  16. Robin Christensen11,
  17. Tom Cochrane12,
  18. Mariette de Rooij13,
  19. Michael Doherty14,
  20. Helen P French15,
  21. Sheila Hickson5,
  22. Rana S Hinman6,
  23. Marijke Hopman-Rock16,17,
  24. Michael V Hurley18,19,
  25. Carol Ingram5,
  26. Jesper Knoop13,
  27. Inga Krauss20,
  28. Chris McCarthy21,
  29. Stephen P Messier22,
  30. Donald L Patrick23,
  31. Nilay Sahin24,
  32. Laura A Talbot25,
  33. Robert Taylor5,
  34. Carolien H Teirlinck2,
  35. Marienke van Middelkoop2,
  36. Christine Walker5,
  37. Nadine E Foster1
  38. in collaboration with the OA Trial Bank
  1. 1 Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
  2. 2 Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
  3. 3 Department of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Orthopaedic Surgery Section, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  4. 4 Sargent College, Boston University, Boston, Massachusetts, USA
  5. 5 Research User Group, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, UK
  6. 6 Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
  7. 7 Faculty of Health, ACHIEVE Centre of Expertise, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
  8. 8 Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  9. 9 Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada
  10. 10 Division of Physical Therapy, Faculty of Health Science, Srinakharinwirot University, Bangkok, Thailand
  11. 11 Musculoskeletal Statistics Unit, The Parker Institute, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
  12. 12 Centre for Research Action in Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
  13. 13 Amsterdam Rehabilitation Research Centre, Centre for Rehabilitation and Rheumatology, Reade, Amsterdam, The Netherlands
  14. 14 Academic Rheumatology, University of Nottingham, Nottingham, Nottinghamshire, UK
  15. 15 School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
  16. 16 TNO Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands
  17. 17 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  18. 18 Faculty of Health, Social Care and Education, St George’s University of London and Kingston University, London, UK
  19. 19 Health Innovation Network South London, London, UK
  20. 20 Department of Sports Medicine, Medical Clinic, University Hospital of Tübingen, Tübingen, Germany
  21. 21 Manchester Movement Unit, Manchester School of Physiotherapy, Manchester Metropolitan University, Manchester, UK
  22. 22 J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Worrell Professional Center, Wake Forest University, Winston Salem, USA
  23. 23 Department of Health Services, University of Washington, Seattle, Washington, USA
  24. 24 Department of Physical Medicine and Rehabilitation, Medical Faculty, Balikesir University, Balikesir, Turkey
  25. 25 Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA
  1. Correspondence to Dr Melanie A Holden; m.holden{at}


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.

  • musculoskeletal disorders
  • hip
  • knee
  • osteoarthritis
  • exercise

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors MAH, DLB, JR, DvdW, RDR, KD, NEF contributed to the initial conception of the study. MAH, DLB, JR, DvdW, RDR, KD, AL, ALE, HA, KB, JB, KLB, DB, LB, KC, RC, TC, MdR, MD,HPF, SH, RSH, MHR, MVH, CI, JK, IK, CM, SPM, DLP, NS, LAT, RT, CHT, MvM, CW and NEF made a substantial contribution to the design of the work. MAH, DLB and JR drafted the manuscript. MAH, DLB, JR, DvdW, RDR, KD, AL, ALE, HA, KB, JB, KLB, DB, LB, KC, RC, TC, MdR, MD,HPF, SH, RSH, MHR, MVH, CI, JK, IK, CM, SPM, DLP, NS, LAT, RT, CHT, MvM, CW and NEF revised the manuscript and approved the final submission. The OA Trial Bank steering committee peer reviewed and approved the study protocol. The guarantor of the review is NEF.

  • Funding This work is supported by a Grant from the Chartered Society of Physiotherapy Charitable Trust (grant no PRF/16/A07), and the National Institute for Health Research (NIHR) School of Primary Care Research (grant no 531). MAH was supported by a National Institute for Health Research (NIHR) School of Primary Care Research Fellowship. DLB is currently supported by a NIHR School of Primary Care Research Fellowship. JR received partial funding from a grant of the Dutch Arthritis Foundation for their center of excellence ‘osteoarthritis in primary care’. KB is funded by an Australian National Health and Medical Research Council Fellowship (no 1058440). Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital (RC) is supported by a core grant from the Oak Foundation (OCAY-13-309). DvdW is a member of PROGRESS Medical Research Council Prognosis Research Strategy (PROGRESS) Partnership (G0902393/99558). KD is part-funded by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR and the NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands. RSH is supported by an Australian Research Council Future Fellowship (FT130100175). NEF, a NIHR Senior Investigator, is supported through an NIHR Research Professorship (NIHR-RP-011-015). The funders did not influence the study design or the writing of this article.

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement After this study has been completed, the individual participant data gathered will be deposited with the OA Trial Bank for the benefit of the wider OA community. Requests for future use of the data will be considered by the OA Trial Bank and individual trial principal investigators, as applicable.