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
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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.