You are here

  • Home
  • Archive
  • Volume 57, Issue 15
  • 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

Article Text

Article menu
Systematic review
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
  1. Qianlin Weng1,
  2. Siew-Li Goh2,3,
  3. Jing Wu4,
  4. Monica S M Persson5,6,
  5. Jie Wei4,7,
  6. Aliya Sarmanova5,6,
  7. Xiaoxiao Li4,
  8. Michelle Hall6,8,9,
  9. Michael Doherty5,6,9,
  10. Ting Jiang1,5,6,10,
  11. Chao Zeng1,4,11,
  12. Guanghua Lei1,4,11,12,
  13. Weiya Zhang5,6,9
  1. 1 Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
  2. 2 Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
  3. 3 Sports and Exercise Medicine Research and Education Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  4. 4 Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
  5. 5 Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
  6. 6 Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
  7. 7 Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
  8. 8 Division of Physiotherapy Rehabilitation Sciences Education, University of Nottingham, Nottingham, UK
  9. 9 Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Nottingham, Nottingham, UK
  10. 10 Department of Ultrasonography, Xiangya Hospital, Central South University, Changsha, Hunan, China
  11. 11 National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
  12. 12 Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
  1. Correspondence to Professor Guanghua Lei, Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China; lei_guanghua{at}csu.edu.cn; Professor Chao Zeng, Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, China; zengchao{at}csu.edu.cn; Professor Weiya Zhang, Academic Rheumatology, Clinical Sciences Building, University of Nottingham, City Hospital, NG7 2RD, Nottingham, UK; weiya.zhang{at}nottingham.ac.uk

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

  • Exercise
  • Osteoarthritis
  • Medicine
  • Meta-analysis
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bjsports-2022-105898

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • QW and S-LG contributed equally.

    • Correction notice This article has been corrected since it published Online First. The article type has been changed to systematic review.

    • Contributors GL, CZ and WZ are joint corresponding authors. WZ, CZ and GL had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: all authors. Acquisition and interpretation of data: all authors. Statistical analysis: QW, JW, JW and XL. Drafting of the manuscript: QW. Critical revision of the manuscript for important intellectual content: all authors. Study supervision: WZ, CZ and GL. The corresponding authors attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding This work was supported by the National Natural Science Foundation of China (81930071, 82072502, U21A20352), Project Program of National Clinical Research Center for Geriatric Disorders (Xiangya Hospital, 2020LNJJ03) and the Science and Technology Program of Hunan Province (2019RS2010).

    • Disclaimer The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.