139 trials reveal a halftone efficiency

Knee osteoarthritis, which affects more than 654 million people worldwide, represents a public health challenge. Consequently, This new systematic cochrane review, including 139 trials and 12,468 participants, takes stock of the effectiveness of therapeutic exercises. Meanwhile, The results. Similarly, although promising, raise important questions on the real clinical significance of the benefits observed and call for in -depth reflection on the optimal prescription methods. Nevertheless,

Arthritis is an affection that can alter all tissues of a synovial joint: cartilage, subchondral bone, menisci and synovial. Nevertheless, It leads to the appearance of bone and cartilaginous osteophytes, leading to a functional failure of the joint. Similarly, Arthrosis is generally associated with a number of comorbidities, such as obesity, cardiovascular disease, diabetes and mental health disorders.

Knee osteoarthritis is frequent and affects more than 654 million people worldwide (about 23 % of people aged 40 and over). Furthermore, 139 trials reveal halftone efficiency Its prevalence increased by 63 % between 1990 and 2016.

Therapeutic exercise: a multifacette approach

Exercise is a sub-category of planned. In addition, structured and repetitive physical activity which aims to improve joint amplitude, muscle strength, balance and/or aerobic endurance capacity. Similarly, Exercise programs are generally heterogeneous in terms of design. Nevertheless, dosage (duration, frequency, intensity), administration methods (supervision or not, individual or in group, face -to -face or remote), type of exercises (muscle strengthening, aerobic) and can be associated with other conservative treatments (education, manual therapy, drugs).

All current recommendations recommend the practice of regular exercise as the cornerstone of the management of knee osteoarthritis. For example, regardless of age, comorbidity, gravity and disability.

The hypotheses suggested to explain the improvement of pain. For example, function through exercises are the increase in muscle strength, the decrease in inflammatory cytokines thanks to aerobic exercises, the maintenance of a healthy weight, the reduction of 139 trials reveal halftone efficiency visceral adipose tissue and the regulation of the various metabolic pathways of healthy cartilage. Physical exercise would also improve beliefs in its ability to accomplish a task. achieve a goal and reduce kinesiophobia (fear of movement).

This systematic review is a third update of Cochrane magazines evaluating the effectiveness of exercises in knee osteoarthritis. It now includes 139 tests (96 new) or 12,468 participants.

Facing the placebo: modest but real gains

A total of 30 studies (3. 065 participants) estimated the effects of the financial year compared to a placebo group.

– Pain : 28/30 studies (2. Additionally, 873 participants) show, with a low level of evidence, that in the exercise group, the pain was improved on average of 8.70/100 points (95 % CI: 5.70 to 11.70) compared to the placebo group after the intervention. The confidence interval of the average difference not reaching the threshold of 12/100 (where 0 represents the 139 trials reveal halftone efficiency absence of. pain) necessary to consider that it is a clinically important effect.

– Function : 24/30 studies (2. 536 participants) show, with a moderate level of evidence, that in the Exercise group, the average of the function score was improved by 11.27/100 points (95 % CI: 7.64 to 15.09) compared to the placebo group after the intervention. The confidence interval of the average difference included both a clinically significant improvement (threshold of 13/100) and clinically non -important improvement.

Versus Inaction: exercise makes the difference

In total. 60 studies (4,834 participants) evaluated the effects of exercises in relation to the lack of processing/usual care or limited education.

– Pain : 56/60 Studies (4. 184 patients) show, with a low level of evidence, that in the Exercise Group Pain was improved on average of 13.14/100 points (95 % CI: 10.36 to 15.91) compared to the control group after the intervention. The confidence interval of 139 trials reveal halftone efficiency the average difference included both a clinically significant improvement (threshold of 12/100 points) and clinically non -important.

– Function : 54/60 Studies (4. 352 participants) show, with a moderate level of evidence, that in the exercise group the average of the function score was improved from 12.53/100 points (95 % CI: 9.74 to 15.31) (where 0 represents the absence of functional incapacity) compared to the control group after the intervention. The confidence interval of the average difference included both clinically significant improvement (threshold of 13/100 points) and clinically non -important improvement.

The exercise in addition: a “plus” therapeutic to confirm

In total. 49 studies (4,569 participants) evaluated the effects of the exercises when added to another co-intervention (compared to this co-intervention alone).

– Pain : 47/49 studies (4. 441 participants) show, with a moderate level of evidence, that in the exercise group, the pain was improved on average of 10.43 points/100 (95 % 139 trials reveal halftone efficiency CI: 8.06 to 12.79) (where 0 represents the absence of pain) compared to the control group after the intervention. The confidence interval of the average difference includes both clinically important improvements (12 points/100 threshold) and clinically unimportant.

– Function : 44/49 studies (4. 381 participants) show, with a moderate level of evidence, that in the exercise group the average of the function score was slightly improved on average of 9.66/100 points (95 % CI: 7.48 to 11.97) (where 0 represents the absence of functional incapacity) compared to the control group after the intervention. The confidence interval of the average difference did not include the threshold (13/100 points) for a clinically important effect.

Critical analysis: between promises. clinical realities

This Cochrane review is a very exhaustive research in the main electronic databases and the language without language restriction registers, making it possible to identify all the relevant tests. Compared to the placebo group. 139 trials reveal halftone efficiency the exercise can probably lead to an improvement in pain and function immediately after the intervention, with uncertain clinical importance.

Compared to the lack of treatment. usual care, the exercise can probably lead to an improvement in pain and function immediately after the intervention, with uncertain clinical importance.

When the exercise is added to another co-intervention (compared to this co-intervention alone). the exercise can probably lead to an improvement in pain and a slight improvement of the function immediately after the intervention, with uncertain clinical importance.

The analysis in subgroups found no difference according to the type of exercise. the total number of prescribed exercise sessions and the number of consultations live/in real time with a health professional.

The limits of these studies are: the longer term results. beyond the duration of the intervention, were only measured in 20 % of the trials; Only 21 % of the trials included presented an overall risk 139 trials reveal halftone efficiency of low biases and had a sample large enough to provide at least 80 % power to detect a clinically important difference for pain; Physical exercise could increase the undesirable endless effects, however, two thirds of studies (66 %) did not report the undesirable effects.

Towards a personalized exercise prescription: the challenges of tomorrow

Despite this large number of studies. the authors point out that future trials on the effectiveness of exercises should use more robust study models and larger samples with more detailed exercise protocols.

Additional studies are necessary to better understand the differences in response to the exercise in order to identify those likely to benefit most. in particular studies on people with different degrees of gravity of the disease.

It would also be important to determine the most suitable type of exercise. as well as the dose and frequency, the type of individual or collective session and to determine whether 139 trials reveal halftone efficiency certain interventions combined with the exercise are more effective.