Effect of exercise and/or educational interventions on physical activity and pain in patients with hip/knee osteoarthritis: A systematic review with meta-analysis.

This systematic review and meta-analysis asked whether exercise and/or educational interventions improve physical activity levels and pain in people with hip or knee osteoarthritis, compared with usual care. Researchers pooled data from 20 randomized controlled trials involving 2,350 patients, split into exercise-only, education-only, and combined intervention studies, and rated the certainty of evidence using GRADE. For combination therapy (exercise plus education), pooled results from 4 articles showed a statistically significant improvement in physical activity level (SMD 0.33) and a statistically significant reduction in pain (SMD -0.15), though both effects were small. The certainty of this evidence was rated very low for physical activity and low for pain, mainly because of risk of bias in the underlying trials, particularly around allocation concealment, which limits how much confidence can be placed in these findings.

If you have hip or knee osteoarthritis, you may wonder whether combining exercise with education about your condition helps you move more and hurt less, compared to standard care. Researchers reviewed 20 clinical trials covering 2,350 patients to find out, looking separately at exercise alone, education alone, and the two combined. When exercise and education were combined, pooled results from 4 studies showed a statistically significant improvement in physical activity levels and a statistically significant reduction in pain.

However, both effects were small, and the researchers rated the overall evidence as very low certainty for physical activity and low certainty for pain. This downgrade happened because many of the original studies had weaknesses in how they were designed, especially in how patients were assigned to groups, which makes it harder to trust the results fully.

No information on side effects or safety was reported in this review, and no other exercise-only or education-only combinations reached the same statistical significance for these outcomes at study endpoints.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review pooled data from 20 RCTs (2,350 patients) evaluating exercise and/or educational interventions against usual care for hip/knee OA, categorizing studies as exercise-only (7), education-only (8), or combined (5). Meta-analysis of 4 combination-therapy trials found a statistically significant improvement in physical activity at study endpoint (SMD 0.33, 95% CI 0.04 to 0.51, P=0.03) and a statistically significant reduction in pain (SMD -0.15, 95% CI -0.29 to -0.02, P=0.03). Using GRADE, certainty was rated very low for the physical activity outcome and low for pain, driven primarily by risk-of-bias concerns across included trials, notably inadequate allocation concealment.

The effect sizes themselves were modest, and the abstract does not report comparable statistically significant pooled effects for exercise-only or education-only interventions on these specific outcomes. Clinicians should interpret these pooled estimates cautiously given the downgraded evidence certainty and methodological limitations in the source trials. The review does not report on adverse events, so no safety conclusions can be drawn from this synthesis alone.