Effects of supervised exercises on pain and disability in patients with hip or knee osteoarthritis: A systematic review and meta-analysis

Background Hip and knee osteoarthritis are among the most prevalent and disabling conditions affecting mainly older adults, with a risk of undergoing a total hip or knee replacement for the end stage. Increasing recommendations of conservative treatments have been reported as the first-line strategy for the initial management of this condition. Objective This review sought to investigate the effects of supervised exercises versus non-pharmacological conservative therapies to reduce pain and disability levels on patients with hip or knee osteoarthritis. Methods Three databases (PubMed, Cochrane Library, and ScienceDirect) were systematically searched for randomized-controlled trials published between 01-01-2001 and 31-10-2022. PEDro scale was used to assess the methodological quality of the included studies. The PRISMA guidelines were applied for this review. Results Twelve randomized-controlled trials of moderate-to-high quality were included in this review. The studies involved 1,049 participants with a mean age (SD) of 64 (6) years old. The duration of the intervention and follow-up varied from 2 weeks to 16 months. Supervised exercises for hip or knee osteoarthritis were significantly less effective in terms of pain reduction (SMD=-0.40 [95%CI 0.16, 0.65], p=0.001) compared to home-based exercises (active musculoskeletal therapies), but not in terms of disability reduction (SMD=-0.04[95%CI −0.43, 0.36], p=0.86). There was a non-significant difference of supervised exercises compared to passive musculoskeletal therapies in terms of disability (SMD=0.21[95%CI −0.09, 0.50], p=0.17), or pain reduction (SMD=-0.19; [95%CI −0.57, 0.19], p=0.33). Conclusion Supervised exercises were found to be less effective in reducing pain, but not in disability reduction when compared to home-based exercises. Systematic review registration Prospero CRD42021271912 ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present work are contained in the manuscript