Does a home-based exercise program play any role in the treatment of knee osteoarthritis? A meta-analysis

BACKGROUND

Knee-osteoarthritis is a very common joint disorder, affecting about 85% of the population worldwide. The effectiveness of home-based exercises is still debatable, with many studies indicating positive outcomes with few side effects, while others find them of limited utility.

OBJECTIVES

To assess the role of home-based exercise (HBE) programs in the treatment of knee osteoarthritis.

MATERIAL AND METHODS

Randomized controlled trials were included as per the predefined Population, Intervention, Comparison, Outcomes and Study (PICOS) criteria. Demographic summaries and event data for osteoarthritis therapy in the exercise and control groups were assessed, and comparative efficacy was evaluated using clustered graphs. The RevMan software was used to calculate the odds ratio (OR) and risk ratio of the included studies. The risk of bias was also evaluated and heterogeneity analysis was performed.

RESULTS

Fifteen clinical trials performed from 2000 to 2022, with a total of 2922 osteoarthritis patients, were included in the study, according to the chosen inclusion criteria. We observed a reduction in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores but a more marked improvement in clinical symptoms in the exercise group. The Knee Injury and Osteoarthritis Outcome Score (KOOS) increased only in the exercise group and not in the control group. We obtained a pooled OR of 0.59 (95% confidence interval (95% CI): 0.36-0.98), T2 value of 0.88, χ2 value of 185.41, degrees of freedom (df) value of 14, I2 value of 92%, and p-value <0.00001. The overall Z effect was 2.04 with a p-value of 0.04. The pooled risk ratio was 0.81 (95% CI: 0.66-0.99) with a T2 value of 0.14, χ2 value of 191.53, df value of 14, I2 value of 93%, and p-value <0.00001.

CONCLUSION

The data from the studies included in this meta-analysis are in favor of the use of HBEs for the treatment of knee osteoarthritis.

Role of platelet-rich plasma in the treatment of osteoarthritis: a meta-analysis

OBJECTIVE

The clinical efficacy of platelet-rich plasma (PRP) in the treatment of osteoarthritis remains controversial. In this paper, we evaluated the clinical efficacy of PRP in the treatment of osteoarthritis using meta-analysis, providing evidence for the selection of clinical treatment options.

METHODS

We performed a computer-based search of PubMed, Embase, and the Cochrane Library databases to retrieve articles using the search terms "platelet-rich plasma", "osteoarthrosis", and "knee joint". Quality evaluation and data extraction were performed. The combined effect was assessed using RevMan 5.3 software.

RESULTS

Five randomized controlled trials, involving 320 patients, were included in this study. No significant differences were observed in the International Knee Documentation Committee score, visual analog scale (VAS) score, or the absolute value of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between the experimental and control groups. The absolute value of the VAS score and change in the WOMAC score were significantly decreased and patient satisfaction was increased in the experimental group, as compared with the control group.

CONCLUSION

The findings of this meta-analysis suggest that intra-articular injection of PRP is an effective treatment for osteoarthritis that can reduce post-operative pain, improve locomotor function, and increase patient satisfaction.

Functional Status in Knee Osteoarthritis and its Relation to Demographic and Clinical Features

Objectives:

To assess the functional status in a cohort of Iraqi patients with knee Osteoarthritis (OA) and its relation to demographic and clinical features.

Patients and methods:

This cross-sectional study was conducted on 150 patients with knee OA diagnosed according to the American College of Rheumatology Criteria for classification knee OA. Patients’ age, gender, body mass index (BMI), smoking history, educational level, and disease duration were recorded. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was used to measure functional status of patients with knee OA.

Results:

A total of 150 (97 females) patients with knee OA were recruited in the study. The mean age of patients was 52.5±10.1 year and mean BMI was 30.3±6.0 kg/m². The mean of total WOMAC score was 8.05±2.10 (Range 3–12). The mean WOMAC of: pain score was 3.22 ±0.76 (1-4), stiffness score was 2.05±1.01 and for functional disability score was 2.79±0.88. There was a positive significant correlation between age of the patients and severity of knee OA assessed with total WOMAC score (p=0.026). However, there was a significant negative correlation between educational level and total WOMAC score (p=0.015).

Conclusions:

Functional status in knee OA was impaired and there was a statistically positive significant correlation between age of the patients and severity of knee OA with functional impairment. Also, significant negative correlation was demonstrated between educational level and functional impairment.