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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

Weng, Qianlin; Goh, Siew-Li; Wu, Jing; Persson, Monica S.M.; Wei, Jie; Sarmanova, Aliya; Li, Xiaoxiao; Hall, Michelle; Doherty, Michael; Jiang, Ting; Zeng, Chao; Lei, Guanghua; Zhang, Weiya

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 Thumbnail


Authors

Qianlin Weng

Siew-Li Goh

Jing Wu

Monica S.M. Persson

Jie Wei

Aliya Sarmanova

Xiaoxiao Li

Michelle Hall

Michael Doherty

Ting Jiang

Chao Zeng

Guanghua Lei



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.

Citation

Weng, Q., Goh, S.-L., Wu, J., Persson, M. S., Wei, J., Sarmanova, A., …Zhang, W. (2023). 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. British Journal of Sports Medicine, 57(15), 990-996. https://doi.org/10.1136/bjsports-2022-105898

Journal Article Type Article
Acceptance Date Dec 20, 2022
Online Publication Date Jan 2, 2023
Publication Date 2023-08
Deposit Date Mar 6, 2023
Publicly Available Date Mar 6, 2023
Journal British Journal of Sports Medicine
Print ISSN 0306-3674
Electronic ISSN 1473-0480
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 57
Issue 15
Article Number 105898
Pages 990-996
DOI https://doi.org/10.1136/bjsports-2022-105898
Keywords Meta-analysis, Osteoarthritis, Medicine, Exercise
Public URL https://nottingham-repository.worktribe.com/output/16216881
Publisher URL https://bjsm.bmj.com/content/early/2023/01/02/bjsports-2022-105898

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