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.

Autor:	Weng Q; Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China., Goh SL; Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia.; Sports and Exercise Medicine Research and Education Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Wu J; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China., Persson MSM; Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK.; Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK., Wei J; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.; Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China., Sarmanova A; Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK.; Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK., Li X; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China., Hall M; Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK.; Division of Physiotherapy Rehabilitation Sciences Education, University of Nottingham, Nottingham, UK.; Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Nottingham, Nottingham, UK., Doherty M; Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK.; Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK.; Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Nottingham, Nottingham, UK., Jiang T; Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.; Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK.; Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK.; Department of Ultrasonography, Xiangya Hospital, Central South University, Changsha, Hunan, China., Zeng C; Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China lei_guanghua@csu.edu.cn zengchao@csu.edu.cn weiya.zhang@nottingham.ac.uk.; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China., Lei G; Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China lei_guanghua@csu.edu.cn zengchao@csu.edu.cn weiya.zhang@nottingham.ac.uk.; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China.; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.; Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China., Zhang W; Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK lei_guanghua@csu.edu.cn zengchao@csu.edu.cn weiya.zhang@nottingham.ac.uk.; Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK.; Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research, University of Nottingham, Nottingham, UK.
Jazyk:	angličtina
Zdroj:	British journal of sports medicine [Br J Sports Med] 2023 Aug; Vol. 57 (15), pp. 990-996. Date of Electronic Publication: 2023 Jan 02.
DOI:	10.1136/bjsports-2022-105898
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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