Subgrouping and targeted exercise programmes for knee and hip osteoarthritis


Therapeutic exercise is a recommended core treatment for people with knee and hip osteoarthritis (OA), however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond, and/or sub-optimal content of exercise programmes. This study aims to identify a) subgroups of people with knee and hip OA that do/ do not respond to therapeutic exercise, and to different types of exercise, and b) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions.


Systematic review update and individual participant data meta-analyses (PROSPERO: CRD42017054049). A previous review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function, to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial- and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% confidence intervals.


Ongoing. 114 RCTs included in the systematic review, 61 trial leads have agreed, in principle, to share data.




Melanie A Holden 1

Danielle L Burke 1

Jos Runhaar 2

Danielle van Der Windt 1

Richard D Riley 1

Krysia Dziedzic 1

Amardeep Legha 1

Amy L Evans 1

Haxby Abbott 3

Kristin Baker 4

Jenny Brown 5

Kim L Bennell 6

Daniël Bossen 7, 8

Lucie Brosseau 9

Kanda Chaipinyo 10

Robin Christensen 11

Tom Cochrane 12

Mariette de Rooij 13

Michael Doherty 14

Helen P French 15

Sheila Hickson 5

Rana S Hinman 6

Marijke Hopman-Rock 16, 17

Michael V Hurley 18, 19

Carol Ingram 5

Jesper Knoop 13

Inga Krauß 20

Chris McCarthy 21

Stephen P Messier 22

Donald L. Patrick 23

Nilay Sahin 24

Laura A Talbot 25

Robert Taylor 5

Carolien H Teirlinck 2

Marienke van Middelkoop 2

Christine Walker 5

Nadine E Foster 1

1. Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, United Kingdom, 2. Erasmus University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands, 3. Centre for Musculoskeletal Outcomes Research, Orthopaedic Surgery Section, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand, 4. Sargent College, Boston University, Boston, United States of America, 5. Research User Group, Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, United Kingdom, 6. Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia, 7. ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands, 8. Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands, 9. Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada, 10. Division of Physical Therapy, Faculty of Health Science, Srinakharinwirot University, Bangkok, Thailand, 11. Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Frederiksberg and Bispebjerg Hospital, Denmark, 12. Centre for Research & Action in Public Health, University of Canberra, Canberra, Australia, 13. Amsterdam Rehabilitation Research Center, Reade, Centre for Rehabilitation and Rheumatology, Amsterdam, the Netherlands, 14. Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom, 15. School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland, 16. TNO Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands, 17. The Netherlands Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands, 18. Faculty of Health, Social Care and Education, St George’s University of London and Kingston University, London, United Kingdom, 19. Health Innovation Network South London, London, United Kingdom, 20. Department of Sports Medicine, Medical Clinic, University Hospital of Tübingen, Tübingen, Germany, 21. Manchester Movement Unit, Manchester School of Physiotherapy, Manchester Metropolitan University, United Kingdom, 22. J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Worrell Professional Center, Wake Forest University, Winston Salem, United States of America, 23. Department of Health Services, University of Washington, Washington, United States of America, 24. Department of Physical Medicine and Rehabilitation, Medical Faculty, Balıkesir University, Balıkesir, Turkey, 25. University of Tennessee Health Science Center, College of Medicine, Department of Neurology, Memphis, United States of America.

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