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.

Protocol and publications


M. (Melanie) A. Holden 1
D. (Danielle) L. Burke 1
J. (Jos) Runhaar 2
D. (Danielle) van Der Windt 1
R. (Richard) D. Riley 1
K. (Krysia) Dziedzic 1
A. (Amardeep) Legha 1
A. (Amy) L Evans 1
J.H. (Haxby) Abbott 3
K. (Kristin) Baker 4
J. (Jenny) Brown 5
K. (Kim) L. Bennell 6
D. (Daniël) Bossen 7, 8
L. (Lucie) Brosseau 9
K. (Kanda) Chaipinyo 10
R. (Robin) Christensen 11
T. (Tom) Cochrane 12
M. (Mariette) de Rooij 13
M. (Michael) Doherty 14
H. (Helen) P. French 15
S. (Sheila) Hickson 5
R. (Rana) S. Hinman 6
M. (Marijke) Hopman-Rock 16, 17
M. (Michael) V. Hurley 18, 19
C. (Carol) Ingram 5
J. (Jesper) Knoop 13
I. (Inga) Krauß 20
C. (Chris) McCarthy 21
S. (Stephen) P. Messier 22
D. (Donald) L. Patrick 23
N. (Nilay) Sahin 24
L. (Laura) A. Talbot 25
R. (Robert) Taylor 5
C. (Carolien) H. Teirlinck 2
M. (Marienke) van Middelkoop 2
C. (Christine) Walker 5
N. (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.