Developing an individualised exercise intervention for hip and knee osteoarthritis
Publication Date
December 15, 2022
Creator
Abstract
Background
Osteoarthritis is a prevalent chronic musculoskeletal condition and is a leading cause of disability worldwide. Non-pharmacological interventions are recommended as first-line of treatment among which exercise is acknowledged as the core intervention for people with hip and knee osteoarthritis. However, there is a need to optimise the effects of therapeutic exercises and improve long-term adherence to it. Therefore, international guidelines recommend individualisation of exercise prescription.
Objectives
The overall aim of this research project is to develop an optimal, individualised exercise package for people with hip or knee OA. In order to achieve this aim, the studies in this thesis aimed to achieve the following objectives:
1. To evaluate the current evidence for individualised exercise interventions for hip and knee OA using a systematic review.
2. To generate a consensus of opinion from a panel of healthcare professionals and patients as to the optimal strategies for individualising exercise interventions for OA using Delphi consensus methodology.
3. To develop a protocol for an individualised exercise programme for knee OA.
4. To test the acceptability of delivering an optimal IE intervention for people with knee OA.
Methods
The project involved three stages with different methodology in each stage. First, reviewing available evidence on individualised exercise and comparing its effects to usual care and non-individualised exercise. This was done by conducting a systematic review with conventional metaanalysis and network meta-analysis. In this review, all individualised exercise studies for hip and knee OA were identified from inception until April 2020. Risk of bias assessment and quality of intervention description of identified studies were assessed. In addition, detailed methods of how exercise was individualised were identified and summarised. Metaanalysis was then used to compare the effect of individualised exercise versus usual care and a network meta-analysis was used to indirectly compare effects of individualised exercise versus non-individualised exercise using a common comparator (usual care).
Second, a consensus of opinion from a panel of healthcare professionals and patients was achieved by conducting a Delphi exercise and stakeholder meetings. The Delphi involved identifying experts in the field of exercise and OA, and then obtaining their opinions on the optimal strategies for individualising exercise interventions in an anonymised voting system. This was followed by two stakeholders’ meetings involving a variety of healthcare professionals and patients to discuss and obtain more views on how to optimally individualise exercise.
Third, an individualised exercise intervention for OA was developed by combining the results of the first two studies. Then, an acceptability study protocol was completed to test the acceptability of delivering the developed intervention. Ethical approval and recruitment stage was completed for this study, however, the whole project was halted due to pandemic national lockdown.
Results
The systematic review identified 17 individualised exercise studies that met the inclusion criteria. The conventional meta-analysis included 8 studies comparing individualised exercise to usual care. Individualised exercise was better than usual care in pain and function outcomes while no significant difference was noted in performance and quality of life outcomes. These results should be taken with caution as the level of heterogeneity was considerably high.
The network meta-analysis showed that the effect size of individualised exercise was better than non-individualised exercise. However, 95% confidence intervals were overlapping, meaning that the difference between these interventions was not significant. The analysis also provided probability ranking score that indicated that individualised exercise is overall the best intervention among the three interventions included (individualised, non-individualised exercise and usual care).
The Delphi study identified 37 different individualisation factors that should be considered when individualising exercise for people with OA. These factors went through two rounds of anonymous voting. The voting resulted in acceptance of 24 items with agreement levels higher than 75%. The stakeholders’ meetings resulted in 30 opinion statements that supported and gave context to the factors voted in by the Delphi panel.
The results of the SR and stakeholders’ opinions were combined together with evidence from the literature to develop an optimised individualised exercise intervention. Four individualisation factors were chosen to be the focus of intervention protocol: the main symptomatic complaint, the patient’s goals, baseline physical capabilities and illness perceptions. These factors were used to constitute an individualised exercise intervention for people with knee OA to be tested in an acceptability study.
Conclusion
Results of this study has demonstrated that IE is beneficial for people with hip and knee OA. IE is significantly better than usual care and is potentially superior to NIE. However, Individualising exercise is a complex procedure and has multiple interacting components that affect its outcomes such as patients and exercise characteristics. IE is poorly described in current RCTs and needs further trials to understand optimal ways of providing IE intervention. The Delphi consensus has identified 24 important individualisation factors that could be considered when prescribing and individualising exercise. Developing a complex intervention is an ongoing process, and the results detailed in this study constitute a part of this process. Further research and trials are warranted to continue the development and optimisation of IE intervention for people with hip and knee OA.
Item Type
ethesis
Thesis Type
PhD
Subjects (LC)
Associated Schools / Departments
School of Health Sciences
eprints ID
71668
UoN Repository URI
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