Osteoarthritis: resistance training offers best nondrug pain relief for elders

  • Zhang Q & al.
  • Am J Phys Med Rehabil
  • 01/06/2019

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Resistance training is the foremost nonpharmacological intervention for pain relief in elderly patients with osteoarthritis (OA), according to a network meta-analysis.
  • Yoga is the foremost intervention for elderly women in subgroup analysis.

Why this matters

  • Nonpharmacological interventions vary greatly in efficacy and expense.

Study design

  • Network meta-analysis of 32 randomized controlled trials (n=3228), after search of PubMed, OVID, EMBASE, Cochrane Library, PsycINFO, Physiotherapy Evidence Database, among others.
  • Primary outcome was pain relief assessed by the Western Ontario and McMaster Universities Osteoarthritis Index, and other measures.
  • Funding: None.

Key results

  • The most effective nonpharmacological interventions were:
    • Resistance training (surface under the cumulative ranking [SUCRA], 82.9%; standardized mean difference [SMD], 1.96; 95% CI, −1.39 to 5.31),
    • Strengthening exercise (SUCRA, 74.1%; SMD, 1.21; 95% CI, 0.62 to 3.05), and
    • Aquatic exercise (SUCRA, 65.3%; SMD, 0.75; 95% CI, 2.18 to 3.67).
  • The least effective nonpharmacological interventions were:
    • Weight loss (SUCRA, 17.8%; SMD, 3.77; 95% CI, 0.23 to 7.76),
    • Healing touch (SUCRA, 35.1%; SMD, 0.63; 95% CI, 2.93 to 1.68), and
    • Acupuncture (SUCRA, 37.8%; SMD, 0.43; 95% CI, 2.08 to 1.22).
  • In subgroup analysis, the most effective interventions were:
    • Yoga for women (SUCRA, 82.4%; SMD not reported).
    • Strengthening exercise for greatest long-term benefit (SUCRA, 98.2%; SMD not reported).

Limitations

  • Small number of participants across trials.