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Exercise in Hand Osteoarthritis

2017; Elsevier BV; Volume: 25; Linguagem: Inglês

10.1016/j.joca.2017.02.581

1522-9653

Nina Østerås, Ingvild Kjeken, Geir Smedslund, Rikke Helene Moe, B. Slatkowsky-Christensen, Till Uhlig, Kåre Birger Hagen,

Foot and Ankle Surgery

Purpose: To assess the benefits and harms of exercise compared to other interventions, including placebo or no intervention, in people with hand osteoarthritis (OA). Methods: A Cochrane systematic review with meta-analysis was conducted. Six electronic databases were searched from inception until September 2015. A hand search of unpublished or ongoing trials was also performed. Two authors independently selected trials, extracted data, assessed risk of bias and assessed the quality of the body of evidence using the GRADE approach. The outcomes investigated were both continuous outcomes (hand pain, physical function, finger joint stiffness, and quality of life) and dichotomous outcomes (proportion of adverse events and withdrawal). Randomised and controlled clinical trials comparing therapeutic exercise versus no exercise or comparing different types of exercise were included. The main time point of interest was the first assessment after completing the exercise programme. We employed a random-effects model to pool outcomes from a sufficiently homogeneous set of studies in meta-analyses to calculate effect sizes (Standardized Mean Difference (SMD) or Mean Difference (MD) with 95% confidence interval (CI)) for continuous outcomes. The risk ratio (RR) with 95% confidence interval (CI) was calculated for dichotomous outcomes. Results: The literature search retrieved 802 citations after duplicates were removed, and five additional citations were identified through hand search of conference proceedings and trial registers. Of 14 full-texts and 1 congress abstract read in full text, we included seven studies in the review. Five of these studies could be included in the meta-analysis. Most studies were free from selection and reporting bias, but one study was only available as a congress abstract. In these kinds of studies, it is impossible to blind the participants to treatment allocation. Although most studies reported blinded outcome assessors, some of the outcomes were self-reported (pain, function, stiffness and quality of life). Hence, the results may be vulnerable to performance and detection bias due to the unblinded participants and self-reported outcomes. Two studies with high drop-out rates may be vulnerable to attrition bias. Evidence from five trials (381 participants) indicated that exercise reduced hand pain (SMD −0.27, 95% CI −0.47 to −0.07) post-intervention (short-term) compared to no exercise. Four studies (369 participants) indicated that exercise improved hand function (SMD −0.28, 95% CI −0.58 to 0.02) post-intervention compared to no exercise. Quality of life was evaluated by one study (113 participants; SF-36 scale: 0–100), and the effect of exercise on quality of life remains uncertain (MD 0.30, 95% CI −3.72 to 4.32). Four studies (369 participants) indicated that exercise reduced finger joint stiffness (SMD −0.36, 95% CI −0.58 to −0.15) post-intervention compared to no exercise. Evidence from three studies indicated an increased likelihood in the exercise group compared to the control group for experiencing adverse events (RR 4.55 (0.53 to 39.31)), but not for withdrawal due to adverse events (RR 2.88 (0.30 to 27.18)). The few reported adverse events consisted of increased finger joint inflammation and increased hand pain. Conclusions: When pooling results from five studies, we found evidence for small beneficial effects of exercise on hand pain, function and finger joint stiffness. The estimated effect sizes were small and whether they represent a clinically important change may be debated. Quality of life was only reported in one study, and the effect is uncertain. Three studies reported on adverse events, which were few and not severe.