Similar Effects of Exercise Therapy, Nonsteroidal Anti-inflammatory Drugs, and Opioids for Knee Osteoarthritis Pain: A Systematic Review with Network Meta-analysis
Thorlund, J. B., Simic, M., Pihl, K., Berthelsen, D. B., Day, R., Koes, B. & Juhl, C. B., apr. 2022, I: Journal of Orthopaedic and Sports Physical Therapy. 52, 4, s. 207-216 10 s.
Publikation: Bidrag til tidsskrift › Review › peer review
OBJECTIVE: To compare the effectiveness of opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and exercise therapy for knee osteoarthritis pain.
DESIGN: Systematic review with network meta-analysis.
LITERATURE SEARCH: We searched the databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from inception to April 15, 2021. Web of Science was used for citation tracking.
STUDY SELECTION CRITERIA: Randomized controlled trials comparing exercise therapy, NSAIDs, and opioids in any combination for knee osteoarthritis pain.
DATA SYNTHESIS: Network meta-analysis comparing exercise therapy, NSAIDs, opioids, and placebo/control for knee osteoarthritis pain. Additional trials from previous reviews were included to create the external placebo/control anchor.
RESULTS: We included 13 trials (1398 patients) with direct comparisons, supplemented with data from 101 additional trials. The treatment effect of NSAIDs for knee osteoarthritis pain was similar to that of opioids (standardized mean difference [SMD], 0.02; 95% confidence interval [CI], -0.14 to 0.18; Grading of Recommendations, Assessment, Development and Evaluations [GRADE]: low certainty). Exercise therapy had a larger effect than NSAIDs (SMD, 0.54; 95% CI, 0.19 to 0.89; GRADE: very low certainty). No estimate could be made for exercise vs opioids due to the lack of studies. Exercise therapy ranked as the "best" intervention in the network meta-analysis, followed by NSAIDs, opioids, and placebo/control intervention (GRADE: low certainty).
CONCLUSION: Exercise therapy ranked as the best treatment for knee osteoarthritis pain, followed by NSAIDs and opioids. The difference between treatments was small and likely not clinically relevant, and the overall confidence in the ranking was low. The results highlight the limited evidence for comparative effectiveness between exercise therapy, NSAIDs, and opioids for knee osteoarthritis pain. J Orthop Sports Phys Ther 2022;52(4):207-216. doi:10.2519/jospt.2022.10490.
|Tidsskrift||Journal of Orthopaedic and Sports Physical Therapy|
|Status||Udgivet - apr. 2022|
1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. 2Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark. 3Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. 4Department of Rehabilitation, Municipality of Guldborgsund, Nykøbing Falster, Denmark. 5Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. 6Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital Sydney, Sydney, Australia. 7Faculty of Medicine, St Vincent’s Clinical School, University of New South Wales, Sydney, Australia. 8Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands. 9Department of Occupational Therapy and Physiotherapy, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark. This study was registered with PROSPERO (International Prospective Register of Systematic Reviews; registration number CRD42018106484). No funding was received for conducting this study. Jonas Bloch Thorlund reports a grant from Pfizer outside the submitted work. Milena Simic is supported by the Sydney University Research Accelerator (SOAR) fellowship. Richard Day has received support for his participation as “Community Expert” from Reckitt Benckiser ending in 2018. The other authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Dr Jonas Bloch Thorlund, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark. E-mail: firstname.lastname@example.org U Copyright ©2022 JOSPT ®, Inc
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