Nina Østerås1,2, Ingvild Kjeken3,4, Geir Smedslund3,4, Rikke H Moe3,4, Barbara Slatkowsky-Christensen3,4, Till Uhlig3,4, Kåre Birger Hagen3,4. 1. From the National Advisory Unit on Rehabilitation in Rheumatology, and the Department of Rheumatology, Diakonhjemmet Hospital; Norwegian Institute of Public Health; University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics, Oslo, Norway. nina.osteras@diakonsyk.no. 2. N. Østerås, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; I. Kjeken, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; G. Smedslund, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and Norwegian Institute of Public Health; R.H. Moe, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; B. Slatkowsky-Christensen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics; K.B. Hagen, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital. nina.osteras@diakonsyk.no. 3. From the National Advisory Unit on Rehabilitation in Rheumatology, and the Department of Rheumatology, Diakonhjemmet Hospital; Norwegian Institute of Public Health; University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics, Oslo, Norway. 4. N. Østerås, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; I. Kjeken, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; G. Smedslund, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and Norwegian Institute of Public Health; R.H. Moe, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; B. Slatkowsky-Christensen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, and University of Oslo, Faculty of Medicine Oslo, Department of Orthopedics; K.B. Hagen, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital.
Abstract
OBJECTIVE: To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand osteoarthritis (OA). METHODS: Systematic review using Cochrane Collaboration methodology. Six electronic databases were searched up until September 2015. INCLUSION CRITERIA: randomized or controlled clinical trials comparing therapeutic exercise versus no exercise, or comparing different exercise programs. MAIN OUTCOMES: hand pain, hand function, finger joint stiffness, quality of life, adverse events, and withdrawals because of adverse effects. Risk of bias and quality of the evidence were assessed. RESULTS: Seven trials were included in the review, and up to 5 trials (n = 381) were included in the pooled analyses with data from postintervention. Compared to no exercise, low-quality evidence indicated that exercise may improve hand pain [5 trials, standardized mean difference (SMD) -0.27, 95% CI -0.47 to -0.07], hand function (4 trials, SMD -0.28, 95% CI -0.58 to 0.02), and finger joint stiffness (4 trials, SMD -0.36, 95% CI -0.58 to -0.15) in people with hand OA. Quality of life was evaluated by 1 study (113 participants) showing very low-quality evidence for no difference. Three studies reported on adverse events, which were very few and not severe. CONCLUSION: Pooled results from 5 studies with low risk of bias showed low-quality evidence for small to moderate beneficial effects of exercise on hand pain, function, and finger joint stiffness postintervention. Estimated effect sizes were small, and whether they represent a clinically important change may be debated.
OBJECTIVE: To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand osteoarthritis (OA). METHODS: Systematic review using Cochrane Collaboration methodology. Six electronic databases were searched up until September 2015. INCLUSION CRITERIA: randomized or controlled clinical trials comparing therapeutic exercise versus no exercise, or comparing different exercise programs. MAIN OUTCOMES: hand pain, hand function, finger joint stiffness, quality of life, adverse events, and withdrawals because of adverse effects. Risk of bias and quality of the evidence were assessed. RESULTS: Seven trials were included in the review, and up to 5 trials (n = 381) were included in the pooled analyses with data from postintervention. Compared to no exercise, low-quality evidence indicated that exercise may improve hand pain [5 trials, standardized mean difference (SMD) -0.27, 95% CI -0.47 to -0.07], hand function (4 trials, SMD -0.28, 95% CI -0.58 to 0.02), and finger joint stiffness (4 trials, SMD -0.36, 95% CI -0.58 to -0.15) in people with hand OA. Quality of life was evaluated by 1 study (113 participants) showing very low-quality evidence for no difference. Three studies reported on adverse events, which were very few and not severe. CONCLUSION: Pooled results from 5 studies with low risk of bias showed low-quality evidence for small to moderate beneficial effects of exercise on hand pain, function, and finger joint stiffness postintervention. Estimated effect sizes were small, and whether they represent a clinically important change may be debated.
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