A P Verhagen1, M Ferreira2, E A E Reijneveld-van de Vendel3, C H Teirlinck3, J Runhaar3, M van Middelkoop3, L Hermsen4, I B de Groot4, S M A Bierma-Zeinstra3. 1. Dept General Practice, Erasmus Medical Centre University, Rotterdam, the Netherlands; Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Australia. Electronic address: Arianne.verhagen@uts.edu.au. 2. Institute of Bone and Joint Research, The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Australia. 3. Dept General Practice, Erasmus Medical Centre University, Rotterdam, the Netherlands. 4. National Health Care Institute, (Zorginstituut Nederland, ZIN), the Netherlands.
Abstract
OBJECTIVE: We aim to investigate if we need additional trials on exercise in knee osteoarthritis (OA) to accept a certain effect size to be a 'true' effect size, and new studies are not needed anymore. DESIGN: We performed a secondary analyses of a meta-analysis of studies on patients with knee osteoarthritis, on pain immediately post treatment. We performed five different analysis: a) we evaluated publication bias, b) we performed subgroup analysis, c) a sensitivity analysis based on the overall risk of bias (RoB) score, d) a cumulative meta-analysis and e) we developed an extended funnel plot to explore the potential impact of a new study on the summary effect estimate. RESULTS: We included 42 studies with in total 6863 patients. The analyses showed that a) there is no clear publication bias, b) subgrouping did not affect the overall effect estimate, c) the effect estimate of exercise is more consistent (no heterogeneity) in the studies of low RoB, d) the benefit of exercise was clear since 2010 and e) the extended funnel plot suggests that an additional study has a none or very limited impact to change the current effect estimate. CONCLUSION: Exercise is effective and clinically worthwhile in reducing pain immediately post treatment compared to no or minimal interventions in patients with knee OA and adding new data will unlikely change this conclusion.
OBJECTIVE: We aim to investigate if we need additional trials on exercise in knee osteoarthritis (OA) to accept a certain effect size to be a 'true' effect size, and new studies are not needed anymore. DESIGN: We performed a secondary analyses of a meta-analysis of studies on patients with knee osteoarthritis, on pain immediately post treatment. We performed five different analysis: a) we evaluated publication bias, b) we performed subgroup analysis, c) a sensitivity analysis based on the overall risk of bias (RoB) score, d) a cumulative meta-analysis and e) we developed an extended funnel plot to explore the potential impact of a new study on the summary effect estimate. RESULTS: We included 42 studies with in total 6863 patients. The analyses showed that a) there is no clear publication bias, b) subgrouping did not affect the overall effect estimate, c) the effect estimate of exercise is more consistent (no heterogeneity) in the studies of low RoB, d) the benefit of exercise was clear since 2010 and e) the extended funnel plot suggests that an additional study has a none or very limited impact to change the current effect estimate. CONCLUSION: Exercise is effective and clinically worthwhile in reducing pain immediately post treatment compared to no or minimal interventions in patients with knee OA and adding new data will unlikely change this conclusion.
Authors: Kelli Allen; Maihan B Vu; Leigh F Callahan; Rebecca J Cleveland; Abigail L Gilbert; Yvonne M Golightly; Ida Griesemer; Kimberlea Grimm; Derek P Hales; David G Hu; Katie Huffman; Amanda E Nelson; Ami Pathak; Jennifer Rees; Zachary D Rethorn; Anne E Wandishin Journal: BMC Musculoskelet Disord Date: 2020-05-16 Impact factor: 2.362