Journal CME, August 2023: The effectiveness of exercise with behavior change techniques in people with knee osteoarthritis: A systematic review with meta-analysis-Journal CME, August 2023: The effectiveness of exercise with behavior change techniques in people with knee osteoarthritis: A systematic review with meta-analysis

Journal CME, August 2023: The effectiveness of exercise with behavior change techniques in people with knee osteoarthritis: A systematic review with meta-analysis

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This systematic review and meta-analysis evaluated the effectiveness of exercise interventions combined with behavior change techniques (BCTs) in individuals with knee osteoarthritis. The study meticulously adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and analyzed data from 21 randomized controlled trials (RCTs) involving 1623 participants.<br /><br />The main findings indicated very low certainty of evidence regarding the impact of BCT-integrated exercise on primary outcomes like physical function, quality of life (QOL), and adverse events. These outcomes were heavily influenced by high risks of bias, imprecise evidence, and insufficient sample sizes. Regarding physical function, the standardized mean difference (SMD) was virtually zero, indicating no significant improvement. For QOL, the data were insufficient for pooling, though individual studies reported no significant benefits. Adverse events also presented very low certainty, showing no clear rise in risk from adding BCTs to exercise routines.<br /><br />Among secondary outcomes, moderate-certainty evidence suggested that exercise with BCTs slightly reduced knee pain (SMD of -0.33) and may improve mobility (SMD of 0.21). However, evidence for exercise adherence and self-efficacy remained very uncertain.<br /><br />The meta-analysis noted a propensity for the effectiveness of multiple BCTs rather than single ones, indicating possibly higher efficacy with comprehensive BCT applications. Nevertheless, no conclusive results could strongly support specific BCTs due to the overall low certainty.<br /><br />Future research should focus on methodologically rigorous trials to mitigate bias, use blinding techniques where appropriate, and implement larger sample sizes to verify these findings conclusively. Consequently, while BCTs integrated with exercise show potential benefits, their applicability and effectiveness require further investigation to form solid clinical guidelines.

Keywords

exercise interventions

behavior change techniques

knee osteoarthritis

systematic review

meta-analysis

randomized controlled trials

physical function

quality of life

adverse events

knee pain