The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs

Lucie Brosseau; Jade Taki; Brigit Desjardins; Odette Thevenot; Marlene Fransen; George A Wells; Aline Mizusaki Imoto; Karine Toupin-April; Marie Westby; Inmaculada C Álvarez Gallardo; Wendy Gifford; Lucie Laferrière; Prinon Rahman; Laurianne Loew; Gino De Angelis; Sabrina Cavallo; Shirin Mehdi Shallwani; Ala' Aburub; Kim L Bennell; Martin Van der Esch; Milena Simic; Sara McConnell; Alison Harmer; Glen P Kenny; Gail Paterson; Jean-Philippe Regnaux; Marie-Martine Lefevre-Colau; Linda McLean

doi:10.1177/0269215517691084

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs

Clin Rehabil. 2017 May;31(5):596-611. doi: 10.1177/0269215517691084. Epub 2017 Feb 1.

Authors

Lucie Brosseau¹, Jade Taki², Brigit Desjardins³, Odette Thevenot³, Marlene Fransen⁴, George A Wells⁵, Aline Mizusaki Imoto⁶, Karine Toupin-April⁷, Marie Westby⁸, Inmaculada C Álvarez Gallardo⁹, Wendy Gifford¹⁰, Lucie Laferrière¹¹, Prinon Rahman¹², Laurianne Loew¹³, Gino De Angelis¹³, Sabrina Cavallo¹³, Shirin Mehdi Shallwani¹³, Ala' Aburub¹³, Kim L Bennell¹⁴, Martin Van der Esch¹⁵, Milena Simic¹⁶, Sara McConnell¹⁷, Alison Harmer¹⁸, Glen P Kenny¹⁹, Gail Paterson²⁰, Jean-Philippe Regnaux²¹, Marie-Martine Lefevre-Colau²², Linda McLean²³

Affiliations

¹ 1 Physiotherapy Program, University of Ottawa, Ottawa, Ontario, Canada.
² 2 Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
³ 3 School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.
⁴ 4 Faculty of Health Sciences, University of Sydney, Sydney, Australia.
⁵ 5 School of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada.
⁶ 6 UNIFESP, Internal Medicine, Brasilia, Brazil.
⁷ 7 Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
⁸ 8 Physical Therapy Teaching Supervisor, University of British Columbia, Vancouver, British Columbia, Canada.
⁹ 9 Department of Physical Education and Sport, University of Granada, Granada, Spain.
¹⁰ 10 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
¹¹ 11 Canadian Forces Health Services Group Headquarters, National Defense, Ottawa, Ontario, Canada.
¹² 12 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
¹³ 13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
¹⁴ 14 Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia.
¹⁵ 15 Department of Rehabilitation, Reade Centre for Rehabilitation and Rheumatology, Amsterdam, Netherlands, Faculty of Health. ACHIEVE, Centre of Applied Research and School of Physiotherapy, University of Applied Sciences, Amsterdam, Netherlands.
¹⁶ 16 Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.
¹⁷ 17 Department of Medicine, St. Joseph's Health Care Centre, Toronto, Ontario, Canada.
¹⁸ 18 Faculty of Health Sciences, Clinical and Rehabilitation Sciences Research Group, University of Sydney, Sydney, Australia.
¹⁹ 19 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
²⁰ 20 The Arthritis Society, Ottawa Office, Ontario Division, Ottawa, Ontario, Canada.
²¹ 21 Centre de recherche Epidémiologie et Biostatistique, Hôpital Hôtel-Dieu, Paris, France.
²² 22 Institute of Rheumatology, Department of Medicine and Rehabilitation, Cochin Hospital, Paris, France.
²³ 23 Full Professor, Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.

PMID: 28183213
DOI: 10.1177/0269215517691084

Abstract

Objective: To identify effective strengthening exercise programs and provide rehabilitation teams and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis.

Methods: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+ or D-) was based on statistical significance ( p < 0.5) and clinical importance (⩾15% improvement).

Results: The 26 high-quality studies identified demonstrated that various strengthening exercise programs with/without other types of therapeutic exercises are generally effective for improving knee osteoarthritis management within a six-month period. Strengthening exercise programs demonstrated a significant improvement for pain relief (four Grade A, ten Grade B, two Grade C+), physical function (four Grade A, eight Grade B) and quality of life (three Grade B). Strengthening in combination with other types of exercises (coordination, balance, functional) showed a significant improvement in pain relief (three Grade A, 11 Grade B, eight Grade C+), physical function (two Grade A, four Grade B, three Grade C+) and quality of life (one Grade A, one Grade C+).

Conclusion: There are a variety of choices for strengthening exercise programs with positive recommendations for healthcare professionals and knee osteoarthritis patients. There is a need to develop combined behavioral and muscle-strengthening strategies to improve long-term maintenance of regular strengthening exercise programs.

Keywords: Therapeutic exercise; clinical practice guideline; knee osteoarthritis; strengthening exercises; systematic review.

Publication types

Review
Systematic Review

MeSH terms

Evidence-Based Medicine*
Exercise Therapy / methods
Exercise Therapy / standards
Humans
Muscle Stretching Exercises / methods
Muscle Stretching Exercises / standards*
Osteoarthritis, Knee / rehabilitation*
Pain Management / methods*
Practice Guidelines as Topic
Resistance Training / methods
Resistance Training / standards*