Exercise Therapy for Osteoarthritis: A Living Systematic Review

Background Exercise therapy has been widely recognized in recent years as an effective intervention for individuals with osteoarthritis, with randomized controlled trials and systematic reviews demonstrating benefits greater than those of pharmacological treatments. However, three recent large-scale RCTs and an individual patient data meta-analysis published in The Lancet have challenged its clinical relevance, showing only marginal benefits over placebo. This has sparked considerable debate among experts and caused uncertainty among physiotherapists, with some questioning whether exercise therapy offers a meaningful advantage over passive treatments. Critics have noted that exercise is often evaluated with less methodological rigor than surgical or pharmaceutical interventions.

In response, experts have emphasized the urgent need to better understand which patients benefit from which types of exercise and how training parameters should be tailored. The aim of this project was to develop a freely accessible, interactive online platform that compiles and visualizes data from existing systematic reviews and original RCTs on exercise therapy for osteoarthritis. This tool is intended to support clinicians and researchers in exploring how training characteristics (e.g., intensity, duration, progression) and patient profiles modify treatment effects through meta-regressions and subgroup analyses.

Methods Although the project initially aimed to conduct an umbrella review, the reporting in existing meta-analyses was insufficient to support this approach. Therefore, we extracted data directly from the primary studies included in those reviews and conducted a supplementary systematic search in Medline (Ovid), Embase, and CENTRAL. We extracted data from the original studies and developed a website enabling users to perform parameterized, on-the-fly meta-analyses using a range of customizable filters and analytical options.

Results The platform (BLINDED) is live. It supports ad hoc meta-analyses for osteoarthritis of the hip, knee, and combined cases. Users can select statistical models, intervention comparisons, and subgroups. A weekly updated table of newly published RCTs is included, with new data extracted and added quarterly.

Conclusions The platform enables physiotherapists, researchers, and policymakers to interactively examine which training modalities are most effective for specific patient groups. It facilitates evidence-based, individualized treatment planning and supports shared decision-making. Future updates will allow seamless integration of new studies, including student research contributions.

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Artikel online veröffentlicht:
23. Oktober 2025