title: Behavioural physical activity interventions in participants with lower-limb osteoarthritis: a systematic review with meta-analysis.
abstract: OBJECTIVE
  To assess effectiveness of osteoarthritis interventions to promote long-term physical activity behaviour change.
  
  
  METHODS
  A systematic review and meta-analysis. Protocol registration PROSPERO CRD4201300444 5 (http://www.crd.york.ac.uk/prospero/).
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing physical activity interventions with placebo, no/or minimal intervention in community-dwelling adults with symptomatic knee or hip osteoarthritis. Primary outcomes were change in physical activity or cardiopulmonary fitness after a minimum follow-up of 6 months.
  
  
  METHODS
  Outcomes were measures of physical activity (self-reported and objectively measured) and cardiovascular fitness. Standard mean differences between postintervention values were used to describe the effect sizes.
  
  
  RESULTS
  27,984 titles were screened and 180 papers reviewed in full. Eleven RCTs satisfied inclusion criteria, total study population of 2741 participants, mean age 62.2. The commonest reasons for study exclusion were follow-up less than 6 months and no physical activity measures. The majority of included interventions implement an arthritis self-management programme targeting coping skills and self-efficacy. Seven studies used self-report measures, the pooled effect of these studies was small with significant heterogeneity between studies (SMD 0.22 with 95% CI -0.11 to 0.56, z=1.30 (p=0.19) I(2) statistic of 85%). Subgroup analysis of 6-12 month outcome reduced heterogeneity and increased intervention effect compared to control (SMD 0.53, 95% CI 0.41 to 0.65, z=8.84 (p<0.00001) I(2) of 66%).
  
  
  CONCLUSIONS
  Arthritis self-management programmes achieve a small but significant improvement in physical activity in the short term. Effectiveness of intervention declines with extended follow-up beyond 12 months with no significant benefit compared to control. The small number of studies (11 RCTs) limited ability to define effective delivery methods. Investigation of behavioural lifestyle interventions for lower limb osteoarthritis populations would benefit from consensus on methodology and outcome reporting. This includes use of validated physical activity reporting tools and planning for long-term follow-up.
authors.affiliation: Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK.
authors.forename: Wilby
authors.initials: W
authors.lastname: Williamson
authors.affiliation: Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kluzek
authors.affiliation: Information Specialist Department, Bodleian Health Care Libraries, University of Oxford, Oxford, UK.
authors.forename: Nia
authors.initials: N
authors.lastname: Roberts
authors.affiliation: School of Public Health and Charles Perkins Centre, University of Sydney, Sydney, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Richards
authors.affiliation: Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Arden
authors.affiliation: Division of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, University of Oxford, Oxford, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Leeson
authors.affiliation: Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Newton
authors.affiliation: Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, University of Oxford, Oxford, UK.
authors.forename: Charlie
authors.initials: C
authors.lastname: Foster
mesh_terms: D000223:Adaptation, Psychological; D001521:Behavior Therapy; D002320:Cardiovascular Physiological Phenomena; D006801:Humans; D009043:Motor Activity; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*; D010809:Physical Fitness; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy
keywords: REHABILITATION MEDICINE; RHEUMATOLOGY; SPORTS MEDICINE