An objective of this systematic review and network meta-analysis was to compare the effectiveness of numerous conservative treatments in improving physical function and quality of life using network meta-analysis as a tool for guiding treatment decisions.
The eligibility criteria for this review included randomized controlled trials involving people diagnosed with KOA using established classification systems. Studies compared pharmacological treatments, rehabilitation, or self-management with control treatments. Outcomes measured included physical function and QoL, with follow-up periods of 6 months. Quasi-randomized trials and studies focusing on surgical interventions or acute inflammation were excluded. A comprehensive literature search across major databases was conducted until June 2023. There were two independent reviewers who selected and extracted data, with disagreements resolved through discussion with a third reviewer. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Pairwise and network meta-analyses were performed using random-effects models to estimate treatment effects, and publication bias was assessed.
29,826 records were identified through electronic databases and hand searches. After duplicates were removed, 11,989 records were screened, and 314 full-text articles were assessed for eligibility. Ultimately, 43 studies met the inclusion criteria, involving 31,557 participants, with a mean age range of 50.1 to 70 years, and BMI ranging from 24.7 to 32.8. In the overall risk of bias assessment, 9 outcomes (24.3%) were judged to have a low risk of bias in at least three of the five domains, 3 outcomes (8.1%) were judged to have some concerns in multiple domains, and 25 outcomes (67.6%) were judged to have a high risk of bias in most domains. For improving physical function, intervention effects were high in the order of rehabilitation, self-management program, drug therapy, and control. For improving QOL, intervention effects were high in the order of rehabilitation, drug therapy, self-management program, and control.
It was found that rehabilitation was the most effective treatment option for improving physical function and quality of life in people with KOA.
People with KOA who can visit a hospital should receive rehabilitation treatment from a specialist such as a physical therapist. Drug therapy and self-management programs are also alternatives that can be considered by those who are unable to go to a hospital because of their health condition.
network meta-analysis
rehabilitation
