PHYSICAL EXERCISE INTERVENTIONS FOR STANDING BALANCE IN ADULTS WITH LOWER LIMB OSTEOARTHRITIS: A SCOPING REVIEW

C.D. Perez¹, G.I. Tablante¹, E. Gorgon^1,2

¹University of the Philippines Manila, Department of Physical Therapy, Manila, Philippines, ²Neuroscience Research Australia, Spinal Cord Injury Research Centre, Sydney, Australia

Background: People with lower limb osteoarthritis (OA) have an increased risk of falling due to sensorimotor system changes that result in impaired standing balance and ineffective compensatory strategies. Physical exercise has been used by physiotherapists to improve different aspects of standing balance. For physiotherapists to provide the best possible intervention, they need comprehensive information from high-quality randomized controlled trials (RCTs) to apply in routine clinical practice.

Purpose: We mapped RCTs that investigated physical exercise interventions and standing balance outcomes in adults with lower limb OA with the following aims:
(1) describe trial characteristics,
(2) assess risk of bias, and
(3) evaluate the reporting of PE interventions.

Methods: We systematically searched for individual RCTs and hand-searched relevant systematic reviews on the effects of PE interventions on standing balance in PEDro, PubMed, CENTRAL, Scopus, EMBASE, and CINAHL from inception until June 2022. We included trials with adult participants (aged ≥18 years) who were diagnosed with OA in at least one lower limb joint. Risk of bias was assessed using the PEDro scale while completeness of reporting was examined using the TIDieR and CERT checklists. We extracted data using a custom-made electronic spreadsheet that we piloted. Two researchers independently conducted eligibility screening, risk of bias assessment, and data extraction, with disagreements resolved by consensus with a third researcher.

Results: Thirty-one trials published from 1998 to 2021 were included from an initial yield of 1,301 titles. Majority of the trials included participants who were female (30/31, 97%) and had knee OA (29/31, 94%). Primary interventions used were muscle performance (20/31, 65%), balance (10/31, 32%), and mind-body (10/31, 32%) exercises with a range of dosages. Trials investigated 4 out of 6 domains of standing balance and used 31 distinct outcome measures. There was low to moderate risk for bias, with a mean PEDro score of 6/10 (range = 4-8/10). While some aspects of the interventions were consistently reported including the rationale (31/31, 100%) and supervision (28/31, 90%), others such as details of tailoring (17/31, 55%) and exercise progression (13/31, 42%) were frequently lacking.

Conclusions: Balance exercises for OA have primarily focused on biomechanical aspects while other balance domains have been targeted only indirectly. The high variability in exercise dosages used in the trials suggests that the optimal dosage to improve balance outcomes remains unclear. The high heterogeneity of standing balance measures used in the trials underscores a key challenge for future systematic reviews in quantitatively comparing and combining results. Insufficient reporting on key aspects of the interventions can limit replicability in clinical practice and potentially discourage use among clinicians.

Implications: There is a need to establish minimum dose requirements for physical exercise interventions for standing balance and observe these requirements in future trials. Future trials should also use the TIDieR and CERT checklists to ensure relevant information is available as poor reporting can undermine clinicians’ ability to effectively use the interventions.

Funding acknowledgements: None

Keywords:
Physical exercise
Balance
Osteoarthritis

Topics:
Disability & rehabilitation
Older people
Musculoskeletal: lower limb

Did this work require ethics approval? No

Reason: The study is a scoping review that does not involve human participants.