Hand OA: exercise or not, that is the question.
Welcome to the December edition of #Chat JRheum.
This month’s article for discussion is a shortened co-publication of a Cochrane systemic review of the effect of exercise interventions in hand osteoarthritis (OA).
The metaanalysis in this review included 5 randomized control trial studies and a total of 381 participants. The pooled results showed mild reductions in pain of 0.5 (on a 0 to 10 scale), function of 2.2 (on a 0 to 36 scale) and stiffness of 0.7 (on a 0-10 scale). The authors further comment on the following:
- Results reveal a small to moderate beneficial effect of exercise, that likely is not of clinical significance.
- Compared to the effects of other modalities for hand OA such as NSAIDs and splints, the effect is similar.
- Like other exercise interventions, the effect is not sustained.
- Results are limited by the small number of studies and participants, and heterogeneity in studies means that the optimal exercise program and dosage is still unknown.
- There is minimal to no harm in exercise (dropout rate was about 1%), and therefore exercise would be a non-harmful treatment alternative.
This study points out discrepancy in recommendations among guidelines and previous reviews. Unfortunately, despite rigorous Cochrane Review methodologies and updated analysis including new RCTs, the answer remains unclear… But I hope after reading this review you will have more confidence explaining this uncertainty to your patients, and making recommendations.
I am interested to hear from you about how you might advise your patients on exercise in hand OA. Did reading this article change your practice?
I welcome your thoughts, comments or questions on this month’s #ChatJRheum forum.
- Sarah Troster, forum moderator
