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Exploring the modification factors of exercise therapy on biomechanical load in patients with knee osteoarthritis: a systematic review and meta-analysis

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Abstract

The objective of this systematic review and meta-analysis is to clarify the effect of exercise therapy on the first peak knee adduction moment (KAM), as well as other biomechanical loads in patients with knee osteoarthritis (OA), and identify physical characteristics that influence differences in biomechanical load after exercise therapy. The data sources are PubMed, PEDro, and CINAHL, from study inception to May 2021. The eligibility criteria include studies evaluating the first peak (KAM), peak knee flexion moment (KFM), maximal knee joint compression force (KCF), or co-contraction during walking before and after exercise therapy in patients with knee OA. The risk of bias was independently assessed by two reviewers using PEDro and NIH scales. Among 11 RCTs and nine non-RCTs, 1119 patients with knee OA were included (average age: 63.7 years). As the results of meta-analysis, exercise therapy tended to increase the first peak KAM (SMD 0.11; 95% CI: −0.03–0.24), peak KFM (SMD 0.13; 95% CI: −0.03–0.29), and maximal KCF (SMD 0.09; 95% CI −0.05–0.22). An increased first peak KAM was significantly associated with a larger improvement in knee muscle strength and WOMAC pain. However, the quality of evidence regarding the biomechanical loads was low-to-moderate according to the GRADE approach. The improvement in pain and knee muscle strength may mediate the increase in first peak KAM, suggesting difficulty in balancing symptom relief and biomechanical load reduction. Therefore, exercise therapy may satisfy both aspects simultaneously when combined with biomechanical interventions, such as a valgus knee brace or insoles. Registration: PROSPERO (CRD42021230966)

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Funding

This research was supported by a Grant-in-Aid for JSPS Research Fellows (grant number: 19J23020).

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Authors and Affiliations

  1. Sportology Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Moeka Yokoyama

  2. Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan

    Moeka Yokoyama

  3. Graduate School of Medicine/Institute for Advanced Research, Nagoya University, Nagoya, Japan

    Hirotaka Iijima

  4. Research & Development Center, Saitama Prefectural University, Saitama, Japan

    Keisuke Kubota

  5. Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Saitama, Japan

    Naohiko Kanemura

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Contributions

Moeka Yokoyama, Hirotaka Iijima, and Naohiko Kanemura contributed to the study’s conception and design. The acquisition of data was performed by Moeka Yokoyama and Hirotaka Iijima, and Keisuke Kubota. The analysis of data was performed by Moeka Yokoyama. All authors contributed to the interpretation of data. The first draft of the manuscript was written by Moeka Yokoyama, and all authors commented on the manuscript including the first submission and revised manuscript. All authors read and approved the final manuscript.

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Correspondence to Naohiko Kanemura.

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Yokoyama, M., Iijima, H., Kubota, K. et al. Exploring the modification factors of exercise therapy on biomechanical load in patients with knee osteoarthritis: a systematic review and meta-analysis. Clin Rheumatol 42, 1737–1752 (2023). https://doi.org/10.1007/s10067-023-06553-4

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