Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group

M A Holden; B Metcalf; B J Lawford; R S Hinman; M Boyd; K Button; N J Collins; E Cottrell; Y Henrotin; J B Larsen; H Master; S T Skou; L M Thoma; R Rydz; E Wellsandt; D K White; K Bennell

doi:10.1016/j.joca.2022.10.009

Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group

Osteoarthritis Cartilage. 2023 Mar;31(3):386-396. doi: 10.1016/j.joca.2022.10.009. Epub 2022 Oct 28.

Authors

M A Holden¹, B Metcalf², B J Lawford³, R S Hinman⁴, M Boyd⁵, K Button⁶, N J Collins⁷, E Cottrell⁸, Y Henrotin⁹, J B Larsen¹⁰, H Master¹¹, S T Skou¹², L M Thoma¹³, R Rydz¹⁴, E Wellsandt¹⁵, D K White¹⁶, K Bennell¹⁷

Affiliations

¹ Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK. Electronic address: m.holden@keele.ac.uk.
² Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia. Electronic address: b.metcalf@unimelb.edu.au.
³ Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia. Electronic address: belinda.lawford@unimelb.edu.au.
⁴ Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia. Electronic address: ranash@unimelb.edu.au.
⁵ Patient Representative, Australia.
⁶ School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, UK. Electronic address: buttonk@cardiff.ac.uk.
⁷ School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Australia. Electronic address: n.collins1@uq.edu.au.
⁸ Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK. Electronic address: e.cottrell@keele.ac.uk.
⁹ Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Belgium; musculoSKeletal Innovative research Lab (mSKIL), Motricity Sciences Department, Institute of Pathology, University of Liège, Belgium; Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Belgium; The Osteoarthritis Foundation, Boncelles, Belgium. Electronic address: yhenrotin@uliege.be.
¹⁰ Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Denmark. Electronic address: jbl@hst.aau.dk.
¹¹ Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: hiral@udel.edu.
¹² Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark. Electronic address: stskou@health.sdu.dk.
¹³ Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: louise_thoma@med.unc.edu.
¹⁴ Patient Representative, Australia. Electronic address: rydzgroup@yahoo.com.au.
¹⁵ Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: elizabeth.wellsandt@unmc.edu.
¹⁶ Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA. Electronic address: dkw@udel.edu.
¹⁷ Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia. Electronic address: k.bennell@unimelb.edu.au.

PMID: 36367486
DOI: 10.1016/j.joca.2022.10.009

Abstract

Objective: To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA).

Design: A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains.

Results: The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise.

Conclusion: The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex.

Keywords: Consensus; Delphi; Exercise; Implementation; Osteoarthritis; Recommendations.

Publication types

Review
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Delphi Technique
Evidence-Based Medicine
Exercise
Exercise Therapy / methods
Humans
Osteoarthritis, Hip* / therapy
Osteoarthritis, Knee* / therapy

Abstract

Publication types

MeSH terms

Grants and funding