Exercise for the win, again!

Opioids are commonly used in the management of chronic musculoskeletal (MSK) conditions, however, the appropriateness of treating conditions such as osteoarthritis (OA) with opioids is widely debated due to the risk of adverse events (AE) and addiction. The most recent guidelines from the Osteoarthritis Research Society International made a strong recommendation against any opioid use for knee OA, and others suggest they only be used after all other treatment options are exhausted or contraindicated.  

Two other common treatment options for knee OA are exercise therapy and nonsteroidal anti-inflammatory drugs (NSAIDs), however, comparing effects of these interventions is difficult due to a lack of direct statistical comparisons in high quality studies.  To account for this, the authors used network meta-analysis (NMA) to provide more valid estimates of the comparative effectiveness of opioids, NSAIDs and exercise therapy for knee OA pain. 

What is a network meta-analysis?

In a network meta-analysis (NMA), researchers can incorporate data from RCTs that do not necessarily have the same comparator group in a virtual ‘network’ of studies.  This allows the authors to include studies that tested two or more kinds of treatment, with or without a control and allows for direct comparison of treatment and indirect comparisons with the network.  Interestingly, this approach allows researchers to rank interventions as comparably more or less effective, which can be very helpful for clinicians and policy makers!  

THIS WEEK'S RESEARCH REVIEW: “Exercise Therapy vs. NSAIDs or Opioids for Knee Osteoarthritis Pain”

This paper was published in JOSPT (2022) and this Review is posted in Recent Reviews, Knee, Osteoarthritis and the 2022 Archive.

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