ArticleRMD open2023
Mechanisms of action of therapeutic exercise for knee and hip OA remain a black box phenomenon: an individual patient data mediation study with the OA Trial Bank.
Article in RMD open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 3 syntheses or guidelines pooled it, 36 citations in OpenAlex.
- Association Between Prescribed Dosage of Resistance Exercise and Change in Pain and Physical Function in Knee Osteoarthritis: A Systematic Review With Meta-Regression.Musculoskeletal care · 2025Pooled it
- Are Exercise Interventions for People With Knee Osteoarthritis Dosed Appropriately to Meet the World Health Organisation's Physical Activity Guidelines?Musculoskeletal care · 2025Pooled it
- Exercise for osteoarthritis of the knee.The Cochrane database of systematic reviews · 2024Pooled it
- The effects of supervised exercise and pain neuroscience education on muscle strength and power in patients with chronic pain after total knee arthroplasty: An exploratory analysis from the NEPNEP trial.Osteoarthritis and cartilage open · 2026Trial
- Pain informed movement compared to neuromuscular exercise and standard education in people with knee osteoarthritis: A pilot and feasibility randomized controlled trial.Osteoarthritis and cartilage open · 2025Trial
- Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial.JMIR mHealth and uHealth · 2024Trial
- Changes in sleep and clinical outcomes in hip osteoarthritis: A longitudinal secondary analysis of a randomised controlled trial.Osteoarthritis and cartilage open · 2026Article
- MULTIple or ONE home strengthening exercise(s) for knee osteoarthritis: Protocol for the MULTI-ONE randomised controlled trial.Osteoarthritis and cartilage open · 2026Article
- Mechanism of Action of Therapeutic Exercise in Rotator Cuff Tendinopathy: What Does Elastography Add?Journal of clinical medicine · 2026Article
- Effect of Knee Extensor Power on Knee Pain in Adults With or at Risk for Osteoarthritis: The Multicenter Osteoarthritis Study.The Journal of rheumatology · 2025Article
- Introducing a specified on-line multimodal prehabilitation approach for total knee replacement surgery candidates using data from the COVID-19 pandemic: An exploratory field-based, pre-post, mixed methods implementation pilot study.Journal of evaluation in clinical practice · 2025Article
- Associations between changes in leg extensor muscle power and physical function after supervised exercise in patients with hip osteoarthritis. Secondary analysis from the hip booster trial.Osteoarthritis and cartilage open · 2024Article
- The Critical Role of Physical Activity and Weight Management in Knee and Hip Osteoarthritis: A Narrative Review.The Journal of rheumatology · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 4 institutions in 3 countries.
Funding
Abstract
objectivesTo evaluate mediating factors for the effect of therapeutic exercise on pain and physical function in people with knee/hip osteoarthritis (OA).
methodsFor Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA), individual participant data (IPD) were sought from all published randomised controlled trials (RCTs) comparing therapeutic exercise to non-exercise controls in people with knee/hip OA. Using the Counterfactual framework, the effect of the exercise intervention and the percentage mediated through each potential mediator (muscle strength, proprioception and range of motion (ROM)) for knee OA and muscle strength for hip OA were determined.
resultsData from 12 of 31 RCTs of STEER OA (1407 participants) were available. Within the IPD data sets, there were generally statistically significant effects from therapeutic exercise for pain and physical function in comparison to non-exercise controls. Of all potential mediators, only the change in knee extension strength was statistically and significantly associated with the change in pain in knee OA (β -0.03 (95% CI -0.05 to -0.01), 2.3% mediated) and with physical function in knee OA (β -0.02 (95% CI -0.04 to -0.00), 2.0% mediated) and hip OA (β -0.03 (95% CI -0.07 to -0.00), no mediation).
conclusionsThis first IPD mediation analysis of this scale revealed that in people with knee OA, knee extension strength only mediated ±2% of the effect of therapeutic exercise on pain and physical function. ROM and proprioception did not mediate changes in outcomes, nor did knee extension strength in people with hip OA. As 98% of the effectiveness of therapeutic exercise compared with non-exercise controls remains unexplained, more needs to be done to understand the underlying mechanisms of actions.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.