Comparative Efficacy of Intra-Articular Injection, Physical Therapy, and Combined Treatments on Pain, Function, and Sarcopenia Indices in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials

Chun-De Liao; Hung-Chou Chen; Mao-Hua Huang; Tsan-Hon Liou; Che-Li Lin; Shih-Wei Huang

doi:10.3390/ijms24076078

Comparative Efficacy of Intra-Articular Injection, Physical Therapy, and Combined Treatments on Pain, Function, and Sarcopenia Indices in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials

Int J Mol Sci. 2023 Mar 23;24(7):6078. doi: 10.3390/ijms24076078.

Authors

Chun-De Liao^{1

2}, Hung-Chou Chen^{2

3}, Mao-Hua Huang⁴, Tsan-Hon Liou^{2

3}, Che-Li Lin^{5

6}, Shih-Wei Huang^{2

3}

Affiliations

¹ International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110301, Taiwan.
² Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan.
³ Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan.
⁴ Department of Biochemistry, University of Washington, Seattle, WA 98015, USA.
⁵ Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
⁶ Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.

Abstract

Knee osteoarthritis (KOA) is associated with a high risk of sarcopenia. Both intra-articular injections (IAIs) and physical therapy (PT) exert benefits in KOA. This network meta-analysis (NMA) study aimed to identify comparative efficacy among the combined treatments (IAI+PT) in patients with KOA. Seven electronic databases were systematically searched from inception until January 2023 for randomized controlled trials (RCTs) reporting the effects of IAI+PT vs. IAI or PT alone in patients with KOA. All RCTs which had treatment arms of IAI agents (autologous conditioned serum, botulinum neurotoxin type A, corticosteroids, dextrose prolotherapy (DxTP), hyaluronic acid, mesenchymal stem cells (MSC), ozone, platelet-rich plasma, plasma rich in growth factor, and stromal vascular fraction of adipose tissue) in combination with PT (exercise therapy, physical agent modalities (electrotherapy, shockwave therapy, thermal therapy), and physical activity training) were included in this NMA. A control arm receiving placebo IAI or usual care, without any other IAI or PT, was used as the reference group. The selected RCTs were analyzed through a frequentist method of NMA. The main outcomes included pain, global function (GF), and walking capability (WC). Meta-regression analyses were performed to explore potential moderators of the treatment efficacy. We included 80 RCTs (6934 patients) for analyses. Among the ten identified IAI+PT regimens, DxTP plus PT was the most optimal treatment for pain reduction (standard mean difference (SMD) = -2.54) and global function restoration (SMD = 2.28), whereas MSC plus PT was the most effective for enhancing WC recovery (SMD = 2.54). More severe KOA was associated with greater changes in pain (β = -2.52) and WC (β = 2.16) scores. Combined IAI+PT treatments afford more benefits than do their corresponding monotherapies in patients with KOA; however, treatment efficacy is moderated by disease severity.

Keywords: injection; meta-analysis; mobility; osteoarthritis; pain; physical therapy; sarcopenia.

Publication types

Meta-Analysis

MeSH terms

Exercise Therapy
Humans
Hyaluronic Acid
Injections, Intra-Articular
Network Meta-Analysis
Osteoarthritis, Knee* / drug therapy
Pain / drug therapy
Randomized Controlled Trials as Topic
Sarcopenia* / drug therapy
Treatment Outcome

Substances

Hyaluronic Acid

Abstract

Publication types

MeSH terms

Substances

Grants and funding