April Cochrane review round-up
medwireNews: The two rheumatology-related reviews published in The Cochrane Library in April investigated the role of vertebroplasty in the treatment of osteoporotic vertebral fractures, and the impact of exercise interventions in patients with osteoarthritis (OA).
In the first review, Rachelle Buchbinder (Monash University, Melbourne, Victoria, Australia) and colleagues analyzed data from 21 randomized or quasi-randomized trials comparing percutaneous vertebroplasty with placebo, usual care, or another intervention in patients with painful osteoporotic vertebral fractures. The number of participants ranged from 46 to 404, and their mean age was 62.6–81.0 years.
High- to moderate-quality evidence from five trials demonstrated that vertebroplasty provides “no clinically important benefits” relative to placebo in terms of pain, disability, quality of life, or treatment success at 1 month, say the researchers.
For example, average pain scores at the 1-month follow up were 4.4 points on a 0–10 point scale for patients receiving vertebroplasty and 5.0 points for those given placebo, translating into an absolute pain reduction of 6% with the intervention, which was below the minimal clinically important difference of 15%.
Moreover, on the basis of moderate quality evidence from seven trials with up to 2 years of follow-up, the researchers report that it is “uncertain” whether vertebroplasty increases the risk for new symptomatic vertebral fractures.
These findings “did not support a role for vertebroplasty for treating osteoporotic vertebral fractures in routine practice,” conclude Buchbinder and colleagues.
The authors of the second review, Michael Hurley (St George’s, University of London and Kingston University, UK) and co-workers, synthesized data from 2372 patients with hip and/or knee OA who participated in 21 trials investigating the effect of exercise programs on pain or function and at least one psychosocial outcome. Comparator groups in the trials were varied and included usual care, wait-list controls, and education.
The team found moderate quality evidence supporting a beneficial effect of exercise on pain and physical function. After approximately 45 weeks, patients who took part in an exercise intervention had a mean pain score of 5.3 points on the 0–20 point Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale, compared with 6.5 points for those given a control intervention. Average WOMAC physical function scores (where lower scores indicate better function) were 44.3 points in the intervention group at the 41-week follow-up, compared with 49.9 points for the control groups. These results translated into a significant 6.0% improvement in pain and a significant 5.6% improvement in physical function for those in the exercise group.
Furthermore, participants who received exercise interventions had increased confidence in their physical ability, felt less depressed, and had better social interaction than those in the control groups, say the researchers.
Hurley and colleagues summarize that patients who took part in exercise programs “had positive experiences” overall, and conclude that “[p]roviding reassurance and exercise advice, challenging poor health beliefs, and providing enjoyable exercise programmes may encourage participation and benefit the health of many people.”
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