Is there a Relationship between the Number of Consultations with a Clinician or Exercise Provider and Outcomes of Pain and Physical Function Following an Exercise Program for People with Knee Osteoarthritis?

Abstract

1. Abstract 1.1 Background Knee osteoarthritis (OA) is a common disease that presents a significant health burden, causing chronic joint pain and physical function limitation. Given that there is no cure, exercise therapy is recommended as the first-line treatment by all current international clinical guidelines. 1.2 Objectives This systematic review aimed to investigate whether the number of consultations with a clinician or exercise provider is associated with changes in pain and physical function following an exercise intervention in individuals with knee OA. 1.3 Methods We conducted a systematic review with meta-regression and subgroup meta- analyses. A comprehensive literature search was performed using three electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase, from inception until 26 February 2025, with no language restrictions. We included randomised controlled trials (RCTs) comparing exercise interventions for knee OA to no treatment, usual care, attention control/placebo, or co- interventions. The primary outcomes were changes in self-reported pain and physical function. Meta-regression were used to evaluate associations between the number of consultations and outcome changes. Additionally, subgroup meta-analyses were conducted across eight consultation-frequency groups (0, 1–3, 4–6, 7–9, 10–15, 16– 20, 21–25, and 26+ sessions). Sensitivity analyses were conducted to address potential outliers and reduce heterogeneity. 1.4 Results A total of 145 RCTs involving 12,633 participants were included. The number of consultations across studies ranged from zero to over 26 sessions. Meta-regression analyses revealed no statistically significant association between the number of consultations and changes in pain (slope coefficient = −0.003 standardised mean difference [SMD], 95% CI: −0.008 to 0.002; p = 0.203) or physical function (slop coefficient = −0.003 SMD, 95% CI: −0.008 to 0.002; p = 0.250). Subgroup meta- analyses similarly found no meaningful differences in outcomes across the different consultation-frequency groups. Substantial between-study heterogeneity was observed, and evidence of publication bias was detected. Sensitivity analyses, which excluded outliers (20 trials for pain and 24 for function with SMD > ±2), did not alter the overall findings. 1.5 Conclusion There was no association between the number of consultations and changes in pain or function following an exercise program for people with knee osteoarthritis (OA). Given the overall poor quality of the included studies, as well as the heterogeneity among studies, the findings should be interpreted with caution.A systematic review with meta-regression and meta-analysis