Review article (meta-analysis)Ottawa Panel Evidence-Based Clinical Practice Guidelines for Aerobic Walking Programs in the Management of Osteoarthritis
Section snippets
Protocols and Registration
The development process of the EBCPGs was similar to that of the Philadelphia Panel and other EBCPGs created by the Ottawa Panel.12 The methodology of this project followed the Preferred Reporting Items for Systematic and Meta-Analyses17 checklist from the Journal of the American Physical Therapy Association, the Ottawa Expert Panel methods, and used a quantitative grading system.
In conjunction with the methodology of previous Ottawa Panel publications,18 the construction of the EBCPGs was
Study Selection
The literature search found 719 potential records (see appendix 2). The reviewers (L.L. and G.M.) screened 88 eligible articles on aerobic walking programs and OA. According to the selection criteria (see table 2), 10 full-text articles were included and 78 articles were excluded for the following reasons (appendix 4): no walking program intervention in 31 trials28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58 dropout
Discussion
The Ottawa Panel created an EBCPG with this systematic review of aerobic walking programs in the management of OA of the knee. In this systematic review, the Ottawa Panel developed recommendations based on 7 out of 10 comparative controlled studies with higher quality (with a Jadad scale score of 3/5).25, 26, 27, 99, 101, 103, 104 The Ottawa Panel concluded that aerobic walking combined with stretching and strengthening exercises, education, and/or behavior programs are recommended to improve
Conclusions/Clinical Implications
The Ottawa Panel found important evidence to support the use of aerobic walking programs in the management of OA, for subjects aged over 40 years who are diagnosed with mild to moderate OA of 1 or both knees. Evidence from 7 high-quality studies demonstrates that facility, hospital, and home-based aerobic walking programs with other therapies are effective interventions in the shorter term for the management of patients with OA to improve stiffness, strength, mobility, and endurance. Moreover,
Acknowledgments
The Ottawa EBCPGs Development Group thanks the following people for their technical support and support with data extraction and data analysis: France Légaré, MD, PhD, Catherine Caron, MD, Martha Hall, MSc, Alison Marshall, MA, Gabrielle Ménard, BSc, Lilliane Francoeur, BSc, Courtney Cohoon, MA, Karen Hidalgo, MScS, Adam Teav, BSc, George Gray, BSc, Catherine Lamothe, BSc, Judith Robitaille, BSc, Lucie Lavigne, BSc, Michel Boudreau, BSc, Guillaume Michaud, BSc, Michelle Vaillant, MSc, Chantal
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2019, Gait and PostureCitation Excerpt :Walking exercise is a commonly suggested conservative treatment strategy that has shown to be effective in reducing pain and improving function in patients with knee OA [2,3]. Current recommendations by clinical practice guidelines advocate for at least 30 min of moderate intensity aerobic exercise, such as walking [4,5], with further participation above the minimum recommendations being encouraged for additional health benefits [6]. Despite the general systemic benefits of walking exercise, it has been hypothesized that prolonged walking in patients with knee OA could lead to excessive knee joint loading due to quadriceps muscle fatigue and loss of effective shock absorption [7].
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Supported by the Canadian Institute of Health Research, The Arthritis Society, the Ontario Ministry of Health and Long-Term Care (Canada), The University of Ottawa, Faculty of Health Sciences, and the Ministry of Human Resources, Summer Students Program (Canada).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
The Ottawa Panel Includes: Mary Egan, PhD,1 Claire-Jehanne Dubouloz, PhD,1 Judy King, PhD,1 Lynn Casimiro, PhD,4 Sydney Brooks-Lineker, PhD,6 Mary Bell, MD,7 Hillel M. Finestone, MD,8 Lucie Laferrière, MHA,9 Angela Haines-Wangda, MSc,10 Marion Russell-Doreleyers, MSc,6 Vivian A. Welch, PhD,2,3 Sarah Milne, MSc,1 Lisa Levesque, BSc,1 Daniel Sredic, BSc,1 Laura Trafford, BSc,1 Jessica McEwan, MLIS,5 Guy Longchamps.11
From the 1School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; 2Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, Ottawa, ON, Canada; 3Centre for Global Health, Institute of Population Health, Ottawa, ON, Canada; 4Department of Academic Affairs, Montfort Hospital, Ottawa, ON, Canada; 5University of Ottawa Health Sciences Library, Ottawa, ON, Canada; 6The Arthritis Society, Ontario Division, Canada; 7Continuing Education and Knowledge Transfer, University of Toronto, Toronto, ON, Canada; 8SCO Health Services, Elisabeth Bruyère Health Centre, Ottawa, ON, Canada; 9Directorate Force Health Protection, Canadian Forces Health Services Group Headquarters, National Defense, Ottawa, ON, Canada; 10The Ottawa Hospital, General Campus, Ottawa, ON, Canada; 11Consumer expert.