OBJECTIVE: To assess the effectiveness of weight-loss interventions on pain and disability in people with knee and hip osteoarthritis (OA) and spinal pain.
DESIGN: Intervention systematic review.
LITERATURE SEARCH: Twelve online databases and clinical trial registries.
STUDY SELECTION CRITERIA: Randomized controlled trials of any weight-loss intervention (eg, diet, physical activity, surgical, pharmaceutical) that reported pain or disability outcomes in people with knee or hip OA or spinal pain.
DATA SYNTHESIS: We calculated mean differences or standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Cochrane risk of bias tool to assess risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation tool to judge credibility of evidence.
RESULTS: Twenty-two trials with 3602 participants were included. There was very low- to very low-credibility evidence for a moderate effect of weight-loss interventions on pain intensity (10 trials, n = 1806; SMD, -0.54; 95% CI: -0.86, -0.22; I2 = 87%, P<.001) and a small effect on disability (11 trials, n = 1821; SMD, -0.32; 95% CI: -0.49, -0.14; I2 = 58%, P<.001) compared to minimal care for people with OA. For knee OA, there was low- to moderate-credibility evidence that weight-loss interventions were not more effective than exercise only for pain intensity and disability, respectively (4 trials, n = 673; SMD, -0.13; 95% CI: -0.40, 0.14; I2 = 55%; 5 trials, n = 737; SMD, -0.20; 95% CI: -0.41, 0.00; I2 = 32%).
CONCLUSION: Weight-loss interventions may provide small to moderate improvements in pain and disability for OA compared to minimal care. There was limited and inconclusive evidence for weight-loss interventions targeting spinal pain. J Orthop Sports Phys Ther 2020;50(6):319-333. Epub 9 Apr 2020. doi:10.2519/jospt.2020.9041.
|Rehab Clinician (OT/PT)|
This interesting and well documented review of previous studies analysed the effect of exercise vs weight loss in patients with musculoskeletal disorders.
Although clinicians may think the finding is common sense, they may not be aware of the number of studies that have investigated this, the quality of the evidence, and the magnitude of the effect.
I don't feel that this is necessarily novel information; although, there may not be extensive research to back it up. I do feel that most clinicians in my field are aware that losing weight will help alleviate symptoms.
The findings for back pain vs hip/knee OA are interesting. It appears that current weight loss measures/studies have not been able to demonstrate substantial weight loss, but the amount of weight loss in the effect size is proportional to the change in pain and disability.