Effectiveness of behavior graded activity on exercise adherence and physical activity in hip and knee osteoarthritis - A systematic review

Background: Osteoarthritis (OA) has a major impact on daily life and often leads to avoidance of physical activity. A lack of regular physical activity in people with OA of the hip or knee is an important risk factor for further functional decline. Recently developed and evaluated exercise program called the behavioral graded activity (BGA) program acts as an approach to enhance adherence to exercises that lead to a more physically active lifestyle. The purpose of this systematic review is to identify Randomized Controlled Trials (RCT) on BGA interventions for hip and knee OA and to provide summary of current evidence. Methods: The database searched with the keywords (knee osteoarthritis, hip osteoarthritis, behavior graded activity, behavior physical therapy, physical activity), in Cochrane Library (Cochrane Database of Systematic Reviews), PubMed, MEDLINE Plus, PEDro and CINAHL for studies published from January 2000 to May 2011. The randomized controlled trials included in the study assessed the effect of behavioral graded activity on hip and knee osteoarthritis. Results: Four RCTs meeting the qualitative levels of evidence based on the grading system described by Tugwell and O'Shea (2004) and recommended by the Cochrane Musculoskeletal Group were considered for analysis and the results were projected. Conclusion: There is a silver level evidence that the BGA results in better exercise adherence and more physical activity than usual care in people with OA of the hip and knee, both in the short- and long-term.