Abstract
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