Fourteen randomised controlled trials (RCTs) with 760 patients were included:
1 RCT (42 patients) examined shortwave pre-exercise diathermy,
1 RCT (74 patients) examined ultrasound pre-exercise diathermy,
2 RCTs (97 patients) examined quadriceps strengthening exercise,
1 RCT (222 patients) examined stretching, strengthening andaerobic exercise,
1 RCT (70 patients) examined capsaicin,
2 RCTs (58 patients) examined laser therapy,
2 RCTs (72 patients) examined acupuncture,
3 RCTs (98 patients) examined TENS, and
1 RCT (27 patients) examined PEMF.
Of the seven therapies exercise had the strongest evidence for a beneficial effect. There were no data on the efficacy of exercise specifically for hip osteoarthritis.
Available evidence suggests that diathermy provides no benefit in terms of pain reduction or improvement in function when added to an exercise programme.
Data were insufficient to evaluate the efficacy of the other five therapies. A single trial of topical treatment with capsaicin suggests it may be useful in reducing pain associated with knee osteoarthritis. Laser treatment may also be useful in reducing the pain and disability associated with knee osteoarthritis, but additional evaluation is required in view of an unusually strong intervention effect and weak placebo effect. The trials of acupuncture gave inconsistent results. TENS studies all reported superior pain control with active treatment but all exhibited a strong placebo effect. PEMF therapy was reported to reduce pain, but the study was small and further evaluation is required.