Objectives To determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life. Design Systematic review with meta-analysis. Data sources Medline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018. Eligibility criteria for selecting studies Randomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise. Results Eight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference −1.06, 95% CI −2.01 to −0.12), but not for outcomes of pain (−0.09, 95% CI –0.96 to 0.79), patient-reported function (−0.74, 95% CI –1.56 to 0.08) or stair function (−0.7, 95% CI –1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI –0.31 to 0.56), patient-reported function (−0.15, 95% CI –0.58 to 0.29) or stair function (0.13, 95% CI –0.3 to 0.57). Conclusion Walking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.

中文翻译：

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在股四头肌锻炼中加入髋关节锻炼是否会为膝关节骨性关节炎患者带来更好的疼痛、功能和生活质量？系统评价和荟萃分析

目的 在膝关节骨性关节炎 (KOA) 患者中确定：i) 在股四头肌锻炼中加入髋部强化锻炼的效果，以及 ii) 具有改善疼痛、功能和生活质量的最大证据的髋部强化锻炼类型。设计系统回顾与荟萃分析。数据来源 Medline、Embase、Cochrane、CINAHL 和 SportDiscus 数据库从开始到 2018 年 1 月进行了搜索。 选择研究的资格标准 调查在 KOA 患者的股四头肌锻炼中加入髋关节锻炼对疼痛、功能和/或质量的影响的随机对照试验生命被包括在内。包括三个髋关节运动亚组：阻力运动、功能性神经肌肉运动或多模式运动。结果共纳入八项研究。汇总数据提供的证据表明，髋关节和股四头肌联合锻炼比单独的股四头肌锻炼更有效地改善步行功能（标准化均数差 -1.06, 95% CI -2.01 至 -0.12），但不适用于疼痛结果（-0.09, 95 % CI –0.96 至 0.79）、患者报告的功能（-0.74, 95% CI –1.56 至 0.08）或楼梯功能（-0.7, 95% CI –1.67 至 0.26）。亚组分析表明，髋部抗阻训练在改善疼痛（p<0.0001）和患者报告的功能（p<0.0001）方面比功能性神经肌肉锻炼更有效。对于疼痛（0.13, 95% CI –0.31 至 0.56）、患者报告的功能（-0.15, 95% CI –0.58 至 0.29）或楼梯功能（0.13, 95% CI – 0.3 至 0.57）。结论 在 KOA 患者中，在股四头肌强化的基础上增加髋部强化后，步行得到改善。在股四头肌上增加阻力髋关节锻炼可以更好地改善患者报告的疼痛和功能。