Effects of exercise on physical function and pain in adults with rheumatoid arthritis: an exit meta-analysis of randomized controlled trials.

The most recent American College of Rheumatology Guidelines concluded, based on meta-analyses, that moderate certainty evidence from randomized controlled trials (RCT) existed to recommend that exercise, compared to no exercise, increased physical function and reduced pain in adults with rheumatoid arthritis (RA). However, effect size stability was not quantitatively established. To address this gap, the purpose of this study was to use quantitative methods to determine whether further RCT and meta-analyses are needed or stability has been reached. Using meta-analytic data from these guidelines, a recently developed and novel approach, the Doi-Abdulmajeed Trial Stability (DAts) index was used to determine effect size stability, i.e., exit status, of exercise on physical function and pain in adults with RA. A DAts < 0 = exit, 0-0.05 = possibly exit, and > 0.05 = no exit. Across all types of exercise, the DAts index was 0.0095 for physical function (20 studies, 1487 participants) and 0.0018 for pain (14 studies, 998 participants), suggesting possible exit status. These findings add to the American College of Rheumatology Guidelines assessment of "moderate" strength of evidence rating, suggesting that additional RCT and subsequent meta-analyses are needed on the effects of exercise on physical function and pain in adults with RA before true stability/exit status can be reached. Key Points • A novel quantitative method was used to examine the stability, i.e., exit status, of exercise on physical function and pain in adults with rheumatoid arthritis (RA). • Only "possible exit" status was found for the eff ects of exercise on physical function and pain in adults with RA. • Additional studies are needed on the eff ects exercise on physical function and pain in adults with RA before stability can be determined.