78, p = 0.003). The test for residual heterogeneity was not significant for pain (QE(df = 9) = 9.93, p = 0.36), but it was for function (QE(df = 9) = 18.22, p = 0.03). Moderator analyses showed that none of the potential covariates (control group, study quality, treatment delivery mode, duration of treatment period, treatment frequency, duration of treatment period

× frequency, sex, age, measurement instrument, and type of weight bearing exercise) had a significant influence on the size of the effects for pain or function. All three intervention types were effective at relieving pain and improving physical function. The effect size of exercise with Wnt inhibitor review additional manual mobilisation on pain (0.69) could be considered of moderate size, while the effect sizes of strength training (0.38) and exercise therapy alone (0.34) could be considered small. The effects on physical function selleck kinase inhibitor tended

to be smaller than those on pain, and would be considered moderate or small. Compared to the review by Fransen and McConnell (2008), our calculated effect sizes are somewhat lower, both for strength training and for exercise therapy (strength training in combination with active range of motion and aerobic exercises). This may be related to the fact that we used a different classification procedure and did not incorporate home exercise programs. Nevertheless, confidence intervals in our study were relatively

narrow, especially for pain, suggesting sufficiently reliable effect sizes. For exercise with additional manual mobilisation only two studies were included, resulting in larger confidence intervals and less reliable effect sizes. The treatments categorised to one of the three intervention types may differ in the regimen in which they were applied. None of the variables we examined, such as duration of treatment period and frequency, had a significant influence on the size of the effect. Also, whether the exercise is weight bearing was not an influencing factor, confirmed by equally significant improvements Oxygenase after weight bearing exercise and non-weight bearing exercise (Jan et al 2009). But the results may be influenced by other factors, such as kind of progression, therapy loyalty, or type of aerobic exercise. In most of the studies stationary bike was part of the treatment and in one study aerobic fitness walking (in two studies the type of aerobic exercise was not specified). It is not known if these aerobic exercises have different effects for pain or physical function. Another possible influencing factor is additional co-ordination and postural control exercise that was applied in two studies, one categorised to exercise (Thorstensson et al 2005) and one to physio/manual therapy (van Baar et al 1998).