| Author, Year, Followup,a Pain Duration, Study Quality | Intervention | Population | Function and Pain Outcomes | Other Outcomes |
|---|---|---|---|---|
Abbott, 201347 9.75 months Duration of diagnosis: Mean 2.5 to 2.8 years Fair | A. Exercise (n=51/29 knee OA): 7 sessions of strengthening, stretching, and neuromuscular control over 9 weeks, with 2 booster sessions at week 16. Individual exercises prescribed as needed. Home exercise prescribed 3 times weekly B. Usual care (n=51/28 knee OA) | A vs. B (total population, includes hip OA) Age: 67 vs. 66 years Female: 52% vs. 58% Percent hip OA: 43% vs. 45% Percent knee OA: 57% vs. 55% Percent both hip OA and knee OA: 20% vs. 26% Baseline WOMAC (0−240): 95.5 vs. 93.8 | A vs. B (knee OA only) A vs. C 9.75 months WOMAC mean change from baseline: −12.7 vs. −31.5 | None |
Allen, 201868 3, 6, and 12 months Duration of pain: NR Fair [New trial] | A. PT (n=140): Up to 8 sessions over 4 months B. IBET (n=142): Strength and stretching (3 times/week) and daily aerobic exercises C. WL (n=68) All Patients: continued to received usual care | A vs. B vs. C Age: 66 vs. 65 vs. 64 years Female: 71% vs. 69% vs. 78% Mean duration of chronicity: 11.6 vs.14.1 vs. 14.2 years Baseline WOMAC-Total (0-96): 32 vs. 31.3 vs. 33.6 Baseline WOMAC-ADL (0-68): 22.6 vs. 21.8 vs. 23.9 Baseline WOMAC-Pain (0-20): 6.1 vs. 6.0 vs. 6.2 Baseline PASE-Total (0-400): 121.4 vs. 132.3 vs. 126.9 Baseline PASE-Household: 70.4 vs. 81.6 vs. 71.8 Baseline PASE-Leisure: 20.9 vs. 22.4 vs. 21.5 Baseline PASE-Work: 29.1 vs. 30.5 vs. 34.2 | A vs. C 8/12 monthsb LSM Δ in WOMAC Total (N=348): −4.4 (95% CI −6.7 to −2.2) vs. −2.8 (95% CI −5.9 to 0.3); difference −1.6 (95% CI −5.3 to 2.1), p=0.390 LSM Δ in WOMAC-ADL (N=348): −3.3 (95% CI −4.9 to −1.7) vs. −1.5 (95% CI −3.8 to 0.7); difference −1.8 (95% CI −4.4 to 0.9), p=0.1900 LSM Δ in WOMAC-Pain (N=350): −0.7 (95% CI −1.2 to −0.2) vs. −0.6 (95% CI −1.4 to 0.1); difference −0.1 (95% CI −0.9 to 0.8), p=0.900 LSM Δ in PASE-Total (N=340): 8.3 (95% CI −2.0 to 18.6) vs. 1.2 (95% CI −13.1 to 15.5); difference 7.1 (95% CI −9.7 to 23.9), p=0.410 LSM Δ in PASE-Leisure (N=344): 8.7 (95% CI 4.3 to 13.1) vs. −0.1 (95% CI −6.3 to 6.0); difference 8.8 (95% CI 1.5 to 16.1), p=0.020 LSM Δ in PASE-Household (N=345): 2.3 (95% CI −3.6 to 8.2) vs. −3.4 (95% CI −11.6 to 4.8); difference 5.7 (95% CI −3.9 to 15.4), p=0.250 LSM Δ in PASE-Work (N=349): −2.6 (95% CI −9.6 to 4.3) vs. 5.2 (95% CI −4.5, 15); difference −7.9 (95% CI −19.4 to 3.6), p=0.180 B vs. C 12 months LSM Δ in WOMAC-Total (N=348): −5.5 (95% CI −7.8 to −3.1) vs. −2.8 (95% CI −5.9 to 0.3); difference −2.6 (95% CI −6.4 to 1.1), p=0.170 LSM Δ in WOMAC-ADL (N=348): −3.4 (95% CI −5.1 to −1.7) vs. −1.5 (95% CI −3.8 to 0.7); difference −1.9 (95% CI −4.6 to 0.8), p=0.170 LSM Δ in WOMAC-Pain (N=350): −1.2 (95% CI −1.7 to −0.6) vs. −0.6 (95% CI −1.4 to 0.1); difference −0.5 (95% CI −1.4 to 0.4), p=0.260 LSM Δ in PASE-Total (N=340): 8.2 (95% CI −3.0 to 19.4) vs. 1.2 (95% CI −13.1 to 15.5); difference 7.0 (95% CI −10.3 to 24.4), p=0.430 LSM Δ in PASE-Leisure (N=344): 7.7 (95% CI 2.9 to 12.4) vs. −0.1 (95% CI −6.3 to 6.0); difference 7.7 (95% CI 0.3 to 15.3), p=0.040 LSM Δ in PASE-Household (N=345): −3.7 (95% CI −10.1 to 2.7) vs. −3.4 (95% CI −11.6 to 4.8); difference D −0.3 (95% CI −10.3 to 9.7), p=0.950 LSM Δ in PASE-Work (N=349): 5.3 (95% CI −2.2 to 12.7) vs. 5.2 (95% CI −4.5 to 15); difference 0.00 (95% CI −11.8 to 11.8), p=1.000 | None |
Bennell, 200548 3 months Duration of pain: 9.6 vs. 8.7 years Fair | A. Neuromuscular Re-education (Physiotherapy) (n=73): Knee taping; exercises to retrain the quadriceps, hip, and back muscles; balance exercises; thoracic spine mobilization; and soft tissue massage. individual sessions lasting 30 to 45 minutes once weekly for 4 weeks, then fortnightly for 8 weeks. Thrice-daily standardized home exercises. B. Control (n=67) Placebo: sham ultrasound and topical nontherapeutic gel. 30 to 45 minutes once weekly for 4 weeks, then fortnightly for 8 weeks. | A vs. B Age: 67 vs. 70 years Female: 68% vs. 66% Baseline WOMAC Physical Function (0-68): 27.6 vs. 28.4 Baseline WOMAC Pain (0-20): 8.2 vs. 8.0 Baseline VAS Pain on movement (0-10): 5.3 vs. 5.2 Baseline KPS (0-36): 16.6 vs. 16.4 Baseline KPS Frequency (0-30): 23.5 vs. 22.8 | A vs. B 3 months Responders (≥1.75 point change), global improvement in pain on VAS (since start of trial): 59% (35/59) vs. 50% (33/65), RR 1.2 (95% CI 0.8 to 1.6) Responders (≥1.75 point change), VAS pain on movement (prior week): 58% (34/59) vs. 42% (27/65), RR 1.4 (95% CI 1.0 to 2.0 WOMAC, Physical Function: 20.0 vs. 21.7, difference −0.9 (95% CI −4.4 to 2.7) WOMAC, Pain: 5.8 vs. 6.0, difference −0.4 (95% CI −1.5 to 0.7) VAS pain on movement: 3.2 vs. 3.5, difference −0.5 (95% CI −1.2 to 0.3) KPS, Severity: 13.5 vs. 14.3, difference −1.0 (95% CI −2.5 to 0.6) KPS, Frequency: 19.4 vs. 20.3, difference −1.7 (95% CI −3.5 to 0.1) | A vs. B 3 months SF-36, Physical Function (0-100): 50.5 vs. 46.2, difference 4.3 (95% CI −1.8 to 10.4) SF-36, Bodily Pain (0-100): 60.4 vs. 61.8, difference 1.8 (95% CI −6.7 to 10.3) SF-36, Role Physical (0-100): 47.0 vs. 46.5, difference 1.6 (95% CI −11.1 to 14.3) AQoL(−0.04 to 1.0): 0.52 vs. 0.48, difference 0.05 (95% CI 0.01 to 0.10) Withdrawals: 18% (13/73) vs. 3% (2/67); RR 6.0 (95% CI 1.4, 25.5) Group A: Minor skin irritation (48%), increased pain with exercises (22%), pain with massage (1%) Group B: Increased pain (2%), itchiness and pain with application of gel (2%) (All were minor and short-lived) |
Chen, 201449 6 months Duration of pain: 10-144 months Poor | A. Exercise (n=30): 3 sessions per week for 8 weeks. Sessions consisted of a 20 minutes of hot packs and 5 minutes of passive range of motion exercises on a stationary bike, followed by an isokinetic muscle-strengthening exercise program B. Control (n=30): Details NR | A + B Age: 63 Females: 85% A vs. B Baseline Lequesne Index (0-26): 7.8 vs. 8.0 Baseline pain VAS (0-10): 5.5 vs. 5.6 | A vs. B 6 months Lequesne Index: 5.4 vs. 7.6, (difference −2.2, 95% CI −3.1 to −1.3) Pain VAS: 4.0 vs. 6.5, (difference −2.5, 95% CI −3.3 to −1.7) | A vs. B 6 months Intolerable knee pain: 10% (3/30) vs. 0% (0/30) RR=infinity, p=0.08 |
Dias, 200350 6 months Duration of pain: NR Poor | A. Exercise (n=25): 12 exercise sessions twice a week for the 6 month study period in addition to three supervised walks of 40 minutes each week. Exercise sessions consisted stretching, concentric and eccentric isotonic progressive resistance exercises, and closed kinetic chain weight-bearing exercises B. Control group (n=25): Subjects were instructed to follow the instructions given at an educational session that all participants attended (see information below) All patients: One-hour educational session consisting of a lecture on disease characteristics, joint protection, pain management, and strategies to overcome difficulties in activities of daily life | A vs. B Age, median: 74 vs. 76 Female: 84% vs. 92% Baseline Lequesne Index, median (0-24): 12 vs. 12.5 Baseline HAQ, median (0-3): 1 vs. 1 | A vs. B 6 months Lequesne Index, median: 4.3 vs. 13, p=0.001 HAQ, median: 0.3 vs. 1.1, p=0.006 | A vs. B 6 months SF-36 functional capacity, median (0-100): 77.5 vs. 40, p<0.001 SF-36 physical role limitation, median (0-100): 92.5 vs. 75, p=0.001 SF-36 bodily pain, median (0-100): 100 vs. 0, p=0.002 SF-36 general health, median (0-100): 100.5 vs. 51, p=0.021 SF-36 vitality, median (0-100): 93.5 vs. 87, p=0.027 Adverse Events: NR |
Ettinger, 199751 (index trial) Pennix 200258 (substudy looking at baseline depressive symptoms) FAST trial 6 months, 15 months Duration of pain: NR Fair | A. Aerobic Exercise Program (n=144): 3-month facility-based walking program of 3 times per week for 1 hour. Each session consisted of a 10-minute warm-up and cool-down phase, including slow walking and flexibility stretches, and a 40-minute period of walking at an intensity equivalent to 50% to 70% of the participants’ heart rate reserve. Followed by 15-month home-based walking program. B. Resistance Exercise Program (n=146): 3-month supervised facility-based program, with three 1-hour sessions per week, and a15-month home-based program. Each session consisted of a 10-minute warm-up and cool-down phase and a 40-minute phase consisting of 2 sets of 12 repetitions of 9 exercises. C. Attention Control (n=149): attended, during the first 3 months, monthly group sessions on education related to arthritis management, including time for discussions and social gathering. Later, participants were called bimonthly (months 4-6) or monthly (months 7-18) to maintain health updates and provide support | A vs. B vs. C Age: 69 vs. 68 vs. 69 years Female: 69% vs. 73% vs. 69% African-American: 24% vs. 28% vs. 26% Baseline function: NR | A vs. C Average across all time-points: FAST Physical Disability Scale Total: 1.7 vs. 1.9 Ambulation subscale: 2.2 vs. 2.6 Transfers subscale: 1.8 vs. 1.9 Pain: 2.1 vs. 2.4 B vs. C Average across all time-points: FAST Physical Disability Scale Total: 1.7 vs. 1.9 Ambulation subscale: 2.7 vs. 2.6 Transfers subscale: 1.7 vs. 1.9 Pain: 2.2 vs. 2.4 | A vs. B vs. C Adverse Events: Falls- 14% (2/144) vs. 14% (2/146) vs. 0% (0/149); p=0.15 for both A vs. C and B vs. C Death- 0% (0/144) vs. 0% (0/146) vs. 0.7% (1/149) CES-D (average across all time-points) CES-D: 2.12 vs. 2.59 vs. 2.80; A vs. C, p<0.001; B vs. C, p=0.27 |
Penninx, 200157 FAST trial (same trial as Ettinger 1997 and Pennix 2002 above): substudy in only patients with no baseline ADL disability 6 and 15 months Duration of pain: NR Fair | A. Aerobic Exercise Program (n=88): 3-month facility-based walking program of 3 times per week for 1 hour. Each session consisted of a 10-minute warm-up and cool-down phase, including slow walking and flexibility stretches, and a 40-minute period of walking at an intensity equivalent to 50% to 70% of the participants’ heart rate reserve. Followed by 15-month home-based walking program. B. Resistance Exercise Program (n=82): 3-month supervised facility-based program, with three 1-hour sessions per week, and a15-month home-based program. Each session consisted of a 10-minute warm-up and cool-down phase and a 40-minute phase consisting of 2 sets of 12 repetitions of 9 exercises. C. Attention Control (n=80): attended, during the first 3 months, monthly group sessions on education related to arthritis management, including time for discussions and social gathering. Later, participants were called bimonthly (months 4-6) or monthly (months 7-18) to maintain health updates and provide support | A vs. B vs. C Age: 70 vs. 69 vs. 69 years Female: 66% vs. 72% vs. 66% African-American: 25% vs. 21% vs. 28% Baseline disability (scale NR): 1.7 vs. 1.7 vs. 1.6 Baseline pain intensity (1-6): 2.2 vs. 2.1 vs. 2.1 | A vs. B vs. C 15 months ADL Disability (overall): 36.4% vs. 37.8% vs. 52.5% Disability in transferring from a bed to a chair: 29.5% vs. 36.6% vs. 50.0% Disability in bathing: 12.5% vs. 13.4% vs. 27.5% Disability in toileting: 19.4% vs. 13.4% vs. 25.0% Disability in dressing: 5.7% vs. 7.3% vs. 17.5% Disability in eating: 0% vs. 1.2% vs. 5.0%, p=0.02 15 months ADL Disability (overall) A vs. C: adjusted RR 0.53 (95% CI 0.33 to 0.85), B vs. C: adjusted RR 0.60 (95% CI 0.38 to 0.97), Disability in transferring from a bed to a chair A vs. C: adjusted RR 0.46 (95% CI 0.28 to 0.76) B vs. C: adjusted RR 0.68 (95% CI 0.42 to 1.09) Disability in bathing A vs. C: adjusted RR 0.31 (95% CI 0.15 to 0.68) B vs. C: adjusted RR 0.44 (95% CI 0.21, 0.93) Disability in toileting A vs. C: adjusted RR 0.58 (95% CI 0.29 to 1.15) B vs. C: adjusted RR 0.61 (95% CI 0.28 to 1.31) Disability in dressing A vs. C: adjusted RR 0.20 (95% CI 0.07 to 0.64) B vs. C: adjusted RR 0.46 (95% CI 0.17 to 1.22) Disability in eating: incidence too small to calculate risks. | A vs. B vs. C 15 months Increased severity of knee OA leading to withdrawal: n=3 (not reported by exercise group) |
Holsgaard-Larsen 2017/2018102,103 10 months Duration of pain: NR Fair [New trial] | A. NEMEX (n=47): 8 weeks of twice weekly 60-minute sessions. B. Standard Pharmaceutical Care (PHARMA) (n=46): Standard recommendations of analgesics and anti-inflammatory drugs (acetaminophen and oral NSAIDs – including prescription if needed) | A vs. B Age: 58 vs. 58 Female: 62% vs. 54% Baseline KOOS-ADL (0-100): 68.2 vs. 68.4 Baseline KOOS-Symptoms (0-100): 66.1 vs. 66.6 Baseline KOOS-Sports/Recreation (0-100): 35.3 vs. 42.6 Baseline UCLA (0-10): 7.1 vs. 6.8 Baseline KOOS-Pain (0-100): 61.6 vs. 60.1 | A vs. B 10 months Mean Δ in KOOS-ADL: 11.4 vs. 7.9; difference −3.6 (95% CI −9.2 to 2.1) p=0.216 MCID KOOS-ADL: number of responders (>10 improvement): 47% (22/47) vs. 28% (13/46); RR 1.7, 95% CI 1.0 to 2.9, p=0.06 Mean Δ in KOOS-Sports/Recreation: 9.4 vs. 6.5; difference −2.9 (95% CI −11.4 to 5.5) p=0.492 Mean Δ in KOOS-Symptoms: 10.9 vs. 3.3; difference −7.6 (95% CI −12.7 to −2.6) p=0.004 Mean Δ in UCLA: 0.0 vs. 0.1; difference 0.1 (95% CI −0.6 to 0.7) p=0.852 Mean Δ in KOOS-Pain: 13.6 vs. 9.4; difference 4.2 (95% CI −10.0 to 1.6) p=0.153 | A vs. B 10 months Mean Δ in KOOS-QoL (0-100): 10.0 vs. 8.7; difference −1.3 (95% CI −7.5 to 4.9) p=0.682 Mean Δ in EuroQol-5D Health State (scale unclear): 0.3 vs. 2.9; difference 2.6 (95% CI −2.9 to 8.1) p=0.347 |
Huang, 200353 10 months Duration of pain: range, 0.33 (4 months) to 9 years Poor | A. Isokinetic Strengthening (n=33): 3 sessions per week for 8 weeks. 60% of average peak torque the initial dose of isokinetic exercise. An increasing dose program was used in the initial first to fifth sessions (1 set to 5 sets), and a dose of 6 sets was applied from 6th to the 24th sessions. Each set consists of 5 repetitions of concentric and eccentric contraction in angular velocity 30°/second and 120°/second for extensors, and 5 repetitions of eccentric and concentric contraction in angular velocity 30°/second and 120°/second for flexors. B. Isotonic Strengthening (n=33): same protocol as in the isokinetic exercise; the isotonic muscle strengthening exercise program consisted of 5 repetitions of concentric and eccentric the maximum velocity that the lever arm could achieve. C. Isometric Strengthening (n=33): protocol as in the isokinetic exercise; the speed of passive forward or backward motion was set at 30°/second. All intervention groups exercised 3 times weekly for 8 weeks. The patients in all groups also received 20 minutes of hot packs and passive range motion exercise by an electric stationary bike (20 cycles per minute) for 5 minutes to both knees before muscle strengthening exercise. D. Control (n=33) Description NR | A+B+C+D Age: 62 years Female: 70% A vs. B vs. C vs. D Baseline Lequesne Index (0-26): 6.9 vs. 7.1 vs. 6.8 vs. 7.2 Baseline VAS pain (0-10): 4.8 vs. 4.6 vs. 4.7 vs. 4.6 | A vs. D 10 months Lequesne Index: 3.1 vs. 7.6, difference −4.5 (95% CI −5.3 to −3.7), VAS Pain: 2.5 vs. 6.1; p<0.05 B vs. D 10 months Lequesne Index: 3.1 vs. 7.6, difference −3.6 (95% CI −4.4 to −2.8) VAS Pain: 2.0 vs. 6.1; p<0.05 C vs. D 10 months Lequesne Index: 4.8 vs. 7.6, difference −2.8 (95% CI −3.6 to −2.0) VAS Pain: 3.2 vs. 6.1; p<0.05 | A vs. B vs. C vs. D 10 months Withdrawals: 3% (1/33) vs. 6% (2/33) vs. 3% (1/33) vs. 18% (6/33) A vs. D: 0.17 (0.02, 1.3) B vs. D: 0.33 (0.07,1.53) C vs. D: 0.17 (0.02, 1.3) Stopped therapeutic exercise due to intolerable pain during exercise: 12.1% (4/33) vs. 6.1% (2/33) vs. 6.1% (2/33) |
Huang, 200554 10 months Duration of pain: 0.42 (5 months) to 12 years Fair | A. Isokinetic Exercise (n=35): 3 times per week for 8 weeks. Began with 60% of the mean peak torque, increasing dose program was used in the first 5 sessions (1 set to 5 sets), and a dose of 6 sets was applied from the 6th to 24th sessions, with the density rising from 60% to 80% of the mean peak torque as the patient was able. Each set consisted of 5 repetitions of concentric contraction in angular velocities of 30°/second and 120°/second for extensors, and 5 repetitions of eccentric and concentric (Ecc/Con) contractions in angular velocities of 30°/second and 120°/second for flexors. B. Control (n=35): Warm-up exercises only | A+B Age: 65 years Female: 81% A vs. B Baseline Lequesne Index (1-26): 7.6 vs. 7.4 Baseline VAS pain (0-10): 5.3 vs. 5.4 | A vs. B 10 months Lequesne Index: 5.8 vs. 8.1, difference −2.3 (95% CI −3.2 to −1.4) VAS Pain: 3.9 vs. 6.6, p<0.05 | A vs. B 10 months Withdrawals 11% (4/35) vs. 11% (4/35) Discontinuation of exercise due to intolerable pain during exercise: 14% (5/35) vs. NA |
Huang 200552 10 months Duration of pain: 0.5 (6 mos.) to 11 years Fair | A. Isokinetic Exercise (n=30): 3 times per week for 8 weeks. Began with 60% of the average peak torque. Intensity of isokinetic exercise increased from 1 set to 5 sets during the first through fifth sessions and remained at 6 sets for the remaining 6th through 24th sessions. Each set consisted of 5 repetitions of concentric contraction in angular velocities of 30°/s and 120°/s for extensors, and 5 repetitions of eccentric and concentric contractions in angular velocities of 30°/s and 120°/s for flexors. B. Control (n=30): Heat for 20 minutes and 5 minutes of passive range of motion on bike only. | A+B Age: 62 (range, 42-72) years Female: 81% A vs. B Baseline Lequesne Index(1-26): 6.7 vs. 7.0 Baseline VAS pain (0-10): 4.9 vs. 4.8 | A vs. B 10 months Lequesne Index: 5.1 vs. 7.8, difference −2.7 (95% CI −3.8 to −1.6) VAS Pain: 3.5 vs. 6.0; p<0.05 | A vs. B 10 months Withdrawals 13% (4/30) vs. 13% (4/30) Discontinuation of exercise due to intolerable pain during exercise: 17% (5/30) vs. NA |
Lund, 200855 3 months Duration of pain: 8.5 vs. 7.8 vs. 4.5 Fair | A. Aquatic Exercise (n=27): 2x per week for 8 weeks. Warm-up, strengthening and endurance exercise, balance exercise and stretching exercise. Each session lasted 50 min, comprising 10 min warm-up, 20 min resistance exercises, 10 min balance and stabilizing exercises, 5 min lower limb stretches and 5 min cool-down period. Compliance was 92%. B. Land-based Exercise (n=25): 2x per week for 8 weeks. Warm-up, strengthening/endurance exercise, balance exercise and stretching exercise. Each session lasted 50 min, comprising 10 min warm-up, 20 min resistance exercises, 10 min balance and stabilizing exercises, 5 min lower limb stretches and 5 min cool-down period. Compliance was 85%. C. Control (n=27): No exercise All 3 groups were asked to continue any other treatment as usual. | A vs. B vs. C Age: 65 vs. 68 vs. 70 years Female: 83% vs. 88% vs. 66% Baseline KOOS symptom (0-100): 50.5 vs. 50.9 vs. 50.1 Baseline KOOS pain (0-100): 47.1 vs. 41.0 vs. 37.9 Baseline KOOS Activities of Daily Living (0-100): 44.7 vs. 40.6 vs. 39.6 Baseline KOOS Sport (0-100): 79.1 vs. 75.6 vs. 70.0 Baseline KOOS Quality of Life (0-100): 63.7 vs. 57.0 vs. 60.8 Baseline VAS pain at rest (0-100): 29.8 vs. 23.3 vs. 15.5 Baseline VAS pain during walking (0-100): 59.8 vs. 53.0 vs. 48.5 | A vs. C 3 months KOOS symptom: 64.1 vs. 63.7; difference 0.5 (95% CI −6.6 to 7.6) KOOS Activities of Daily Living: 63.0 vs. 61.4; difference 1.6 (95% CI −5.7 to 8.9) KOOS sport: 24.2 vs. 23.5; difference 0.7 (95% CI −9.3 to 10.7) KOOS quality of life: 42.8 vs. 41.4; difference 1.7 (95% CI −5.4 to 8.2) KOOS pain: 60.7 vs. 62.6; difference −1.5 (95% CI −8.7 to 5.8) VAS pain at rest: 18.1 vs. 23.8; difference −5.7 (95% CI −13.3 to 2.0) VAS pain: 52.9 vs. 58.3; difference −5.4 (95% CI −16.2 to 5.4) B vs. C 3 months KOOS symptom: 66.1 vs. 63.7; difference 2.4 (95% CI −4.8 to 9.5) KOOS Activities of Daily Living: 63.9 vs. 61.4; difference 2.5 (95% CI −5.0 to 9.9) KOOS sport: 31.6 vs. 23.5; difference 8.1 (95% CI −2.0 to 18.2) KOOS quality of life: 43.1 vs. 41.4; difference 1.7 (95% CI −5.3 to 8.7) KOOS pain: 62.0 vs. 62.6; difference −0.3 (95% CI −7.5 to 7.0) VAS pain at rest: 15.6 vs. 23.8; difference −8.1 (95% CI −15.8 to −0.4) VAS pain walking: 50.1 vs. 58.3; difference −8.2 (95% CI −19.7 to 2.7) | A vs. B vs. C 3 months Withdrawals: 4% (1/27) vs. 20% (5/25) vs. 7% (2/27) A vs. C: RR 0.5 (95% CI 0.05, 5.2) B vs. C: RR 2.5 (95% CI 0.6, 12.7) Increased pain during and after exercise: 11% (3/27) vs. 32% (8/25) vs. NR Swollen knees: 0% (0/27) vs. 12% (3/25) vs. NR Withdrawals due to adverse events: 0% (0/27) vs. 12% (3/25) vs. NR |
Mat, 201770 Immediately post-treatment (6 months) Duration of pain: NR Fair [New trial] | A. Home Based Balance and Exercise Program [Modified Otago Exercise Program] (n=17): Encouraged to train 3 times/week, in 30 minute sessions for 6 month period. B. Usual Care (n=24) | A vs. B Age: 76 vs. 72, p=0.02 Female: 82.4% vs. 82.4% Baseline KOOS-ADL (0-100): 65.1 vs. 79.7 Baseline KOOS-Sport/Recreation (0-100): 33.8 vs. 57.1 Baseline KOOS-Symptoms (0-100): 70.5 vs. 75.9 Baseline KOOS-Pain (0-100): 73.3 vs. 80.3 | A vs. B 6 months KOOS-ADL: 75.0 vs. 80.4; difference 9.2 (95% CI NR), p=0.230 KOOS-Sport/Rec: 44.1 vs. 62.3; difference 5.0 (95% CI NR), p=0.620 KOOS-Symptoms: 80.4 (18.8) vs. 80.6; difference 5.1 (95% CI NR), p=0.430 KOOS-Pain: 81.2 vs. 80.0; difference 8.2 (95% CI NR), p=0.210 | A vs. B 6 months Short FES-I (7-28): 13.9 vs. 13.6; difference −5.2 (95% CI NR), p=0.020 KOOS-QoL (0-100): 55.9 vs. 62.0; difference 6.6 (95% CI NR), p=0.460 |
Messier, 200456 Rejeski, 200260 3, 6 and18 months Duration of pain: NR Fair | A. Exercise (n=80): Three 1-hour sessions per week done at the study facility for 4 months. Option to undergo a 2 month transition phase alternating between facility and home sessions, after which they carried out the program at home. Sessions consisted of 15 minutes of aerobic exercises, 15 minutes of resistance-training, an additional 15 minutes of aerobic exercises, and a 15 minute cool down phase. B. Control (n=78): 1 hour sessions monthly for three months consisting of presentations on OA, obesity, and exercise and a question and answer session. Monthly phone contact was maintained for months 4-6 and bimonthly phone contact was maintained for months 7-18. All subjects: Instructed to continue use of all medications and other treatments as prescribed by their personal physicians | A vs. B Age: 69 vs. 69 Female: 74% vs. 68% Baseline WOMAC physical function (0-68): 24.0 vs. 26.0 Baseline WOMAC pain (0-20): 6.6 vs. 7.3 | A vs. B 6 months WOMAC physical function*: 22.0 vs. 22.0 WOMAC pain: 6.2 vs. 6.2, difference 0.0 (95% CI −0.2 to 0.2) 18 months WOMAC physical function: 21.0 vs. 22.6 WOMAC physical function, mean change: 3.1 vs. 3.4 WOMAC pain: 6.2 vs. 6.0, difference 0.2 (95% CI 0.04 to 0.4) | A vs. B 3 months Accident related to treatment: 1% (1/80) vs. 0% (0/78) 6-18 months (average; reported by Rejeski 2002) SF-36 PCS: 37.1 vs. 34.4 SF-36 PCS, adjusted mean: 37.6 vs. 35.3 SF-36 MCS: 52.9 vs. 53.5 SF-36 MCS, adjusted mean: 54.1 vs. 53.7 |
Quilty, 200359 2.5 months, 10.5 months Duration of pain: NR Fair | A. Combination (Physiotherapy) (n=40): 9 sessions over a 10 week period. Sessions consisted of patellar taping, 7 individualized exercises, posture correction, and footwear advice. All exercises were performed 10 times each, 5 times a day B. Control (n=43): Baseline discussion with the physiotherapist concerning diagnosis, prognosis, footwear, weight reduction, and activity. General exercise was encouraged but no specific quadriceps exercises were advised | A vs. B Age: 69 vs. 67 years Baseline WOMAC Function (0-68): 27.4 vs. 27.8 Baseline VAS pain (0-100): 51.0 vs. 53.4 | A vs. B 2.5 months WOMAC function: 26.5 vs. 27.5; Adjusted difference −0.6 (95% CI −3.7, 2.4) VAS Pain: 42.8 vs. 50.5; Adjusted difference −6.4 (95% CI −15.3, 2.4) 10.5 months WOMAC function: 29.7 vs. 28.3; Adjusted difference 1.7 (95% CI −1.8, 5.2) VAS Pain: 48.1 vs. 54.1; Adjusted difference −4.9 (95% CI −13.6, 3.8) | A vs. B Withdrawals 2% (1/43) vs. 0% (0/44) Adverse Events: None |
de Rooij, 201769 3 months Duration of symptoms: Mean 8.6 to 9.4 years Fair [New trial] | A. Individualized Exercise Therapy (n=63): 2 sessions of 30–60 minutes per week under the supervision of a PT for 20 weeks. Training consisted of muscle-strength training of the lower extremity, aerobic training, and training of daily activities. 86% (54/93) of patients received ≥27 of 40 sessions. B. Usual Care and Waitlist (n=63) | A vs. B Age: 63 vs. 64 years % Female: 78% vs. 73% Baseline WOMAC physical functioning (0-68): 35.1 vs. 31.0 Baseline SF-36 physical functioning (0-20): 18.4 vs. 18.8 Baseline patient-specific functioning list (PSFL) (0-10): NR Baseline NRS knee pain (0-10): 6.4 vs. 5.9 Baseline WOMAC pain (0-20): 10.1 vs. 9.4 | A vs. B 3 months WOMAC physical functioning (0–68): 23.5 vs. 31.4, difference −9.3 (95% CI −12.8 to −5.8) SF-36 physical functioning (0–20): 21.4 vs. 18.9, difference 2.1 (95% CI 0.9 to 3.3) PSFL (performance of activites 0-10): 4.1 vs. 5.9, difference −1.7 (95% CI −2.5 to −1.0) NRS knee pain severity (0–10): 4.7 vs. 6.2, difference −1.6 (95% CI −1.6 to −1.0) WOMAC pain (0–17): 6.6 vs. 8.6, difference −2.0 (95% CI −3.1 to −0.8) | NR |
Rosedale, 201461 2.5 months Duration of pain: NR Fair | A. Exercise (n=120): Given end-range exercises in the direction they had responded to, to be performed 10 times every 2 to 3 hours. A nonresponder subgroup was given exercises to strengthen quadriceps and aerobic exercises. All subjects in the exercise group attended 4 to 6 physiotherapy sessions, 2 to 3 assessment sessions lasting up to 1 hour and the rest followup sessions lasting 20 minutes, over a 2 week period. B. Waiting list (n=60): Subjects were followed up in the orthopedic department at the surgeon’s discretion and continued receiving their usual care. | A vs. B vs. C Age: 66 vs. 64 Female: 56% vs. 60% Median comorbidities: 3 vs. 3 Baseline KOOS function (0-100): 56 vs. 51 Baseline KOOS function in sport and recreation(0-100): 22 vs. 20 Baseline KOOS knee symptoms (0-100): 50 vs. 48 Baseline KOOS quality of life(0-100): 28 vs. 27 Baseline KOOS pain(0-100): 51 vs. 46 Baseline P4 pain scale: 21 vs. 23 | A vs. B 2.5 months KOOS function: 61 vs. 52, (adjusted difference 5, 95% CI 1 to 9) KOOS function in sport and recreation: 31 vs. 24, (adjusted difference 6, 95% CI 0 to 11) KOOS pain: 56 vs. 46, (adjusted difference 7, 95% CI 3 to 11) P4 pain scale: 24 vs. 21, (adjusted difference −2, 95% CI −4 to 1) KOOS knee symptoms: 56 vs. 52, (adjusted difference 2, 95% CI −2 to 6) KOOS quality of life: 34 vs. 32, (adjusted difference 1, 95% CI −3 to 6) | NR |
Segal, 201562 3 and 9 months Duration of pain: NR Fair (3 months) Poor (9 months) | A. Gait Training (n=24): guided strategies to optimize knee movements during treadmill walking; computerized motion analysis with visual biofeedback; individualized home programs from physical therapist; Twice weekly sessions (45 minutes) for 12 weeks (24 total sessions) B. Usual Care (n=18): Usual care for knee OA and were not asked to make changes in their lifestyle (e.g., annual visit to their physician, use of pain medications, knee surgery and/or physical therapy); ask to keep a diary | A vs. B Age: 70 vs. 69 years Female: 76% vs. 53% Race: NR Baseline LLFDI basic lower limb function score: 65.8 vs. 63.5 Baseline KOOS Symptoms: 60.1 vs. 63.0 Baseline KOOS Pain: 62.7 vs. 59.8 | A vs. B, between group difference in change score compared with baseline 3 months LLFDI basic lower limb function score: 2.3 (95% CI −1.8 to 6.3) KOOS Pain: 3.7 (95% CI −4.7 to 12.1) KOOS Symptoms: 6.2 (95% CI −2.9 to 15.4) 9 months LLFDI basic lower limb function score: 1.0 (95% CI −7.4 to 9.4) KOOS Pain: 7.2 (95% CI −2.0 to 16.5) KOOS Symptoms: 6.0 (95% CI −6.2 to 18.2) | NR |
Sullivan, 199863 10 months Duration of pain: NR Poor | A. Exercise (n=52): 3 group sessions of 10-15 subjects per week were done for 8 weeks. Sessions were structured as a hospital-based supervised fitness walking and supportive patient education program. Sessions consisted of stretching and strengthening exercises, expert speakers, group discussions, instructions in safe walking techniques, and up to 30 minutes of walking. At the end of the 8 week treatment period, subjects were encouraged to continue walking and given guidelines for managing individualized programs of fitness walking. B. Usual care (n=50): Subjects continued to receive the standard routine medical care they had been receiving prior to enrollment in the study. Subjects were interviewed weekly during the 8 week treatment period about their functional and daily activities. | A vs. B Age: 71 vs. 68 Female: 77% vs. 90% Baseline AIMS physical activity subscale (0-10): 6.3 vs. 6.4 Baseline AIMS arthritis impact subscale (0-10): 4.6 vs. 4.5 Baseline AIMS pain subscale (0-10): 4.9 vs. 5.5 Baseline AIMS general health perception subscale (0-10): NR Baseline pain VAS (0-10): 4.1 vs. 6.3 | A vs. B 10 months AIMS physical activity subscale: 6.1 vs. 6.2, difference −0.1, (95% CI −1.7 to 1.5) AIMS arthritis impact subscale: 3.3 vs. 3.8, difference −0.5, (95% CI −1.8 to 0.8) AIMS pain subscale: 4.6 vs. 5.5, difference −0.9, (95% CI −2.2 to 0.4) Pain VAS: 5.0 vs. 5.4, difference −0.4, (95% CI −2.0 to 1.2) AIMS general health perception subscale: 3.7 vs. 3.3, difference 0.4 (95% CI −1.0 to 1.8) | NR |
Thomas, 200264 6 months, 12 months, 18 months, 24 months Duration of pain: NR Poor | A. Exercise (n=470): Two year, self-paced program that started with four 30 minute visits in the first 2 months followed by visits every 6 months. Designed to maintain and improve strength of muscles around the knee, range of motion at the knee joint, and locomotor function. 121 of the 470 patients also received attention control which consisted of monthly phone calls by a study researcher that sought to monitor symptoms and offer simple advice on knee pain management. 114 of the 470 patients received the attention control and a placebo tablet in addition to the exercise program. The remaining 235 participate in the exercise program only.* B. Control (n=316): 160 subjects received attention control consisted of monthly phone calls by a study researcher that sought to monitor symptoms and offer simple advice on knee pain management. 78 subjects took a placebo tablet. 78 patients had no contact with the researchers between assessment visits. | A vs. B Age: 62 vs. 62 Female: 63% vs. 66% Baseline WOMAC physical function score (0-68): 23.2 vs. 23.0 Baseline WOMAC pain score (0-20): 7.15 vs. 7.35 | A vs. B 6 months WOMAC physical function: difference NR WOMAC pain: difference −0.6 (95% CI −1.0 to −0.2) 24 months WOMAC physical function: difference −2.6 (95% CI −4.1 to −1.1) WOMAC pain: difference −0.82 (95% CI −1.3 to −0.3) | A vs. B 6 months SF-36: NR 24 months |
Thorstensson, 200565 5 months Duration of pain: NR Fair | A. Exercise (n=30): 1 hour group exercise sessions of 2 to 9 participants, twice a week for 6 weeks. Sessions consisted of weight-bearing exercises to increase postural control and to increase endurance and strength in the lower extremity. Patients were given daily exercises to perform at home. B. Control group (n=31): Subjects were told not to make any lifestyle changes. Subjects met with the physical therapist at baseline, at 6 weeks, and at 6 months | A vs. B Age: 55 vs. 57 Female: 50% vs. 52% Baseline KOOS ADL (0-100): 69 vs. 71 Baseline KOOS Symptoms (0-100): 63 vs. 66 Baseline KOOS sports and recreation (0-100): 34 vs. 37 Baseline KOOS Pain (0-100): 60 vs. 64 | A vs. B 5 months KOOS ADL, mean change: 0.9 vs. −1.9, p=0.61 KOOS pain, mean change: 3.1 vs. −1.1, p=0.32 KOOS symptoms, mean change: 1.0 vs. −3.4, p=0.31 KOOS sports and recreation, mean change: 0.5 vs. −8.3, p=0.32 | A vs. B 5 months KOOS QOL, mean change (0-100): 5.1 vs. −2.3, p=0.02 SF-36 PCS, mean change (0-100): 3.0 vs. −0.7, p=0.09 SF-36 MCS, mean change (0-100): 0.7 vs. −0.7, p=0.40 Adverse Events: A vs. B Increased knee pain: 3% (1/30) vs. 0% (0/31) |
Waller, 201771 12 months Duration of pain: NR Fair [New trial] | A. Aquatic Exercise (n=43): Aquatic resistance training sessions (1 hour long) 3 times per week for 16 weeks (48 sessions total). Variable resistance equipment used to progress intensity B. Usual Care (n=44): Asked to continue regular leisure activities, offered two sessions (1 hour each) of light stretching, relaxation and social interaction during 12 week intervention period. | A vs. B Age: 64 vs. 64 Female: 100% vs. 100% Baseline KOOS-Symptoms (0-100): 74.4 vs. 74.8 Baseline KOOS-ADL (0-100): 84.5 vs. 85.2 Baseline KOOS-Sport/Recreation (0-100): 63.6 vs. 64.8 Baseline KOOS-Pain (0-100): 80.6 vs. 82.1 | A vs. B 12 months KOOS-ADL: 89.2 vs. 88.3; difference 1.0 (95% CI −2.6 to 4.3), p=0.397 KOOS-Sport/Rec: 71.0 vs. 68.7; difference 2.5 (95% CI −4.8 to 9.0), p=0.396 KOOS-Symptoms: 81.4 vs. 77.9; difference 3.31 (95% CI −1.2 to 7.3), p=0.119 KOOS-Pain: 86.8 vs. 85.1; difference 1.5 (95% CI −2.7 to 5.7), p=0.187 | A vs. B 12 months KOOS-QoL (0-100): 75.0 vs. 76.4; differnce 1.21 (95% CI −6.0 to 8.0), p=0.308 |
Weng, 200966 10 months Duration of pain: 42.5 months Poor | A. Isokinetic exercise (n=33): 3 sessions a week for 8 weeks. Sessions consisted of sets of concentric and eccentric contractions at varying angular velocities and start and stop angles. Hot packs for 10 minutes and passive range of motion exercises B. No intervention (n=33): Warm-up cycling for 10 minutes. Hot packs for 10 minutes and passive range of motion exercises | A+B Age: 64 Female: 75% A vs. B Baseline Lequesne Index (0-24): 7.3 vs. 7.1 Pain VAS (0-10): 4.7 vs. 4.5 | A vs. B 10 months Lequesne Index: 6.3 vs. 7.3 Pain VAS: 3.6 vs. 5.0 | A vs. B 10 months Treatment related pain causing withdrawal: 9% (3/33) vs. 0% (0/33) RR=infinity, p=0.08 |
Williamson, 200767 1.5 months Duration of pain: NR Poor | A. Combination (Physiotherapy) (n=60): Groups of 6–10 patients, hourly, once a week for 6 weeks. Exercise circuit of static quadriceps contractions; inner range quadriceps contractions; straight leg raises; sit to stands, stair climbing; calf stretches; theraband resisted knee extensions; wobble board balance training; knee flexion/extension sitting on gym ball and free standing peddle revolutions. B. Control (n=61): Usual Care (home exercise and advice leaflet) | A vs. B Age: 70 vs. 70 years Female: 52% vs. 54% Baseline OKS (0-48): 39.3 vs. 40.5 Baseline WOMAC (unclear scale): 50.2 vs. 51.1 Baseline VAS pain (0-10): 6.8 vs. 6.9 | A vs. B 1.5 months OKS: 38.8 vs. 40.8 WOMAC: 49.4 vs. 52.3 VAS Pain: 6.4 vs. 7.2 | A vs. B 1.5 months HADS Anxiety (0-21): 7.1 vs. 6.5 HADS Depression (0-21): 6.8 vs. 7.1 Withdrawals: 17% (10/60) vs. 0% (0/61) Adverse Events: None |
ADL = activity of daily living; AIMS = Arthritis Impact Measurement Scale; AQoL = Assessment of Quality of Life; CES-D = Center for Epidemiologic Studies Depression; CI = confidence interval; HADS = Hospital Anxiety and Depression Scale; HAQ = Health Assessment Questionnaire; IBET = internet-based exercise training; ITT = intention-to-treat; KOOS = Knee Injury and Osteoarthritis Outcome Score; KPS = Knee Pain Scale; LLFDI = Late-Life Function and Disability Instrument; LSM = Least squares mean; MCS = Mental Component Score; NA = not applicable; NEMEX = neuromuscular exercise; NR = not reported; NS = not statistically significant; OA = osteoarthritis; OKS = Oxford Knee Score; PASE = Physical Activity Scale for the Elderly; PCS = Physical Component Score; PT = physical therapy; RR = relative risk; QoL = quality of life; SF-36 = Short-Form-36; VAS, visual analog scale; WL = waitlist; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index
Unless otherwise noted, followup time is calculated from the end of the treatment period.
Group A ceased treatment after 4 months, whereas Groups B and C continued their protocols until the 12 month F/U, therefore the ‘4 month F/U’ for group A is actually the beginning of post-treatment, and their 12 month f/u is therefore 8 months post-treatment. For intermediate followup, only group A’s ‘8 month F/U’ is compared with group C’s last F/U (12 months). Long-term followup is the comparison of 12 month followups for groups B and C only.
From: Results
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