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AI-Generated Summaries: Supervised vs Non-Supervised Exercise in OA

These summaries are generated automatically using Claude based on included RCTs comparing supervised vs non-supervised exercise for osteoarthritis. They are intended as a research aid — always refer to the original articles for clinical decisions.

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📊 Overarching Synthesis: Supervised vs Non-Supervised Exercise

Based on 437 included studies · Created: 2026-03-14 14:01:30

Supervised Versus Non-Supervised Exercise for Osteoarthritis: A Comprehensive Narrative Synthesis

Overview

This synthesis draws on 437 randomized controlled trials published between 1987 and 2026, encompassing a broad range of joints affected by osteoarthritis (OA), with the majority focusing on the knee (n = 318), followed by the hip (n = 79), hand (n = 12), meniscus-related pathology (n = 10), ankle (n = 2), foot (n = 2), and shoulder (n = 1). The corpus spans nearly four decades of evidence, reflecting the evolution of exercise delivery from traditional clinic-based physiotherapy through home programs using printed handouts, and most recently to sophisticated digital and telehealth platforms incorporating mobile applications, wearable sensors, augmented reality, computer vision, and artificial intelligence. Across this literature, a central and clinically consequential question persists: does it matter whether exercise is supervised by a healthcare professional, and if so, how, for whom, and to what degree?

Key Findings: Supervised Versus Non-Supervised Exercise

The overall picture that emerges from this body of evidence is one of qualified equivalence with important contextual moderators. For many patients with knee and hip OA, structured home-based exercise produces clinically meaningful improvements in pain and physical function that are broadly comparable to those achieved under direct supervision — a finding replicated across a wide range of delivery formats and populations. The landmark PEAK trial (Hinman et al., 2024) demonstrated that telerehabilitation consultations with a physiotherapist were non-inferior to in-person consultations across both pain and physical function in 394 adults with chronic knee pain. Similarly, He et al. (2025) found telerehabilitation non-inferior to face-to-face physiotherapy for degenerative meniscal tears, and Tedeschi et al. (2024) observed equivalent outcomes between tele-rehabilitation and conventional in-person rehabilitation for knee OA over three months.

However, this equivalence is not universal. Several trials demonstrate that direct supervision confers measurable advantages, particularly in populations with lower baseline self-efficacy, greater pain severity, or limited exercise experience. Bozgeyik et al. (2024) found that physiotherapist-supervised exercise produced substantially greater pain reduction and functional gain than home-based exercise in women with knee OA following platelet-rich plasma injection, with the home-based group showing no significant functional improvement. Aksu et al. (2026) reported that physiotherapist-supervised neuromuscular exercise produced significantly greater gains in meniscal-specific symptoms and physical function than a home program over six weeks. Critically, Martinsen et al. (2025) quantified this adherence differential, finding that patients were 4.2 times more likely to adhere to their exercise program under physiotherapist supervision compared to a smartphone app program — a finding with profound implications for translating trial efficacy into real-world effectiveness.

Across joints, the pattern holds broadly. For hip OA, Wainwright et al. (2025) found a group-based supervised cycling and education programme produced statistically greater improvements in daily living activities compared to usual physiotherapy, though clinical significance remained borderline. For hand OA, Rodríguez Sánchez-Laulhé et al. (2023) demonstrated that a mobile app-based intervention outperformed standard written exercises on multiple functional and pain outcomes, suggesting that even lightly supported digital delivery can surpass passive unsupervised approaches. An important and counterintuitive finding came from Bonhof-Jansen et al. (2025), who observed that education alone produced better hand function outcomes than supervised hand therapy after thumb base joint arthroplasty, cautioning against assuming supervision is universally beneficial regardless of context.

The TeMPO trial (Katz et al., 2025) — one of the largest and most methodologically rigorous contributions in this corpus, enrolling 879 adults — provided perhaps the most consequential finding: adding supervised physical therapy to a structured home exercise program with motivational text messages produced no additional benefit in knee pain at three months. This result challenges assumptions about the necessity of direct supervision when patients are already engaged in a well-structured, supported home program.

A nuanced but consistent theme across the literature is that the comparative advantage of supervision diminishes as the quality and structure of the comparator home program increases. Souto et al. (2025), in a feasibility trial, found that self-directed exercisers actually demonstrated higher exercise log completion rates than supervised participants (88% vs. 57%), suggesting that appropriately designed self-directed programs may foster greater autonomy and self-regulatory behavior.

Supervision Models Studied

The field has moved well beyond the binary of "clinic versus home." The trials in this corpus reflect a rich taxonomy of supervision models. Traditional in-person individual physiotherapy remains the most common reference standard. Group-based supervised exercise has emerged as a clinically effective and cost-efficient alternative, with programs such as GLA:D® demonstrating sustained benefits across tens of thousands of patients (Grønne et al., 2024). Telehealth-delivered supervision — encompassing synchronous video consultations (Barton et al., 2026; Cai et al., 2026), telephone-based support (Brazeiro et al., 2025), and hybrid blended care models (Weber et al., 2023) — has been extensively studied and broadly shown to be non-inferior to in-person care for most outcomes.

Technology-augmented home programs represent the most rapidly expanding category, including smartphone apps with video instruction (Özden et al., 2025; Im et al., 2025), sensor-based real-time movement feedback (Plavoukou et al., 2025; Jarungvittayakon et al., 2025), computer vision systems (Zhu et al., 2025; Xu et al., 2024), wearable exergaming platforms, and AI-assisted exercise prescription (You et al., 2024). Holm et al. (2023) compared online and onsite physiotherapist-supervised programs at scale (n = 3,789) and found online delivery non-inferior across all primary outcomes. Notably, Mayer et al. (2025), in a trial of 259 patients with patella disorders, reported that a self-directed digital health application actually produced greater improvements in knee function and pain than conventional physiotherapy — a finding that, while requiring replication, underscores the potential of well-designed digital programs to exceed traditional care.

Asynchronous video-based exercise (Mbada et al., 2025), prehabilitation models (Okpara et al., 2025; Gränicher et al., 2024), and community follow-up programs (Hu et al., 2025) further illustrate the diversity of supervision paradigms now under investigation.

Clinical Implications

For clinicians, the synthesis supports several actionable conclusions. Structured home-based exercise is a legitimate and effective treatment for OA that should not be viewed as a second-tier substitute for supervised care. When patients are motivated, cognitively capable, and provided with a clear, progressive exercise program — ideally with at least some initial instruction — outcomes are broadly comparable to clinic-based supervision for most functional and pain outcomes.

Supervision should be prioritized for patients with significant comorbidities, poor self-efficacy, high pain catastrophizing, or those initiating exercise for the first time. Patients with frailty (Nicolson et al., 2025; Okpara et al., 2025) or advanced age warrant particular attention, as adherence and safety monitoring become more critical. The TEMPO feasibility trial (Nicolson et al., 2025) highlights that adults over 80 years with OA and comorbidities represent a population in whom tailored supervised programs are still being evaluated and for whom current evidence is insufficient.

Telehealth represents a clinically acceptable and pragmatically important delivery channel that substantially improves access, particularly for rural and underserved populations (Allworth et al., 2025). Clinicians can deploy telehealth with confidence for patients with mild-to-moderate OA who are comfortable with technology. However, patient preferences matter: Lawford et al. (2024) found that while many patients adapted positively to telerehabilitation, initial skepticism about effectiveness and inability to be physically assessed was common, and clinician communication skills in the telehealth environment require deliberate development.

Adherence is the pivotal variable separating efficacy from real-world effectiveness. Technology-assisted home programs — particularly those incorporating goal-setting, motivational messaging, and activity tracking — demonstrate superior adherence to passive paper-based approaches (Hinman et al., 2025; Garg et al., 2025), without necessarily requiring direct supervision.

Gaps and Future Directions

Despite the breadth of this literature, important gaps remain. Long-term follow-up beyond 12 months is uncommon, leaving open questions about whether the equivalence of home and supervised exercise persists or diverges over time, particularly regarding disease modification and surgical conversion rates. Economic analyses are scarce but urgently needed: while telehealth and home exercise may be cost-saving, formal cost-effectiveness data remain limited (Wainwright et al., 2025). Under-represented joints — ankle, foot, shoulder, and wrist OA — have a fraction of the evidence available for knee and hip, and dedicated, well-powered trials for these joints are needed (Smith et al., 2024; Larsson et al., 2025).

Dose-response relationships for supervision intensity remain poorly characterized: it is unclear whether one or two physiotherapist contacts meaningfully alters outcomes compared to five or more, or whether periodic "booster" supervision maintains gains more efficiently than continuous oversight. The field also lacks sufficient data on older adults with frailty and multimorbidity, populations with low health literacy, and patients from low- and middle-income settings, where digital delivery faces different infrastructural and cultural constraints.

Finally, the rapid proliferation of digital and AI-assisted platforms (You et al., 2024; Hu et al., 2025) demands rigorous implementation science to understand how these tools perform in routine clinical deployment, not merely in controlled trials with high-engagement research participants. The COASTAL trial (Yuan et al., 2025), with its 1,348-participant implementation design, represents the kind of pragmatic, large-scale investigation the field now requires to translate this evidence into scalable, equitable OA care.

Beaufsichtigte versus nicht beaufsichtigte Bewegungstherapie bei Osteoarthritis: Eine umfassende narrative Synthese

Überblick

Diese Synthese stützt sich auf 437 randomisierte kontrollierte Studien, die zwischen 1987 und 2026 veröffentlicht wurden, und umfasst ein breites Spektrum von Gelenken, die von Osteoarthritis (OA) betroffen sind. Der überwiegende Anteil konzentrierte sich auf das Kniegelenk (n = 318), gefolgt von der Hüfte (n = 79), der Hand (n = 12), meniskusbedingten Pathologien (n = 10), dem Sprunggelenk (n = 2), dem Fuß (n = 2) und der Schulter (n = 1). Das Korpus umspannt nahezu vier Jahrzehnte an Evidenz und spiegelt die Entwicklung der Bewegungstherapie von der traditionellen klinikbasierten Physiotherapie über häusliche Programme auf Basis gedruckter Anleitungen bis hin zu ausgereiften digitalen Plattformen und Telegesundheitslösungen wider, die mobile Anwendungen, tragbare Sensoren, Augmented Reality, Computer Vision sowie künstliche Intelligenz integrieren. Durch diese gesamte Literatur zieht sich eine zentrale und klinisch bedeutsame Fragestellung: Spielt es eine Rolle, ob die Bewegungstherapie von einer medizinischen Fachkraft beaufsichtigt wird — und wenn ja, auf welche Weise, für wen und in welchem Ausmaß?

Zentrale Befunde: Beaufsichtigte versus nicht beaufsichtigte Bewegungstherapie

Das Gesamtbild, das sich aus dieser Evidenz ergibt, lässt sich als qualifizierte Äquivalenz mit wichtigen kontextuellen Moderatoren beschreiben. Bei vielen Patienten mit Knie- und Hüft-OA führt ein strukturiertes häusliches Übungsprogramm zu klinisch bedeutsamen Verbesserungen von Schmerz und körperlicher Funktion, die mit jenen unter direkter Beaufsichtigung weitgehend vergleichbar sind — ein Befund, der über ein breites Spektrum an Durchführungsformaten und Patientenpopulationen hinweg repliziert wurde. Die wegweisende PEAK-Studie (Hinman et al., 2024) zeigte, dass Telerehabilitations-Konsultationen mit einem Physiotherapeuten In-person-Konsultationen bei sowohl Schmerz als auch körperlicher Funktion in einer Stichprobe von 394 Erwachsenen mit chronischen Knieschmerzen nicht unterlegen waren. Ebenso befanden He et al. (2025) die Telerehabilitation der Physiotherapie von Angesicht zu Angesicht bei degenerativen Meniskusrissen als nicht unterlegen, und Tedeschi et al. (2024) beobachteten über einen Zeitraum von drei Monaten gleichwertige Ergebnisse zwischen Telerehabilitation und konventioneller Präsenzrehabilitation bei Knie-OA.

Diese Äquivalenz ist jedoch nicht universell. Mehrere Studien zeigen, dass eine direkte Beaufsichtigung messbare Vorteile bringt, insbesondere bei Patientenpopulationen mit geringer Grundselbstwirksamkeit, höherer Schmerzintensität oder begrenzter Übungserfahrung. Bozgeyik et al. (2024) stellten fest, dass eine physiotherapeutisch beaufsichtigte Bewegungstherapie zu substanziell größerer Schmerzreduktion und funktionellen Verbesserungen führte als ein häusliches Übungsprogramm bei Frauen mit Knie-OA nach Thrombozytenreich-Plasma-Injektion; die häusliche Gruppe zeigte dabei keine signifikante funktionelle Verbesserung. Aksu et al. (2026) berichteten, dass physiotherapeutisch beaufsichtigte neuromuskuläre Übungen über sechs Wochen zu signifikant größeren Gewinnen bei meniskusspezifischen Symptomen und körperlicher Funktion führten als ein häusliches Programm. Martinsen et al. (2025) quantifizierten dieses Adhärenz-Differenzial und stellten fest, dass Patienten unter physiotherapeutischer Aufsicht mit 4,2-fach höherer Wahrscheinlichkeit ihrem Übungsprogramm adhärent waren als unter einem Smartphone-App-Programm — ein Befund mit weitreichenden Implikationen für die Übertragung von Studienwirksamkeit in reale Effektivität.

Gelenkübergreifend bleibt dieses Muster weitgehend bestehen. Bei Hüft-OA stellten Wainwright et al. (2025) fest, dass ein gruppenbasiertes beaufsichtigtes Rad- und Schulungsprogramm statistisch größere Verbesserungen bei Aktivitäten des täglichen Lebens erzielte als die übliche Physiotherapie, wenngleich die klinische Bedeutsamkeit grenzwertig blieb. Bei Hand-OA demonstrierten Rodríguez Sánchez-Laulhé et al. (2023), dass eine App-basierte Intervention standardmäßigen schriftlichen Übungen bei mehreren funktionellen und schmerzbezogenen Ergebnismaßen überlegen war, was darauf hindeutet, dass selbst eine leicht unterstützte digitale Durchführung passive unbeaufsichtigte Ansätze übertreffen kann. Ein wichtiger und kontraintuitiver Befund stammte von Bonhof-Jansen et al. (2025), die beobachteten, dass reine Aufklärung nach einer Daumensattelgelenk-Arthroplastie zu besseren Handfunktionsergebnissen führte als beaufsichtigte Handtherapie — eine Warnung davor, Beaufsichtigung kontextunabhängig als universell vorteilhaft zu betrachten.

Die TeMPO-Studie (Katz et al., 2025) — eine der größten und methodisch rigorosesten Arbeiten in diesem Korpus mit 879 eingeschlossenen Erwachsenen — lieferte möglicherweise den bedeutsamsten Befund: Das Hinzufügen beaufsichtigter Physiotherapie zu einem strukturierten häuslichen Übungsprogramm mit motivierenden Textnachrichten erbrachte nach drei Monaten keinen zusätzlichen Nutzen bei Knieschmerzen. Dieses Ergebnis stellt Annahmen über die Notwendigkeit direkter Beaufsichtigung in Frage, wenn Patienten bereits in ein gut strukturiertes, unterstütztes häusliches Programm eingebunden sind.

Ein nuanciertes, aber konsistentes Thema in der Literatur ist, dass der komparative Vorteil der Beaufsichtigung abnimmt, je höher die Qualität und Struktur des Vergleichs-Heimprogramms ist. Souto et al. (2025) fanden in einer Machbarkeitsstudie, dass selbstgesteuerte Übende tatsächlich höhere Abschlussquoten im Übungsprotokoll aufwiesen als beaufsichtigte Teilnehmer (88 % vs. 57 %), was darauf hindeutet, dass angemessen konzipierte selbstgesteuerte Programme möglicherweise größere Autonomie und selbstregulatorisches Verhalten fördern.

Untersuchte Beaufsichtigungsmodelle

Das Feld hat sich weit über die Dichotomie „Klinik versus häusliches Umfeld" hinausbewegt. Die Studien in diesem Korpus spiegeln eine reichhaltige Taxonomie von Beaufsichtigungsmodellen wider. Traditionelle In-person-Einzelphysiotherapie bleibt der häufigste Referenzstandard. Gruppenbasierte beaufsichtigte Bewegungstherapie hat sich als klinisch wirksame und kosteneffiziente Alternative etabliert, wobei Programme wie GLA:D® nachhaltige Vorteile bei Zehntausenden von Patienten gezeigt haben (Grønne et al., 2024). Telegesundheitlich vermittelte Beaufsichtigung — einschließlich synchroner Videokonsultationen (Barton et al., 2026; Cai et al., 2026), telefonischer Unterstützung (Brazeiro et al., 2025) und hybrider Blended-Care-Modelle (Weber et al., 2023) — wurde umfassend untersucht und hat sich für die meisten Ergebnismaße allgemein als der Präsenzversorgung nicht unterlegen erwiesen.

Technologisch ergänzte Heimprogramme stellen die am schnellsten wachsende Kategorie dar und umfassen Smartphone-Apps mit Videoanleitungen (Özden et al., 2025; Im et al., 2025), sensorbasiertes Echtzeit-Bewegungsfeedback (Plavoukou et al., 2025; Jarungvittayakon et al., 2025), Computer-Vision-Systeme (Zhu et al., 2025; Xu et al., 2024), tragbare Exergaming-Plattformen sowie KI-gestützte Bewegungstherapieverschreibung (You et al., 2024). Holm et al. (2023) verglichen online und vor Ort physiotherapeutisch beaufsichtigte Programme in großem Maßstab (n = 3.789) und stellten fest, dass die Online-Durchführung bei allen primären Ergebnismaßen nicht unterlegen war. Bemerkenswert ist, dass Mayer et al. (2025) in einer Studie mit 259 Patienten mit Pathaologien der Kniescheibe berichteten, dass eine selbstgesteuerte digitale Gesundheitsanwendung tatsächlich zu größeren Verbesserungen der Kniefunktion und der Schmerzen führte als konventionelle Physiotherapie — ein Befund, der, obwohl er einer Replikation bedarf, das Potenzial gut gestalteter digitaler Programme aufzeigt, traditionelle Versorgung zu übertreffen.

Asynchrone videobasierte Bewegungstherapie (Mbada et al., 2025), Prähabilitationsmodelle (Okpara et al., 2025; Gränicher et al., 2024) und kommunale Nachsorgeprogramme (Hu et al., 2025) veranschaulichen darüber hinaus die Vielfalt der aktuell untersuchten Beaufsichtigungsparadigmen.

Klinische Implikationen

Für Kliniker stützt die Synthese mehrere handlungsorientierte Schlussfolgerungen. Strukturierte häusliche Bewegungstherapie ist eine legitime und wirksame Behandlung für OA, die nicht als zweitrangiger Ersatz für beaufsichtigte Versorgung betrachtet werden sollte. Wenn Patienten motiviert, kognitiv in der Lage und mit einem klaren, progressiven Übungsprogramm ausgestattet sind — idealerweise mit zumindest anfänglicher Anleitung — sind die Ergebnisse für die meisten funktionellen und schmerzbezogenen Maße mit klinikbasierter Beaufsichtigung weitgehend vergleichbar.

Beaufsichtigung sollte priorisiert werden bei Patienten mit erheblichen Komorbiditäten, geringer Selbstwirksamkeit, ausgeprägter Schmerzkatastrophisierung oder bei Personen, die erstmals mit Bewegungstherapie beginnen. Patienten mit Gebrechlichkeit (Nicolson et al., 2025; Okpara et al., 2025) oder höherem Lebensalter verdienen besondere Aufmerksamkeit, da Adhärenz und Sicherheitsüberwachung zunehmend kritisch werden. Die TEMPO-Machbarkeitsstudie (Nicolson et al., 2025) unterstreicht, dass Erwachsene über 80 Jahre mit OA und Komorbiditäten eine Population darstellen, für die maßgeschneiderte beaufsichtigte Programme noch evaluiert werden und bei der die aktuelle Evidenzlage unzureichend ist.

Telegesundheit stellt einen klinisch akzeptablen und pragmatisch bedeutsamen Versorgungskanal dar, der den Zugang insbesondere für Bevölkerungsgruppen in ländlichen und unterversorgten Regionen erheblich verbessert (Allworth et al., 2025). Kliniker können Telegesundheit mit Zuversicht bei Patienten mit leichter bis mittelschwerer OA einsetzen, die einen vertrauten Umgang mit Technologie aufweisen. Patientenpräferenzen spielen jedoch eine Rolle: Lawford et al. (2024) fanden, dass sich viele Patienten zwar positiv an die Telerehabilitation anpassten, anfängliche Skepsis gegenüber der Wirksamkeit und die Einschränkung bei der körperlichen Untersuchung jedoch häufig waren, und dass die kommunikativen Fähigkeiten der Kliniker im Telegesundheitsumfeld einer gezielten Weiterentwicklung bedürfen.

Adhärenz ist die entscheidende Variable, die Wirksamkeit unter Studienbedingungen von realer Effektivität trennt. Technologiegestützte Heimprogramme — insbesondere solche, die Zielsetzung, motivierende Nachrichten und Aktivitätsverfolgung integrieren — zeigen im Vergleich zu passiven papierbasierten Ansätzen überlegene Adhärenz (Hinman et al., 2025; Garg et al., 2025), ohne zwingend eine direkte Beaufsichtigung zu erfordern.

Forschungslücken und zukünftige Richtungen

Trotz der Breite dieser Literatur bestehen weiterhin wichtige Lücken. Langzeit-Follow-up über 12 Monate hinaus ist selten, sodass offen bleibt, ob die Äquivalenz von häuslicher und beaufsichtigter Bewegungstherapie langfristig bestehen bleibt oder divergiert, insbesondere hinsichtlich Krankheitsmodifikation und chirurgischer Konversionsraten. Ökonomische Analysen sind selten, aber dringend erforderlich: Obwohl Telegesundheit und häusliche Bewegungstherapie kosteneffizient sein können, sind formale Kosten-Effektivitäts-Daten nach wie vor begrenzt (Wainwright et al., 2025). Unterrepräsentierte Gelenke — Sprunggelenk, Fuß, Schulter und Handgelenk-OA — verfügen nur über einen Bruchteil der für Knie und Hüfte verfügbaren Evidenz, und dedizierte, ausreichend gepowerte Studien zu diesen Gelenken werden benötigt (Smith et al., 2024; Larsson et al., 2025).

Dosis-Wirkungs-Beziehungen für die Intensität der Beaufsichtigung sind nach wie vor unzureichend charakterisiert: Es bleibt unklar, ob ein oder zwei Physiotherapeutenkontakte die Ergebnisse im Vergleich zu fünf oder mehr meaningful verändern oder ob periodische „Auffrischungs"-Beaufsichtigung Therapieerfolge effizienter au

Exercice Supervisé Versus Non Supervisé dans l'Arthrose : Une Synthèse Narrative Complète

Vue d'ensemble

Cette synthèse s'appuie sur 437 essais contrôlés randomisés publiés entre 1987 et 2026, couvrant un large éventail d'articulations touchées par l'arthrose (OA), avec une majorité portant sur le genou (n = 318), suivie de la hanche (n = 79), de la main (n = 12), des pathologies liées au ménisque (n = 10), de la cheville (n = 2), du pied (n = 2) et de l'épaule (n = 1). Ce corpus s'étend sur près de quatre décennies de données probantes, reflétant l'évolution de la dispensation de l'exercice, depuis la kinésithérapie traditionnelle en cabinet jusqu'aux programmes à domicile utilisant des documents imprimés, et plus récemment jusqu'aux plateformes numériques et de télésanté sophistiquées intégrant des applications mobiles, des capteurs portables, la réalité augmentée, la vision par ordinateur et l'intelligence artificielle. À travers cette littérature, une question centrale et cliniquement conséquente persiste : le fait qu'un exercice soit supervisé par un professionnel de santé a-t-il de l'importance, et si oui, de quelle manière, pour quels patients et dans quelle mesure ?

Résultats Clés : Exercice Supervisé Versus Non Supervisé

Le tableau d'ensemble qui se dégage de ce corpus de données est celui d'une équivalence qualifiée avec d'importants modérateurs contextuels. Pour de nombreux patients atteints d'arthrose du genou et de la hanche, un programme d'exercices structuré à domicile produit des améliorations cliniquement significatives de la douleur et de la fonction physique qui sont globalement comparables à celles obtenues sous supervision directe — un résultat reproduit dans une large gamme de formats de dispensation et de populations. L'essai phare PEAK (Hinman et al., 2024) a démontré que les consultations de téléréhabilitation avec un kinésithérapeute n'étaient pas inférieures aux consultations en personne, tant pour la douleur que pour la fonction physique, chez 394 adultes présentant une douleur chronique du genou. De même, He et al. (2025) ont constaté la non-infériorité de la téléréhabilitation par rapport à la kinésithérapie en face-à-face pour les déchirures méniscales dégénératives, et Tedeschi et al. (2024) ont observé des résultats équivalents entre la téléréhabilitation et la rééducation conventionnelle en présentiel pour l'arthrose du genou sur une période de trois mois.

Cependant, cette équivalence n'est pas universelle. Plusieurs essais démontrent que la supervision directe confère des avantages mesurables, notamment dans les populations présentant une auto-efficacité initiale plus faible, une sévérité douloureuse plus importante ou une expérience limitée de l'exercice. Bozgeyik et al. (2024) ont constaté que l'exercice supervisé par un kinésithérapeute produisait une réduction de la douleur et un gain fonctionnel substantiellement supérieurs à ceux de l'exercice à domicile chez des femmes atteintes d'arthrose du genou après injection de plasma riche en plaquettes, le groupe à domicile ne montrant aucune amélioration fonctionnelle significative. Aksu et al. (2026) ont rapporté que l'exercice neuromusculaire supervisé par un kinésithérapeute produisait des gains significativement plus importants sur les symptômes méniscaux spécifiques et la fonction physique qu'un programme à domicile sur six semaines. De manière cruciale, Martinsen et al. (2025) ont quantifié ce différentiel d'adhésion, constatant que les patients étaient 4,2 fois plus susceptibles de respecter leur programme d'exercices sous supervision d'un kinésithérapeute que dans le cadre d'un programme sur application smartphone — un résultat aux implications profondes pour la transposition de l'efficacité des essais vers l'efficacité en situation réelle.

D'une articulation à l'autre, ce schéma se vérifie globalement. Pour l'arthrose de la hanche, Wainwright et al. (2025) ont constaté qu'un programme supervisé en groupe de cyclisme et d'éducation produisait des améliorations statistiquement plus importantes dans les activités de la vie quotidienne par rapport à la kinésithérapie habituelle, bien que la signification clinique soit restée borderline. Pour l'arthrose de la main, Rodríguez Sánchez-Laulhé et al. (2023) ont démontré qu'une intervention basée sur une application mobile surpassait les exercices écrits standard sur plusieurs critères fonctionnels et de douleur, suggérant que même une dispensation numérique légèrement encadrée peut surpasser les approches non supervisées passives. Une constatation importante et contre-intuitive provient de Bonhof-Jansen et al. (2025), qui ont observé que l'éducation seule produisait de meilleurs résultats sur la fonction de la main que la thérapie supervisée de la main après arthroplastie de la base du pouce, mettant en garde contre l'hypothèse que la supervision est universellement bénéfique indépendamment du contexte.

L'essai TeMPO (Katz et al., 2025) — l'une des contributions les plus importantes et les plus rigoureuses sur le plan méthodologique de ce corpus, ayant enrôlé 879 adultes — a fourni peut-être le résultat le plus conséquent : l'ajout d'une kinésithérapie supervisée à un programme d'exercices structuré à domicile accompagné de messages texte motivationnels n'a produit aucun bénéfice supplémentaire sur la douleur du genou à trois mois. Ce résultat remet en question les hypothèses sur la nécessité d'une supervision directe lorsque les patients participent déjà à un programme à domicile bien structuré et soutenu.

Un thème nuancé mais cohérent dans l'ensemble de la littérature est que l'avantage comparatif de la supervision diminue à mesure que la qualité et la structure du programme à domicile comparateur augmentent. Souto et al. (2025), dans un essai de faisabilité, ont constaté que les participants en exercice auto-dirigé affichaient en réalité des taux de complétion de journal d'exercices plus élevés que les participants supervisés (88 % vs 57 %), suggérant que des programmes auto-dirigés conçus de manière appropriée peuvent favoriser une plus grande autonomie et un comportement d'autorégulation accru.

Modèles de Supervision Étudiés

Le domaine a largement dépassé la dichotomie « cabinet versus domicile ». Les essais de ce corpus reflètent une taxonomie riche de modèles de supervision. La kinésithérapie individuelle traditionnelle en personne demeure l'étalon de référence le plus courant. L'exercice supervisé en groupe s'est imposé comme une alternative cliniquement efficace et économiquement efficiente, avec des programmes tels que GLA:D® démontrant des bénéfices durables chez des dizaines de milliers de patients (Grønne et al., 2024). La supervision dispensée par télésanté — englobant les consultations vidéo synchrones (Barton et al., 2026 ; Cai et al., 2026), le soutien par téléphone (Brazeiro et al., 2025) et les modèles de soins hybrides mixtes (Weber et al., 2023) — a été largement étudiée et s'est généralement révélée non inférieure aux soins en personne pour la plupart des critères de jugement.

Les programmes à domicile augmentés par la technologie représentent la catégorie en expansion la plus rapide, incluant les applications smartphone avec instruction vidéo (Özden et al., 2025 ; Im et al., 2025), le retour d'information en temps réel sur le mouvement basé sur des capteurs (Plavoukou et al., 2025 ; Jarungvittayakon et al., 2025), les systèmes de vision par ordinateur (Zhu et al., 2025 ; Xu et al., 2024), les plateformes d'exergaming portables et la prescription d'exercices assistée par IA (You et al., 2024). Holm et al. (2023) ont comparé des programmes supervisés par un kinésithérapeute en ligne et en présentiel à grande échelle (n = 3 789) et ont constaté que la dispensation en ligne était non inférieure pour tous les critères de jugement primaires. Il est à noter que Mayer et al. (2025), dans un essai portant sur 259 patients présentant des troubles de la rotule, ont rapporté qu'une application de santé numérique auto-dirigée produisait en réalité des améliorations plus importantes de la fonction du genou et de la douleur que la kinésithérapie conventionnelle — un résultat qui, bien que nécessitant une réplication, souligne le potentiel des programmes numériques bien conçus à surpasser les soins traditionnels.

L'exercice vidéo asynchrone (Mbada et al., 2025), les modèles de préhabilitation (Okpara et al., 2025 ; Gränicher et al., 2024) et les programmes de suivi communautaire (Hu et al., 2025) illustrent davantage la diversité des paradigmes de supervision désormais à l'étude.

Implications Cliniques

Pour les cliniciens, la synthèse soutient plusieurs conclusions exploitables. L'exercice structuré à domicile est un traitement légitime et efficace de l'arthrose qui ne devrait pas être considéré comme un substitut de second ordre aux soins supervisés. Lorsque les patients sont motivés, cognitivement capables et disposent d'un programme d'exercices clair et progressif — idéalement avec au moins quelques instructions initiales — les résultats sont globalement comparables à la supervision en cabinet pour la plupart des critères fonctionnels et de douleur.

La supervision doit être priorisée pour les patients présentant des comorbidités significatives, une faible auto-efficacité, une catastrophisation importante de la douleur, ou ceux qui commencent à pratiquer un exercice pour la première fois. Les patients présentant une fragilité (Nicolson et al., 2025 ; Okpara et al., 2025) ou d'un âge avancé méritent une attention particulière, car la surveillance de l'adhésion et de la sécurité devient plus critique. L'essai de faisabilité TEMPO (Nicolson et al., 2025) souligne que les adultes de plus de 80 ans atteints d'arthrose et de comorbidités représentent une population pour laquelle des programmes supervisés adaptés sont encore en cours d'évaluation et pour laquelle les données probantes actuelles sont insuffisantes.

La télésanté représente un canal de dispensation cliniquement acceptable et pragmatiquement important qui améliore substantiellement l'accès, notamment pour les populations rurales et mal desservies (Allworth et al., 2025). Les cliniciens peuvent déployer la télésanté en toute confiance pour les patients présentant une arthrose légère à modérée qui sont à l'aise avec la technologie. Cependant, les préférences des patients ont leur importance : Lawford et al. (2024) ont constaté que, bien que de nombreux patients se soient adaptés positivement à la téléréhabilitation, un scepticisme initial quant à son efficacité et l'impossibilité d'être évalué physiquement étaient courants, et les compétences en communication des cliniciens dans l'environnement de télésanté nécessitent un développement délibéré.

L'adhésion est la variable pivot séparant l'efficacité dans les essais de l'efficacité en situation réelle. Les programmes à domicile assistés par la technologie — en particulier ceux intégrant la fixation d'objectifs, les messages motivationnels et le suivi de l'activité — démontrent une adhésion supérieure aux approches passives sur support papier (Hinman et al., 2025 ; Garg et al., 2025), sans nécessiter pour autant une supervision directe.

Lacunes et Orientations Futures

Malgré l'étendue de cette littérature, des lacunes importantes subsistent. Le suivi à long terme au-delà de 12 mois est peu fréquent, laissant ouvertes des questions quant à la persistance ou la divergence de l'équivalence entre l'exercice à domicile et l'exercice supervisé dans le temps, notamment en ce qui concerne la modification de la maladie et les taux de conversion chirurgicale. Les analyses économiques sont rares mais urgemment nécessaires : bien que la télésanté et l'exercice à domicile puissent générer des économies, les données formelles de coût-efficacité restent limitées (Wainwright et al., 2025). Les articulations sous-représentées — la cheville, le pied, l'épaule et le poignet — disposent d'une fraction des données probantes disponibles pour le genou et la hanche, et des essais dédiés, correctement dimensionnés, sont nécessaires pour ces articulations (Smith et al., 2024 ; Larsson et al., 2025).

Les relations dose-réponse concernant l'intensité de la supervision restent mal caractérisées : on ne sait pas si un ou deux contacts avec un kinésithérapeute modifient de manière significative les résultats par rapport à cinq contacts ou plus, ni si une supervision périodique de « rappel » maintient les acquis plus efficacement qu'une surveillance continue. Le domaine manque également de données suffisantes sur les adultes âgés présentant une fragilité et une multimorbidité, les populations à faible littératie en santé et les patients dans les contextes à revenus faibles et intermédiaires, où la dispensation numérique se heurte à des contraintes infrastructurelles et culturelles différentes.

Enfin, la prolifération rapide des plateformes numériques et assistées par IA (You et al., 2024 ; Hu et al., 2025) exige une science de la mise en œuvre rigoureuse pour comprendre comment ces outils fonctionnent dans le déploiement clinique courant, et pas seulement dans des essais contrôlés impliquant des participants très engagés. L'essai COASTAL (Yuan et al., 2025), avec son dispositif de mise en œuvre portant sur 1 348 participants, représente le type d'investigation pragmatique à grande échelle que le domaine requiert désormais pour traduire ces données probantes en soins de l'arthrose évolutifs et équitables.

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437 summaries

An Assessor-Blinded Randomized Controlled Trial Comparing A Tele-Rehabilitation Program With Wearable Technology To Conventional Face-To-Face Physiotherapy In Patients With Knee Osteoarthritis.

Cai C (2026) · Knee · PMID: 41723580

This randomized controlled trial compared a 12-week tele-rehabilitation program using video-conferencing and wearable motion sensors to conventional face-to-face physiotherapy in 35 patients with moderate knee osteoarthritis. Both approaches led to significant and comparable improvements in pain, physical function, and self-reported knee symptoms, with no meaningful differences detected between groups at the end of treatment or at 3- and 6-month follow-up. The study's relatively small sample size warrants caution in interpreting these findings, though the consistency of results across multiple outcomes is encouraging. These findings suggest that tele-rehabilitation supported by wearable technology is a clinically viable alternative to in-person physiotherapy, which has important implications for patients facing geographic, mobility, or scheduling barriers to accessing care.

Group-Based Versus Individual-Based Circuit Training In Elderly Women With Knee Osteoarthritis: Study Protocol For A Non-Inferiority Randomized Controlled Trial.

Lima-Lopes C (2026) · Knee · PMID: 41699686

This registered randomized controlled trial (ReBEC ID: RBR-5bq9jh3) is testing whether group-based circuit training (4 participants per session) is just as effective as one-on-one physical therapy for elderly women (aged 60+) with knee osteoarthritis. Over 8 weeks, both groups receive the same supervised muscle training program delivered by a physical therapist, with outcomes including pain (measured by the WOMAC questionnaire), quality of life, and physical function assessed at baseline, post-intervention, and 4 weeks later. The central clinical question is one of non-inferiority: can group delivery match individualized care, rather than surpassing it? This is particularly relevant given the real-world constraints of limited physiotherapy staffing and funding, which often prevent patients from accessing guideline-recommended individualized treatment. If group training proves non-inferior, it could significantly expand access to evidence-based exercise therapy for the roughly 67% of women over 60 affected by this condition.

Risk Assessment And Management Program (Ramp) On Knee Osteoarthritis In Primary Care-A One-Year Pragmatic Randomized Controlled Trial.

Sit Rw (2026) · Knee · PMID: 41629997

This one-year randomized controlled trial (228 participants total) compared a structured Chronic Care Model program called RAMP-Knee OA against usual primary care for adults with knee osteoarthritis in Hong Kong. The RAMP-Knee OA program integrates comprehensive risk assessment, a structured care protocol, and self-management support, addressing not just pain and physical function but also psychological factors such as anxiety, depression, and sleep quality. The primary measure of success is self-reported knee pain at 52 weeks using the WOMAC questionnaire, with additional assessments at 16 and 32 weeks to track progress over time. For clinicians, this trial is clinically relevant because it tests a holistic, scalable model that could bridge the gap between research evidence and real-world primary care practice for a condition affecting millions globally. Results will help determine whether supervised, structured care coordination meaningfully outperforms standard care across a broad range of biopsychosocial outcomes in knee OA management.

Changing Habits With The Happy Hands App: Qualitative Focus Group Study Of A Hand Osteoarthritis Self-Management Intervention.

Fjeldstad Ka (2026) · Hand · PMID: 41628446

This qualitative study, embedded within an RCT, explored how 26 people with hand osteoarthritis (mean age 67) in Norway experienced using the Happy Hands app, a 12-week digital self-management program including hand exercises and educational videos. Participants reported feeling acknowledged and validated in their condition, gained meaningful knowledge that fostered hope and informed decision-making, and successfully developed new daily habits such as hand exercises and ergonomic practices. The app was perceived as motivating, flexible, and well-structured, though some users experienced pain during or after exercise. These findings suggest that digital self-management tools can meaningfully empower patients with hand osteoarthritis to integrate disease management into everyday life.

Comparison Of Voice Call Based And Multimodal Telerehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial.

Aslan Sn (2026) · Knee · PMID: 41562392

This randomized controlled trial compared two telerehabilitation approaches in 45 patients recovering from total knee arthroplasty (TKA): a multimodal program (MTR, n=24) combining digital booklets, exercise videos, video calls, and text messages, versus a voice-call-based program (VTR, n=21) using printed booklets and phone calls, both delivered over 8 weeks. Both groups achieved meaningful improvements in knee range of motion, pain, and physical function. However, the MTR group showed significantly greater gains across all outcomes at 8 weeks, including notably better pain control during activity (effect size r=0.62) and reduced fear of movement. Clinically, these findings suggest that richer, technology-enabled telerehabilitation produces better post-surgical outcomes, though voice-call-based programs remain a viable option where technology access is limited. The relatively small sample size warrants cautious interpretation, and future studies comparing telerehabilitation to in-person care are needed.

Telehealth-Delivered Group-Based Exercise Therapy And Education For Knee Osteoarthritis: A Non-Inferiority Randomised Clinical Trial Disrupted By Covid-19.

Barton Cj (2026) · Knee · PMID: 41505342

This randomized clinical trial compared telehealth-delivered versus in-person group exercise therapy and education (GLA:D® program) for people with knee osteoarthritis, though recruitment was cut short by COVID-19, resulting in only 44 participants instead of the planned 110. The key finding was that telehealth delivery was likely non-inferior to in-person care for knee-related burden (pain, symptoms, daily function, and quality of life) at both 3 and 12 months, suggesting patients did not lose meaningful benefit by attending remotely. Notably, participants in the telehealth group reported greater reductions in worst pain at 3 months compared to the in-person group, though no other secondary outcomes differed significantly between groups. While the small sample size limits definitive conclusions, these results are clinically relevant as they suggest telehealth could be a viable alternative for patients who face barriers to attending in-person exercise programs for knee osteoarthritis.

Online Unsupervised Tai Chi Intervention For Knee Pain And Function In People With Knee Osteoarthritis: The Retreat Randomized Clinical Trial.

Zhu Sj (2026) · Knee · PMID: 41143827

The RETREAT trial compared a 12-week unsupervised, video-based Yang-style tai chi program delivered online to 89 adults with knee osteoarthritis against a control group of 89 adults who received only educational website access, with 96% of the 178 participants completing the study. Participants in the tai chi group experienced significantly greater reductions in knee pain during walking (mean difference of 1.4 points on a 0–10 scale) and physical function difficulty (mean difference of 5.6 points on a 0–68 scale) compared to controls. Crucially, nearly three-quarters of tai chi participants achieved a clinically meaningful improvement in both pain (73%) and function (72%), compared to roughly half in the control group, and no serious adverse events were reported. Benefits also extended to quality of life, balance confidence, mental well-being, and self-efficacy, suggesting this free, internet-based program addresses multiple dimensions of the condition. These findings are clinically significant because they demonstrate that effective, guideline-recommended tai chi exercise for knee osteoarthritis can be delivered safely and at scale without in-person supervision, potentially removing a major barrier to access for patients.

Effectiveness Of A Neuromuscular Exercise Program Conducted With A Physiotherapist In Individuals With Degenerative Meniscal Tears.

Aksu Zb (2026) · Menisc · PMID: 40567077

This randomized controlled trial compared a physiotherapist-supervised neuromuscular exercise program against a home exercise program in 50 patients (ages 20–65) with degenerative meniscal tears, treated three times weekly over six weeks. Both groups experienced meaningful improvements in pain, knee function, and quality of life, but patients who exercised under physiotherapist supervision showed significantly greater gains — particularly in meniscal-specific symptoms (WOMET), physical function (KOOS-PS), and nighttime pain. The supervised group's superior outcomes on validated clinical measures suggest that professional guidance enhances the quality and effectiveness of neuromuscular training beyond what patients can achieve independently at home. For clinicians, these findings reinforce the value of referring patients with degenerative meniscal tears to supervised physiotherapy rather than relying solely on self-directed home programs. While the sample size is modest (n=50), the results provide clinically relevant evidence supporting structured, supervised exercise as the preferred conservative treatment approach for this common knee condition.

Long-Term Effects Of Neuromuscular Exercise Therapy And The Need For Surgical Conversion In Wrist Osteoarthritis: 24-Month Results From A Randomized Controlled Trial.

Larsson Sl (2025) · PMID: 41469620

This randomized controlled trial compared two 12-week exercise programs for wrist osteoarthritis in 48 participants: a neuromuscular exercise therapy program (targeting joint strength and movement control) versus a range-of-motion exercise program. Neither program proved superior to the other, with negligible effect sizes for pain and functional outcomes at both 6 and 12 months. Importantly, surgical conversion rates at 24 months were low in both groups (21% neuromuscular vs. 17% range-of-motion), suggesting that either exercise approach may help patients avoid or delay surgery. These findings indicate that for wrist osteoarthritis, a simpler range-of-motion program may be just as effective as more complex neuromuscular training, which has practical implications for clinical decision-making and patient self-management. Larger, well-powered studies are needed to further clarify the role of exercise therapy in the long-term management of wrist osteoarthritis.

Development Of Video Exercise-Based Mobile Application To Improve The Clinical Outcomes In Patients With Knee Osteoarthritis: A Randomized Controlled Trial.

Ã–zden F (2025) · Knee · PMID: 41456047

This randomized controlled trial of 52 adults with knee osteoarthritis compared an 8-week exercise program delivered via a custom video-based mobile app versus the same program provided as paper handouts. Both groups showed meaningful improvements in pain, stiffness, and physical function, suggesting that home-based exercise—regardless of delivery format—is beneficial for knee OA. No statistically significant differences were found between the two groups for pain, function, expectation, or satisfaction outcomes. However, clinically important thresholds (minimal clinically important difference, MCID) for function and satisfaction were exceeded in favor of the mobile app group, hinting at potential practical advantages that a larger study may better detect. These findings suggest that video-based mobile apps can be a viable, modern alternative to paper-based home exercise programs for knee OA rehabilitation.

Mobile App To Support Home Exercise Adherence In Knee Osteoarthritis: A Randomized Clinical Trial.

Hinman Rs (2025) · Knee · PMID: 41418994

This randomized clinical trial of 182 adults with knee osteoarthritis compared a physiotherapist-prescribed home strengthening program alone versus the same program supported by a mobile app ("My Exercise Messages") that provided exercise tracking, goal-setting, and motivational messages. At 26 weeks, participants using the app were more than twice as likely to fully adhere to their prescribed exercise frequency (36% vs. 16%), a statistically significant and clinically meaningful difference. However, this improved adherence did not translate into better physical function, knee pain, or quality of life compared to the exercise-only group. With a high follow-up rate of 94–95% and robust outcomes, the trial suggests that while digital tools can meaningfully boost exercise compliance, adherence alone may not be sufficient to drive functional improvements in knee osteoarthritis. Clinicians should consider apps as useful adherence aids but should not expect them to independently produce superior clinical outcomes.

Feasibility And Preliminary Effectiveness Of A Mobile App-Based Personalized Exercise Program In Older Patients With Chronic Knee Osteoarthritis: Pilot Randomized Controlled Trial.

Im Yj (2025) · Knee · PMID: 41401375

This pilot randomized controlled trial (n=29) compared a physiotherapist-guided mobile app exercise program against a conventional paper-based program over 6 weeks in adults aged 60+ with chronic knee osteoarthritis. The app-delivered group received personalized, remotely monitored exercise plans that were dynamically adjusted by physiotherapists, while the control group followed a static paper handout. The mobile app group showed clinically meaningful improvements in both pain (average reduction of ~2 points on a 10-point scale) and overall knee function (WOMAC score), with 88% of participants reporting high satisfaction and 69% exercising five or more days per week. The small sample size and pilot design limit definitive conclusions, but feasibility outcomes — including safety, adherence, and retention — were all favorable. These findings suggest that app-based, remotely supervised exercise programs may be a practical and effective self-management strategy for knee osteoarthritis, warranting a larger confirmatory trial.

A Sensor-Augmented Telerehabilitation System For Knee Osteoarthritis: A Randomized Controlled Trial Of Neuromuscular, Functional, And Psychosocial Outcomes.

Plavoukou T (2025) · Knee · PMID: 41374487

This 8-week randomized controlled trial (n=42, mean age 68.4 years) compared a sensor-augmented telerehabilitation system called KneE-PAD — which uses real-time muscle activity and motion feedback with remote physiotherapist supervision — against conventional face-to-face physiotherapy for adults with mild-to-moderate knee osteoarthritis. The telerehabilitation group showed clinically meaningful improvements in quadriceps strength, neuromuscular activation, pain (WOMAC scores), and functional mobility that exceeded those seen in the conventional therapy group. Modest positive trends were also observed in psychological outcomes, including self-efficacy and depressive symptoms. Importantly, these gains were maintained at a 12-week follow-up, suggesting durability of the treatment effect. While results are promising and support telerehabilitation as a viable alternative to in-person care, the relatively small sample size means larger, longer-term trials are needed before broad clinical adoption can be recommended.

Impact Of Home-Based Exercise And Clinic-Based Physiotherapy On Mobility Status Of Patients Undergoing Total Knee Replacement: A Randomized Clinical Trial.

Ahmadi M (2025) · Knee · PMID: 41316605

This randomized controlled trial compared home-based exercise to clinic-based physiotherapy in 80 patients recovering from total knee replacement surgery, with 40 patients in each group following a structured four-week rehabilitation program. Both approaches produced significant improvements in functional mobility, as measured by the Lysholm Knee Scoring Scale, but no meaningful difference was found between the two settings (p = 0.078). These findings suggest that home-based rehabilitation can be just as effective as supervised clinic physiotherapy after knee replacement, provided the program is well-structured and patients remain adherent. For clinicians, this supports offering home-based rehabilitation as a viable alternative, particularly for patients with limited access to clinic-based care. Patient engagement and program structure may matter more than the physical location of rehabilitation.

Exploring Experiences Of People With Knee Osteoarthritis Who Participated In An Online Unsupervised Tai Chi Program: A Qualitative Study.

Zhu Sj (2025) · Knee · PMID: 41307295

This qualitative study, nested within a randomized controlled trial, interviewed 20 people with knee osteoarthritis about their experiences completing a 12-week online, unsupervised Tai Chi program. Most participants reported positive experiences, highlighting the flexibility to pause, rewind, and practice at their own pace and location as key advantages. However, some found the program repetitive, and many noted that the absence of real-time instructor feedback made learning certain movements challenging. The majority perceived improvements in their symptoms and felt more motivated to stay physically active, though a minority noticed no meaningful change. These findings offer valuable insights to help refine the program before public release, with the goal of making Tai Chi a more accessible and appealing exercise option for people living with osteoarthritis.

Effectiveness Of Mobile Exergaming With Sensor-Based Visual Feedback As An Adjunct Therapy For Home-Based Quadriceps Exercise Training In Knee Osteoarthritis: A Prospective Randomized Controlled Trial.

Jarungvittayakon C (2025) · Knee · PMID: 41302162

This 6-week randomized controlled trial of 56 knee osteoarthritis patients compared a mobile exergaming program — using a smartphone-based exercise game paired with a wearable wireless motion sensor — against a standard home-based exercise program to assess which approach better supported quadriceps strengthening and functional recovery. Patients using the exergaming app showed significantly greater improvements in quadriceps strength, knee range of motion, pain (at rest and during movement), walking ability (Timed Up and Go test), and knee-specific quality of life scores compared to those following standard exercises. Importantly, no device- or exercise-related complications were reported in either group, suggesting the technology is safe for this population. With a modest but meaningful sample size of 28 patients per group, these findings suggest that sensor-based visual feedback and gamification can meaningfully enhance engagement and outcomes in home-based rehabilitation for knee osteoarthritis. For clinicians, this study supports considering interactive digital tools as a practical adjunct to conventional exercise prescriptions, particularly for patients who may struggle with motivation or adherence to unsupervised home programs.

Internet Of Things-Based Pulsed Electromagnetic Field Combined With Exercise Therapy In Patients With Knee Osteoarthritis: Randomized, Controlled, Noninferiority Trial Protocol.

Shi X (2025) · Knee · PMID: 41272831

This randomized controlled trial protocol (n=112 patients aged ≥40 years with knee osteoarthritis) compares a novel Internet of Things-based home rehabilitation approach — combining pulsed electromagnetic field therapy with exercise delivered remotely — against traditional supervised outpatient therapy over 4 weeks. Rather than examining supervision alone, the study tests whether this technology-enabled, community-based treatment is *non-inferior* to clinic-based care across outcomes including pain (WOMAC, NRS), physical function, quality of life, and patient adherence. If the IoT-based approach proves comparable to outpatient therapy, it could offer a practical, accessible alternative for patients who face barriers to attending in-person rehabilitation. The study is currently a published protocol, meaning results are not yet available, and findings should be interpreted cautiously given limitations including reliance on self-reported measures and a follow-up period capped at 12 weeks. Clinicians and patients should note this represents a promising but still-investigational model for delivering combined physical and electromagnetic therapy outside traditional clinical settings.

User Engagement And Experiences With An Online Unsupervised Tai Chi Program For People With Knee Osteoarthritis: Mixed Methods Process Evaluation Nested In A Randomized Controlled Trial.

Zhu Sj (2025) · Knee · PMID: 41237400

This randomized controlled trial compared a 12-week unsupervised online Tai Chi program (combined with educational materials and an adherence support app) against online education alone in 89 people with knee osteoarthritis. The trial previously demonstrated that the Tai Chi intervention improved pain and physical function, and this process evaluation found that 73% of participants met the adherence threshold of practicing at least twice per week. Among the 64 participants who completed follow-up questionnaires, satisfaction was high, with most rating the program 9 out of 10 and expressing willingness to recommend it to others. While many participants reported a positive experience and perceived improvements in their knee condition, some noted challenges such as sessions feeling too long, technological difficulties, and occasional dissatisfaction with outcomes. These findings suggest that free, digitally delivered exercise programs like this online Tai Chi intervention hold real promise for improving access to guideline-recommended care for osteoarthritis patients who may face barriers to traditional in-person exercise programs.

Kong Sh (2025) · NA · PMID: 41226962

This South Korean randomized controlled trial compared two adapted versions of the GLA:D® rehabilitation program in patients recovering from total knee replacement surgery: one delivered with direct therapist supervision (GLA:D-M) and one conducted primarily as home-based exercise with additional strength training (GLA:D-C). Both groups showed improvements over 3 and 6 months, but the supervised program produced statistically significant and clinically meaningful gains across functional performance, gait speed, and psychosocial outcomes, consistently exceeding established thresholds for what patients would notice as real improvement. The home-based group gained lower-limb strength but fell short of these clinically important benchmarks in higher-level functional recovery. While the sample size was not reported explicitly in the abstract, the findings suggest that how rehabilitation is delivered—not just what exercises are prescribed—matters significantly for post-surgical outcomes. Clinicians should consider that therapist supervision may be a critical ingredient in achieving comprehensive recovery after knee replacement, and larger long-term studies are needed to confirm these results.

Partial Wrist Denervation Versus Patient Education And Self-Managed Exercise Therapy In Patients With Wrist Osteoarthritis: Study Protocol For A Randomized Controlled Trial.

Larsson Sl (2025) · PMID: 41168861

This multicenter randomized controlled trial is comparing two approaches for wrist osteoarthritis (specifically SLAC and SNAC wrist): a minimally invasive surgery called partial wrist denervation (cutting small sensory nerve branches to reduce pain) versus a non-surgical program combining patient education and self-managed exercise focused on wrist strength and stability. The trial will enroll 140 adults and follow them for 12 months, with the primary outcome being patient-reported wrist pain and function (PRWE score) at 6 months. This is noteworthy as the first RCT to directly compare surgical and non-surgical treatments for wrist OA, addressing a significant evidence gap. Results will help clinicians and patients make better-informed decisions about when surgery adds meaningful benefit over conservative care. No results are yet available, as this publication describes the study protocol only.

Efficacy Of Different Rehabilitation Protocols Following Total Knee Arthroplasty: A Randomized Controlled Trial.

Christy C (2025) · Knee · PMID: 41164538

This randomized controlled trial of 120 patients compared three rehabilitation approaches after total knee replacement surgery: conventional in-person physiotherapy, virtual rehabilitation, and home-based telerehabilitation. Virtual rehabilitation produced significantly better functional outcomes — including improved knee scores and range of motion — at both 3 and 6 months post-surgery, while home-based telerehabilitation was most effective at reducing pain at 6 months. Notably, both technology-based approaches outperformed conventional physiotherapy in at least one key outcome measure. These findings are clinically relevant because they suggest that digital and remote rehabilitation tools may offer a viable — and potentially superior — alternative to traditional face-to-face therapy following knee replacement, which could also improve patient access and convenience. Clinicians should consider integrating virtual or telerehabilitation options into post-TKA care pathways, particularly for patients with barriers to attending in-person sessions.

A Randomized Trial Of Physical Therapy For Meniscal Tear And Knee Pain.

Katz Jn (2025) · Menisc; knee · PMID: 41160820

This randomized controlled trial (the TeMPO trial) enrolled 879 adults aged 45–85 with knee pain, osteoarthritis, and a degenerative meniscal tear to compare four approaches: a home exercise program alone, home exercise with motivational text messages, home exercise with text messages plus sham (placebo) physical therapy, and home exercise with text messages plus supervised standard physical therapy. The primary outcome was change in knee pain scores (KOOS) at 3 months. Crucially, adding supervised physical therapy or motivational text messages to a home exercise program produced no meaningful additional pain reduction compared to home exercise alone—the differences between groups were small (around 2.5 points on a 100-point scale) and not statistically significant. With nearly 900 participants, this well-powered trial provides strong evidence that a structured home exercise program is as effective as supervised clinic-based physical therapy for this common condition. Clinically, this suggests that for many patients with degenerative meniscal tears and knee pain, a well-designed, independent home exercise program may be sufficient—potentially reducing healthcare burden and costs without compromising outcomes.

Evaluating Home-Based Personalised Virtual Reality Physiotherapy Rehabilitation Compared With Usual Care In The Treatment Of Pain For People With Knee Osteoarthritis: Protocol For A Randomised Feasibility Study.

Al-Amri M (2025) · Knee · PMID: 41125281

This feasibility study is testing a home-based virtual reality (VR) physiotherapy system called SPIN-VR against standard physiotherapy care for people with knee osteoarthritis over 12 weeks, with 50 participants randomly assigned to each approach. Rather than comparing supervised versus unsupervised exercise directly, the study evaluates whether a gamified, sensor-based VR platform can make home exercises more engaging and personalized, potentially improving the well-known problem of poor adherence to physiotherapy programs. The primary goal is not yet to prove effectiveness, but to determine whether the trial design itself is practical — including how easy it is to recruit patients, whether they are willing to be randomized, and whether they stick with the program. Secondary outcomes include pain, muscle strength, endurance, and aerobic capacity, measured at 12 and 24 weeks. If feasibility is confirmed, this technology could offer a clinically meaningful solution for the many osteoarthritis patients who struggle to maintain consistent home exercise routines.

Virtual Reality Versus Conventional Exercise For Knee Osteoarthritis: Protocol For A Randomised Controlled Trial On Functionality And Fall Risk.

Tunas-Maceiras I (2025) · Knee · PMID: 41120141

This is a published protocol for a randomised controlled trial — meaning the study is planned and registered, but results are not yet available. The trial will compare immersive virtual reality (VR) exercise using Meta Quest 3 headsets against conventional therapeutic exercise in adults aged 60 and older with knee osteoarthritis, with participants randomly assigned 1:1 to each group. Both groups receive 18 supervised sessions over 8 weeks, with follow-up assessments at 9 weeks, 6 months, and 12 months. Outcomes will include pain, stiffness, physical function, fall risk, movement biomechanics, and psychological measures such as kinesiophobia and depressive symptoms. Clinicians and patients should note that no efficacy conclusions can yet be drawn; this summary describes the research design only.

Safdar G (2025) · NA · PMID: 41112750

This small study (32 patients, ages 40–60) compared supervised clinic-based exercise with independent home-based exercise in knee osteoarthritis patients who received two platelet-rich plasma (PRP) injections. Both groups improved significantly in pain, knee movement, and overall function after one month of exercise three times per week. However, patients in the supervised group achieved greater pain relief, better knee bending (flexion), and higher functional scores on the KOOS questionnaire compared to those exercising at home independently. Notably, there was no meaningful difference between groups in knee straightening (extension), suggesting supervision may matter more for some movement directions than others. While these findings support the added value of supervised exercise following PRP treatment, the small sample size and quasi-experimental design limit how confidently results can be generalized, and larger randomized trials are needed to confirm these conclusions.

Effectiveness Of The Self-Directed Mhealth Exercise Intervention Re.flex In Patients With Knee Osteoarthritis: Randomized Controlled Trial.

Dieter V (2025) · Knee · PMID: 41066658

This randomized controlled trial of 195 German patients with moderate-to-severe knee osteoarthritis compared a 12-week self-directed smartphone app and sensor-based exercise program (re.flex) added to usual care against usual care alone. The app-guided exercise group showed a statistically significant and clinically meaningful reduction in knee pain compared to the control group (adjusted mean difference of 4.8 points on a 100-point scale), though improvements in daily physical function did not reach statistical significance. Participants showed strong engagement, completing 77% of all scheduled exercise sessions over the 12 weeks, and no serious adverse events were reported. With roughly half of knee OA patients never receiving adequate exercise guidance, this study suggests that self-directed digital exercise tools can serve as a practical and safe alternative to traditional supervised exercise programs. These findings are clinically relevant for healthcare providers seeking scalable, accessible options to increase exercise uptake in knee OA management.

Multiform-Based Yi Jin Jing Exercise Against Osteoarthritis Of The Knee: Study Protocol For A Randomised Controlled Trial.

Hu Z (2025) · Knee · PMID: 41039469

This randomized controlled trial (n=3 groups, ages 40–75) is comparing conventional medication alone against two forms of Yi Jin Jing—a traditional Chinese qigong exercise—added to standard medication for patients with knee osteoarthritis (KOA). The key innovation is a "modified" Yi Jin Jing program that blends elements from three traditional practices (Yijinjing, Baduanjin, and Wuqinxi) and offers three posture options (upright, seated, recumbent) to match different severity levels, using a stepped training model tailored to individual joint mobility. Notably, all exercise participants receive only one day per week of supervised training, with the remaining sessions performed independently, making this a predominantly self-directed exercise protocol. Primary outcomes include pain, stiffness, and physical function (WOMAC), with secondary measures covering knee performance, mobility, timed walking, and quality of life (SF-36). If effective, this adaptable, low-supervision exercise prescription could offer clinicians and patients a practical, personalized rehabilitation tool for managing KOA across varying stages of disease severity.

Effectiveness Of Adapted Physical Activity On Quality Of Life Of Patients With Knee And Hip Replacement: A Randomized Pilot Study.

Zinno R (2025) · Knee; hip · PMID: 41008463

This small pilot study (18 participants) compared a six-month supervised physical activity program against standard care in patients who had undergone total hip or knee replacement for end-stage osteoarthritis. Both groups improved in quality of life and functional mobility tests (such as the Timed Up and Go and 30-Second Chair Stand Test) over the 12-month follow-up period, suggesting that surgery itself drives meaningful recovery. The supervised exercise group showed greater gains in physical functioning and lower limb strength, though these differences did not reach statistical significance—likely due to the small sample size. Importantly, no adverse events were reported, supporting the safety and feasibility of structured physical activity programs following joint replacement rehabilitation. Larger randomized trials are needed to determine whether supervised exercise offers a clinically meaningful advantage over standard care alone.

Tailored Exercise Management Versus Usual Care For People Aged 80 Years Or Older With Hip/Knee Osteoarthritis And Comorbidities (Tempo): Multicentre Feasibility Randomised Controlled Trial In England.

Nicolson Pja (2025) · Hip; knee · PMID: 40983572

The TEMPO feasibility trial tested whether a 12-week tailored exercise programme delivered through NHS physiotherapy services could be compared against usual care in adults aged 80 and older with hip or knee osteoarthritis and at least one additional health condition. Out of 133 people screened across four English NHS sites, 51 were enrolled (mean age 84 years), and 88% completed follow-up assessments at 14 weeks, indicating strong retention. However, only about half of participants in the exercise group attended the required minimum of four sessions, and home exercise log completion declined substantially over the 12 weeks, highlighting challenges with intervention fidelity and adherence. The study population was notably homogeneous, with over 96% identifying as White British, which raises concerns about generalisability. Overall, the findings suggest a full-scale RCT is feasible but should first address participant diversity and strategies to improve exercise programme adherence before proceeding.

Prosthesis Versus Exercise For Rotator Cuff Tear Arthropathy - Protocol Of A Randomised Controlled Trial.

Larsen Jb (2025) · PMID: 40927835

This Nordic multicenter randomized controlled trial is comparing reverse total shoulder arthroplasty (a type of shoulder replacement surgery) against a structured exercise program in 102 patients with rotator cuff tear arthropathy who are candidates for surgery. The exercise intervention consists of 12 weeks of training, combining one weekly physiotherapist-supervised session with two home-based exercise sessions per week. The primary outcome measure is shoulder function and pain assessed by the Western Ontario Osteoarthritis of the Shoulder index at 12 months. Notably, surgical treatment for this condition has never previously been compared to non-surgical management in a randomized trial, making this study clinically important. Results will help clinicians and patients make more informed decisions about whether surgery offers meaningful advantages over conservative exercise-based treatment.

Adherence To In-Person And App-Based Exercise For Patients With Hip Or Knee Osteoarthritis; Secondary Analyses From A Randomized Controlled Trial.

Martinsen L (2025) · Hip; knee · PMID: 40856813

This randomized controlled trial compared adherence to supervised in-person physiotherapy versus an app-based home exercise program in 68 patients with hip or knee osteoarthritis over 6 weeks. The key finding was that patients were 4.2 times more likely to adhere to their exercise program when sessions were supervised by a physiotherapist compared to using a smartphone app independently. Patient factors also mattered: higher fatigue levels reduced the likelihood of adherence, while greater education level and higher self-efficacy increased it. Interestingly, adherence levels did not significantly predict improvements in disease-specific outcomes such as pain and function, suggesting that even partial participation may offer benefit. These findings highlight the clinical value of physiotherapist supervision in supporting exercise adherence, and suggest that app-based programs may need additional motivational strategies—particularly for patients with high fatigue or low self-efficacy—to be effective alternatives.

Telerehabilitation Versus Face-To-Face Physical Therapy For Middle-Aged Patients With Degenerative Meniscal Tear In China: A Non-Inferiority Randomized Controlled Trial.

He J (2025) · Menisc · PMID: 40842229

This randomized controlled trial conducted across two hospitals in Shanghai, China compared telerehabilitation (remote, digital platform-based physical therapy) to traditional face-to-face physical therapy over 12 weeks in patients with degenerative meniscal tears. Both groups showed meaningful improvements in knee function, pain, and quality of life, with no significant differences detected between the two approaches on key outcome measures including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and SF-36. Adherence and patient satisfaction were similarly high in both groups, supporting the feasibility of remote delivery. Importantly, telerehabilitation was significantly less costly than in-person care, offering a clear economic advantage without sacrificing clinical outcomes. These findings suggest that telerehabilitation is a clinically equivalent and more cost-effective alternative to clinic-based rehabilitation for patients with degenerative meniscal tears, which has important implications for expanding access to care.

Efficacy Of A Very-Low-Calorie Weight Loss Diet Plus Exercise Compared With Exercise Alone On Hip Osteoarthritis Pain : A Randomized Controlled Trial.

Hall M (2025) · Hip · PMID: 40759020

This randomized controlled trial compared a home-based exercise program alone versus the same exercise program combined with a very-low-calorie weight loss diet in 101 adults with hip osteoarthritis who were overweight or obese, delivered over 6 months via telehealth. Although participants in the combined group lost significantly more weight (8.5% more than the exercise-only group), adding the diet did not produce a clinically meaningful improvement in hip pain severity beyond exercise alone, as the difference between groups fell below the minimum threshold considered clinically important. However, the diet-plus-exercise group showed improvements in several secondary outcomes—including body weight, BMI, and overall hip improvement—that persisted at 12 months, suggesting broader health benefits even without superior pain relief. Clinicians should note that while weight loss through dietary intervention offers meaningful secondary benefits for patients with hip osteoarthritis and obesity, exercise alone remains an effective core treatment for pain management. Both approaches were safe, with no serious related adverse events reported.

Clinical And Cost-Effectiveness Of A Cycling And Education Intervention Versus Usual Physiotherapy Care For The Treatment Of Hip Osteoarthritis In The Uk (Cleat): A Pragmatic, Randomised, Controlled Trial.

Wainwright Tw (2025) · Hip · PMID: 40753994

The CLEAT trial compared a group-based cycling and education programme (CHAIN) with standard one-to-one physiotherapy for 221 adults with hip osteoarthritis in the UK. Participants in the CHAIN group attended an 8-week programme at a community leisure centre combining static cycling with education sessions, and showed statistically greater improvements in daily living activities compared to those receiving usual physiotherapy care. However, the between-group difference of 6.9 points on the Hip Disability and Osteoarthritis Outcome Score narrowly missed the pre-defined threshold of 7.4 points considered clinically meaningful, meaning the real-world benefit to patients remains uncertain. From a health economics perspective, CHAIN was cost-effective at £4,092 per quality-adjusted life year gained, well below the NHS approval threshold of £20,000–£30,000. These findings suggest that community-based group cycling may be a viable, affordable alternative to traditional physiotherapy for hip osteoarthritis, though longer-term follow-up and broader testing across diverse populations are needed.

Improving Muscle Function Through A Multimodal Behavioural Intervention For Knee Osteoarthritis And Obesity: The Pomelo Trial.

Godziuk K (2025) · Knee · PMID: 40746030

The POMELO trial was a small pilot randomized controlled trial (50 participants) that compared a structured 3-month multimodal intervention—combining progressive resistance exercise three times weekly, personalized nutrition counseling, and group arthritis self-management education—against usual clinical care in adults aged 40–75 with severe obesity (BMI ≥35) and knee osteoarthritis. The supervised intervention met feasibility benchmarks (80% completion, 74% adherence) and was significantly more satisfying to participants than usual care. Crucially, while both groups lost fat mass, only the usual care group lost muscle mass and grip strength, suggesting that the supervised, combined approach protected against muscle loss—a common and clinically important concern in this population. The POMELO group also showed meaningful improvements in physical function (chair stands, six-minute walk test) and quality of life compared to usual care. These promising pilot results support a larger confirmatory trial, as this multimodal approach may offer important advantages in mobility and health outcomes without requiring a primary focus on weight loss.

Effects Of A Home-Based Prehabilitation Program On Biomarkers And Hospital Outcomes In Total Knee Arthroplasty: A Protocol For A Randomized Controlled Trial.

Halmenschlager G (2025) · Knee · PMID: 40746820

This randomized controlled trial compares a remote-supervised, home-based exercise program (8 weeks before knee replacement surgery) against standard care in patients scheduled for total knee arthroplasty (TKA). Researchers will examine whether structured preoperative exercise can favorably alter blood biomarkers related to inflammation (CRP, IL-6), nutrition, and blood clotting, which are known to influence how well patients recover after surgery. Key secondary outcomes include hospital length of stay, postoperative complications, pain, joint function, and patient satisfaction. Importantly, this is currently a published protocol — the trial is ongoing and results are not yet available. If effective, this scalable home-based approach could improve surgical readiness and recovery outcomes, particularly for patients in healthcare systems with limited access to facility-based rehabilitation.

Self-Directed Versus Supervised Exercise Therapy Program Combined With Digitally Supported Patient Education For Knee Osteoarthritis: A Randomised, Parallel-Group Feasibility Trial.

Souto Lr (2025) · Knee · PMID: 40716116

This small feasibility trial (24 participants with knee osteoarthritis) tested whether a larger comparison of self-directed versus supervised exercise therapy — both combined with digital patient education — could be successfully conducted. All participants completed both online education sessions and none dropped out, suggesting the study design is acceptable to patients. Notably, self-directed exercisers showed higher logbook completion rates (88%) compared to supervised participants (57%), and 93% of self-directed participants achieved the target of at least 12 exercise sessions. Clinically meaningful improvements in knee pain, function, and quality of life were observed within the self-directed group, suggesting this lower-cost approach may produce benefits comparable to supervised therapy. The authors conclude that a full-scale non-inferiority trial is feasible and warranted, with minor adjustments needed to improve recruitment speed and data collection.

Protocol For The Comparison Of Remote Versus Face-To-Face Osteoarthritis Management Programs (Coastal): A Randomized Implementation Trial.

Yuan S (2025) · PMID: 40697621

The COASTAL trial is a randomized controlled trial comparing three ways of delivering osteoarthritis (OA) care for people with knee OA: traditional face-to-face clinic visits, telehealth (remote video/phone consultations), and a mobile app called "OA Coach," with all three approaches providing the same core elements of care including exercise, education, and pain management. The study will enroll 1,348 participants referred to a public OA care program in New South Wales, Australia, with the main goal of determining whether telehealth and the app are "non-inferior" (not meaningfully worse) compared to in-person care, as measured by knee pain during walking at six months. A non-randomized control group of people who declined the program will also be included to assess the overall benefit of all three active treatments. This large, real-world implementation trial is clinically relevant because it directly addresses a pressing healthcare challenge—how to scale up evidence-based OA care across different delivery formats to reach more patients, including those in remote or underserved areas. Results will help patients, clinicians, and health policymakers make informed decisions about which mode of OA care delivery is most effective and practical.

Consumer-Focused Osteoarthritis E-Learning To Complement Physiotherapy Care In People With Knee Osteoarthritis: Protocol For The Peeko Randomised Controlled Trial.

Nelligan Rk (2025) · Knee · PMID: 40610701

This RCT (the PEEKO trial) compared two approaches for managing knee osteoarthritis (OA): a standard physiotherapy program involving verbal OA education and a home strengthening exercise plan delivered via two video consultations, versus the same program supplemented with access to a free, four-module online e-learning course about OA and its recommended management. The trial enrolled 136 community-dwelling Australian adults with clinically diagnosed knee OA, with primary outcomes measuring knee pain during walking and physical function (using the WOMAC scale) at 24 weeks. Secondary outcomes broadly assessed quality of life, self-efficacy, OA knowledge, fear of movement, exercise adherence, and medication use, among others. It is important to note that this is a published protocol, meaning results are not yet available; the trial will determine whether adding consumer-focused digital education meaningfully enhances outcomes beyond standard physiotherapy care alone. The findings will have direct clinical relevance for physiotherapists and patients seeking scalable, low-cost tools to complement hands-on or telehealth OA management.

Strength Training Intervention For Adult Individuals With Knee Osteoarthritis: Establishing Fidelity.

KÃ¼Ã§Ã¼k H (2025) · Knee · PMID: 40606231

This randomized controlled trial enrolled 72 adults (average age 56 years) with knee osteoarthritis, randomly assigning them to either a structured home-based strength training program (n=37) or a control group (n=35) to evaluate both the program's effectiveness and how faithfully participants followed the prescribed exercises. The strength training group showed significantly better scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) compared to controls (p<0.001), suggesting meaningful improvements in pain, stiffness, and physical function. Notably, participants reported strong adherence to their home workout routines, indicating that the intervention was delivered with high fidelity. These findings reinforce that structured resistance training is a clinically viable, non-pharmacological option for managing knee osteoarthritis symptoms in middle-aged and older adults. However, clinicians should note that the study relied on self-reported adherence, which may overestimate true compliance, and independent verification of exercise fidelity would strengthen confidence in these results.

Effects Of A Multicomponent Exercise Regimen On Subchondral Bone And Cartilage In Postmenopausal Women With Knee Osteoarthritis: Protocol For A Randomized Controlled Trial.

Konola Vm (2025) · Knee · PMID: 40551179

This randomized controlled trial is comparing a structured, supervised multicomponent exercise program against a standard home exercise program in at least 90 postmenopausal women (ages 55–75) with mild knee osteoarthritis. The supervised intervention combines step aerobics and resistance training (alternating every two weeks, three sessions per week for eight months), while the comparison group follows unsupervised home exercises representing typical rehabilitative care. The primary focus is on whether supervised exercise produces measurable improvements in knee cartilage biochemistry and subchondral bone health, assessed using advanced MRI and cone beam CT imaging at baseline, 8 months, and 12 months. Importantly, this trial addresses a gap in the literature by examining how exercise affects the functional relationship between cartilage and the underlying bone—two tissues that deteriorate together in osteoarthritis. Findings could meaningfully guide clinicians in prescribing more targeted and effective exercise regimens for this common and debilitating condition.

Patients' Experiences And Usability Of A Self-Directed M-Health Exercise Intervention For Knee Osteoarthritis: A Qualitative Study.

Dieter V (2025) · Knee · PMID: 40523788

This qualitative study, nested within an RCT (DRKS00023269), explored 14 knee osteoarthritis patients' experiences with a 12-week self-directed mobile health (m-health) exercise app. Participants generally found the app easy to use and valued features like instructional videos, real-time biofeedback, and push notification reminders for supporting motivation and correct exercise performance. However, some participants missed having human support during the program. The authors conclude that treatment modality — digital self-directed vs. human-supported — should be matched to individual patient preferences and needs.

Development Of A Mobile App To Promote Physical Activity In Individuals With Knee Osteoarthritis: The "Move For Knee"â„¢ Study Protocol.

Liguori S (2025) · Knee · PMID: 40519987

This document describes the protocol for a planned randomized controlled trial evaluating a mobile app called "Move for Knee"™, designed to help people aged 45–70 with knee osteoarthritis (KOA) become more physically active. The app offers personalized exercise programs, activity tracking, real-time monitoring, and a chat function connecting users with healthcare providers. The trial will compare outcomes — including pain, physical function, and quality of life — between app users and a control group receiving standard physical activity advice. Importantly, this is a study protocol only; no results are yet available, so no conclusions about effectiveness can currently be drawn. Clinicians and patients should note that this technology shows promise for improving adherence to exercise guidelines, but clinical evidence awaits completion of the trial.

Remote And In-Person Supervised Exercise In Patients With Knee Osteoarthritis (Rise-Koa): Study Protocol For A Non-Inferiority Randomized Controlled Trial.

Carvalho Mtx (2025) · Knee · PMID: 40394687

The RISE-KOA trial is comparing two delivery methods for exercise therapy in knee osteoarthritis: remote supervision via video call versus in-person supervision at a physiotherapy clinic, using a non-inferiority design to determine whether telehealth is "just as good" as traditional care. A total of 48 adults aged 45 and older with confirmed knee osteoarthritis (grades II–III) will complete the same 12-week lower limb muscle-strengthening program under one of the two supervision formats, with follow-up assessments at 6, 12, and 18 weeks. The key outcomes being measured include pain intensity, physical function, psychological well-being, sleep quality, and muscle architecture, giving a comprehensive picture of how each approach affects patients. The researchers hypothesize that video-supervised exercise will perform no worse than in-person therapy across all these outcomes. Clinically, if confirmed, these findings would support telehealth-delivered exercise as a viable, accessible alternative to clinic-based rehabilitation for knee osteoarthritis, potentially expanding care to patients with limited access to in-person services.

Impact Of Monthly Community Follow-Ups In Knee Osteoarthritis Management For Elderly Patients.

Hu R (2025) · Knee · PMID: 40356209

This randomized controlled trial of 112 elderly patients with knee osteoarthritis compared monthly community-based follow-ups (including pain education and exercise supervision) against standard semi-annual check-ins over 14 months. Both groups showed pain improvement, but patients receiving monthly structured follow-ups demonstrated significantly greater gains in pain reduction (VAS), knee function (KOOS), and overall quality of life (SF-36) compared to those seen only twice yearly. The more frequent supervision appeared to work largely by improving patients' adherence to prescribed exercise regimens. With a modest but meaningful sample size, these findings suggest that increasing the frequency of community-based monitoring is a practical and effective strategy for managing knee osteoarthritis in older adults. Clinicians and healthcare systems should consider integrating regular structured follow-ups into rehabilitation pathways for this population.

Effects Of A Computer Vision-Based Exercise Application For People With Knee Osteoarthritis: Randomized Controlled Trial.

Zhu D (2025) · Knee · PMID: 40354624

This 6-week randomized controlled trial (n=60, ages 60–80) compared a computer vision-based exercise app that provided real-time movement feedback against a standard video/brochure education program for people with knee osteoarthritis. Participants using the supervised app showed statistically significant improvements in physical function and self-efficacy compared to the unsupervised education group, though both groups experienced similar reductions in pain and stiffness. The app group also reported positive usability and engagement, suggesting that digital supervision can meaningfully enhance patient motivation and confidence in performing rehabilitation exercises. These findings are clinically relevant as they highlight a scalable, accessible alternative to in-person supervised exercise, particularly for older adults who may face barriers to clinic attendance. However, the relatively small sample size and short follow-up period call for larger, longer-term studies before widespread clinical adoption can be recommended.

Effectiveness Of Self-Training With A Web-Based Digital Health Application Versus Physiotherapy In The Treatment Of Disorders Of The Patella: Randomized Controlled Trial.

Mayer Ta (2025) · PMID: 40323642

This randomized controlled trial of 259 patients compared a 12-week web-based digital health application (DHA) for self-directed exercise against conventional physiotherapy covered by statutory health insurance in Germany, specifically for patella disorders (kneecap problems). The DHA group showed 4.5 times greater improvement in knee function (KOOS-ADL score: +15.7 points) and 3.5 times greater pain reduction (VAS: -22.5 points) compared to standard physiotherapy (+3.5 points and -6.5 points, respectively), with both differences reaching statistical and clinical significance. Pain medication use also decreased substantially in the DHA group but remained largely unchanged in the physiotherapy group. These results suggest that a well-designed digital exercise program may not only overcome practical barriers like scheduling and session limits inherent to conventional therapy, but may actually outperform it for this condition. Based on these findings, the DHA has received regulatory approval from the German Federal Institute for Drugs and Medical Devices for patients aged 12 and older, making it a clinically validated alternative to supervised physiotherapy for patella disorders.

Moderators And Mediators Of Pain And Function Outcomes In A New Service Delivery Model For Management Of Knee Osteoarthritis In Primary Care: Secondary Exploratory Analysis Of A Randomized Controlled Trial.

Farivar A (2025) · Knee · PMID: 40297975

This study examined what factors influenced the success of a structured primary care program (PARTNER) compared to usual GP care for people with knee osteoarthritis, involving 217 patients followed over 12 months. Researchers found that while age did not affect pain outcomes, younger participants (under 50) in the PARTNER program showed significantly greater improvements in physical function compared to older participants, suggesting the program may be particularly beneficial for younger patients. A key finding was that patient satisfaction — including overall satisfaction and satisfaction with treatment and symptom management — acted as an important pathway through which the PARTNER program reduced pain and improved function, regardless of age. Clinically, these results suggest that optimizing patient satisfaction with care delivery may be a meaningful target for improving outcomes in knee osteoarthritis management. Future research should consider age-tailored approaches and prioritize strategies that enhance the patient experience within structured primary care models.

A Telehealth Physical Therapy Intervention To Increase Physical Activity In Adults With Knee Oa: The Delaware Peak Randomized Controlled Trial.

White Dk (2025) · Knee · PMID: 40258072

This randomized controlled trial (the Delaware PEAK trial) compared a 12-week telehealth physical therapy program—involving five video consultations with a physical therapist focused on strengthening exercises, step goals, and education—against a control group that received only web-based osteoarthritis resources, in 103 adults with knee osteoarthritis. Despite the structured supervision and daily step goals, the telehealth intervention did not increase moderate-to-vigorous physical activity (MVPA) or daily step counts significantly more than the control group at 12 weeks. However, participants in the telehealth group did experience greater improvements in pain and physical function compared to controls, suggesting meaningful clinical benefits beyond activity volume alone. The relatively modest sample size (67 participants with complete accelerometer data at 12 weeks) limits the certainty of these findings, and the higher rate of non-serious adverse events in the intervention group warrants attention. Clinically, these results suggest that telehealth-delivered exercise therapy for knee osteoarthritis can improve patient-reported outcomes like pain and function, but may require additional or different strategies to meaningfully increase overall physical activity levels.

Face-To-Face Exercises Are Not Superior To Tele-Rehabilitation In Recent Post-Operative Total Hip Arthroplasty: A Randomized Clinical Trial.

Brazeiro Mc (2025) · Hip · PMID: 40206449

This randomized controlled trial compared in-clinic, face-to-face supervised exercise to a home-based telerehabilitation program (using a printed booklet and weekly phone calls) in 24 patients recovering from total hip arthroplasty (THA) over 6 weeks. Both groups showed meaningful improvements in hip function scores (Harris Hip Score), while the telerehabilitation group also demonstrated significant gains in timed walking performance (Timed Up and Go test), suggesting home-based exercise may be equally or slightly more effective in some functional outcomes. Neither approach was superior across all measures, including muscle strength, range of motion, pain, and fear of movement. The small sample size (14 face-to-face, 10 telerehabilitation) limits definitive conclusions, and results should be interpreted cautiously. Clinically, these findings suggest that telerehabilitation is a viable, cost-effective, and accessible alternative to in-person supervision for patients in the early stages of post-THA rehabilitation, which is particularly relevant for those with limited access to clinic-based care.

Structured Home-Based Exercise Programme And Concentric Versus Eccentric-Based Stair Training Programme For Pain And Function In Knee Osteoarthritis: A Two-Phase, Double-Blinded, Randomised Controlled Trial Protocol.

Hossain Kma (2025) · Knee · PMID: 40191839

This registered randomized controlled trial (n=247) will compare a structured home-based exercise program (HEP) against a control group, and subsequently evaluate concentric versus eccentric stair training programs over 16 weeks with a 24-week follow-up in adults with knee osteoarthritis. The two-phase design allows researchers to first test the value of a self-managed home exercise approach, then examine whether the direction of stair training muscle contractions (concentric vs. eccentric) produces meaningfully different outcomes. Primary outcomes include pain intensity, pressure pain threshold, and physical function measured by WOMAC, while secondary outcomes capture muscle strength, joint mobility, aerobic capacity, and quality of life. Notably, this is a protocol paper — results are not yet available — but the study is designed to generate clinically actionable guidance for a condition that affects millions globally. If the home-based program proves effective, it could offer a practical, low-cost management strategy for patients with limited access to supervised care.

Effects Of A Digitally Supported Physical Activity Intervention In Knee Osteoarthritis: A Pilot Randomized Controlled Trial.

AkgÃ¼l H (2025) · Knee · PMID: 40148223

This pilot randomized controlled trial of 30 women with knee osteoarthritis compared a standard home exercise program plus patient education and smartwatch use (control group) against the same program with an added digitally supported walking intervention (intervention group) over 8 weeks. The group receiving the digital walking program showed meaningfully greater improvements in pain (1.4-point reduction on a pain scale), physical function (6.4-point improvement on the WOMAC), and daily step count (nearly 1,550 more steps per day) compared to the control group. Both groups improved similarly in exercise adherence, quality of life, and pain catastrophizing, suggesting that basic digital support alone provides some benefit. These findings indicate that structured, digitally supervised physical activity programs offer clinically relevant added value beyond standard home exercise for women with knee osteoarthritis. While promising, the small sample size and short follow-up period mean larger, longer-term trials are needed before broad clinical recommendations can be made.

Effect Of Clinic-Based And Asynchronous Video-Based Exercise On Clinic And Psychosocial Outcomes In Patients With Knee Osteoarthritis: Quasi-Experimental Study.

Mbada Ce (2025) · Knee · PMID: 40138680

This 8-week quasi-experimental study of 52 patients with knee osteoarthritis compared a clinic-based supervised strengthening exercise program (CbSE) to an asynchronous video-based home exercise version of the same program (AVbSE). Both approaches improved patient outcomes and quality of life, but the video-based group showed greater improvements in mental health, pain perception (via quality-of-life questionnaire), social support, and social activities at both 4 and 8 weeks. Interestingly, the clinic-based supervised group showed superior results in average pain reduction as measured by the Quadruple Visual Analog Scale, suggesting that direct supervision may still offer advantages for pain control. The relatively small sample size (52 completers) and quasi-experimental design limit the strength of conclusions, but the findings are clinically relevant as they suggest that telerehabilitation via pre-recorded video is a viable, and in some respects superior, alternative to in-person care for knee osteoarthritis. Clinicians may consider offering asynchronous video-based exercise programs to patients who face barriers to clinic attendance, while recognizing that supervised exercise may still be preferable for optimizing pain management.

Novel Uses Of Healthcare Technology For Individuals With Mild To Moderate Hip Or Knee Osteoarthritis: The Technology, Exercise And Activity Prescription For Enhanced Mobility (Team) Study Randomized Controlled Trial Protocol.

Thornton J (2025) · Hip; knee · PMID: 40115196

This randomized controlled trial (TEAM Study) is comparing three approaches to managing mild-to-moderate hip and knee osteoarthritis: a physician-delivered physical activity prescription tool (PARx), PARx combined with a free online exercise and education platform with optional physiotherapist telerehabilitation (Joint Management), and usual care. The study will enroll 339 adults aged 40 and older, divided equally across the three groups, with follow-up at 2, 6, and 12 months. The key question is whether adding structured digital exercise programming—with or without supervised telerehabilitation from a physiotherapist—improves pain, function, and physical activity levels beyond what patients typically receive from their doctors. Primary outcomes are measured using validated patient-reported joint-specific scores (KOOS/HOOS), alongside physical performance tests and activity monitoring. This study is clinically relevant because it tests scalable, low-cost digital tools that could make evidence-based exercise therapy more accessible to the large and growing population living with osteoarthritis.

Getting Fit For Hip And Knee Replacement: The Fit-Joints Multimodal Intervention For Frail Patients With Osteoarthritis - A Pilot Randomized Controlled Trial.

Okpara C (2025) · Hip; knee · PMID: 40042971

The Fit-Joints trial was a pilot randomized controlled trial that tested a multimodal prehabilitation program — combining exercise, protein and vitamin D supplementation, and medication review — in 69 older adults (average age 74) with frailty who were awaiting hip or knee replacement surgery in Ontario, Canada. The study demonstrated strong feasibility, with 81% of participants completing the trial, good adherence to exercise (strength training ~4 days/week) and supplements (~82%), and adequate data completion. Most notably, participants in the intervention group showed a clinically meaningful and statistically significant improvement in knee function scores (Oxford Knee Score) at 6 months after surgery, along with encouraging trends in frailty reduction and quality of life. These findings suggest that frail older adults can successfully engage with an intensive prehabilitation program before joint replacement, and that doing so may lead to better surgical outcomes. While this was a small pilot study designed primarily to test feasibility, the results provide a strong foundation for a larger, definitive trial to confirm whether this approach should become standard of care for frail patients awaiting joint replacement.

Nutrition Supplementation Combined With Exercise Versus Exercise Alone In Treating Knee Osteoarthritis: A Double-Blinded, Randomised, Placebo-Controlled Trial.

Liu W (2025) · Knee · PMID: 39982001

This 6-month randomized controlled trial compared a combination of nutrition supplementation (glucosamine sulphate, chondroitin sulphate, and rhizoma drynariae) plus supervised exercise against supervised exercise alone in 65 adults aged 40–75 years with knee osteoarthritis. Both groups showed meaningful improvements in pain, stiffness, and physical function by 6 months; however, participants receiving the nutrition supplement achieved these improvements earlier—by 3 months—and were significantly more likely to reach clinically meaningful thresholds on key outcomes including overall symptom scores and joint stiffness. The nutrition plus exercise group also demonstrated greater knee flexor muscle strength at 3 months compared to the exercise-only group. With 86% of participants completing the trial, these findings suggest that adding a glucosamine/chondroitin-based supplement to a supervised exercise program may accelerate symptom relief and functional gains in knee osteoarthritis patients. Clinicians should note the modest sample size and single-centre design, which limit generalizability, but the results support considering combined supplementation and exercise as a potentially more efficient treatment strategy.

Minimal Important Change In The Hip Disability And Osteoarthritis Outcome Score And The European Quality Of Life 5 Dimensions In Adults With Hip Osteoarthritis After 12 Weeks Of Exercise.

ChÃ©ret Epbm (2025) · Hip · PMID: 39970818

This study analyzed data from a randomized trial of 160 adults with hip osteoarthritis who completed 12 weeks of supervised group exercise, with the goal of determining the "minimal important change" (MIC) — the smallest improvement that patients themselves would consider meaningful. Researchers tested seven different outcome measures, but only two showed a strong enough relationship to patients' self-reported sense of improvement to be used for MIC estimation: the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the EuroQol quality-of-life scale (EQ-5D-5L). The MIC for HOOS subscales ranged from 6 to 10 points (on a 0–100 scale), while the EQ-5D-5L index required a change of approximately 0.054 and the visual analog scale required a change of about 5 points to be considered meaningful by patients. These thresholds are clinically relevant because they give clinicians and researchers a concrete benchmark for judging whether exercise programs produce changes that actually matter to patients, rather than just statistically significant differences. Importantly, most commonly used physical performance tests did not correlate sufficiently with patients' perceived improvement, suggesting these tests alone may not capture what patients value most in their recovery.

Exploration Of Heterogeneity Of Treatment Effects Across Exercise-Based Interventions For Knee Osteoarthritis.

Dennis Pa (2025) · Knee · PMID: 39968101

This study pooled data from two clinical trials involving 621 patients with knee osteoarthritis to compare three exercise-based approaches — group physical therapy, individual physical therapy, and a Stepped Exercise Program — against an education-only control, using machine learning to identify which patients responded best to which treatment. The primary measure of success was improvement in the WOMAC score, a validated tool capturing pain, stiffness, and physical function. The key finding was that group-based physical therapy produced the greatest symptom improvements overall, and this advantage held regardless of how severe a patient's symptoms were at the start. Notably, patients with higher baseline symptom severity (WOMAC score above 44) tended to benefit more from all exercise interventions, suggesting that those with moderate-to-severe osteoarthritis may have the most to gain. Clinically, these results support prioritizing group-based physical therapy for knee osteoarthritis and highlight that even patients with more advanced symptoms should not be discouraged from exercise-based treatment.

Impact Of Resistance Exercise And Nitrate Supplementation On Muscle Function And Clinical Outcomes After Knee Osteoarthritis Surgery In Middle-Aged Women With Sarcopenia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

Park Hs (2025) · Knee · PMID: 39860619

This randomized, double-blind, placebo-controlled trial enrolled 36 middle-aged women with sarcopenia who underwent knee cartilage surgery, comparing 12 weeks of supervised resistance exercise combined with either nitrate supplementation or placebo. The key finding was that nitrate supplementation helped preserve thigh muscle mass (which declined in the placebo group) and produced significantly greater improvements in both knee extension and flexion strength at 6 and 12 weeks. Functional outcomes measured by the SPPB and IKDC scores also improved more in the nitrate group, though pain and disability scores (WOMAC) improved similarly in both groups. While promising, the small sample size of 36 participants limits the generalizability of these findings, and larger trials are needed. Clinically, dietary nitrate supplementation may be a practical, low-cost adjunct to post-surgical rehabilitation programs for women with sarcopenia and knee osteoarthritis.

Exploring Participant Satisfaction With An Ehealth Intervention For Low Back Pain And Knee Osteoarthritis: Enhancing Physiotherapy Access In Rural Australia.

Allworth I (2025) · Knee · PMID: 39805211

This pilot RCT compared an eHealth physiotherapy intervention to usual care for adults with knee osteoarthritis or low back pain living in rural Australia, enrolling 156 participants with 75 completing a satisfaction survey. Patients receiving the eHealth intervention reported significantly higher overall satisfaction (median 9 vs. 8) and rated accessibility, cost, travel distance, and time to reach a physiotherapist more favorably than the usual care group. However, eHealth participants more frequently reported difficulties with exercises, suggesting that remote delivery requires careful attention to exercise guidance and patient motivation. Clinically, these findings support eHealth as an acceptable and potentially advantageous model for delivering physiotherapy in underserved rural areas. Future telehealth programs should prioritize strategies to help patients manage exercise workload independently.

Preoperative Home-Based Multimodal Physiotherapy In Patients Scheduled For A Knee Arthroplasty Who Catastrophize About Their Pain: A Randomized Controlled Trial.

Terradas-Monllor M (2025) · Knee · PMID: 39797350

This randomized controlled trial investigated whether preoperative home-based physiotherapy could reduce pain catastrophizing (a tendency to fear and magnify pain) in 40 patients with knee osteoarthritis scheduled for total knee replacement surgery. Two intervention approaches were compared: Therapeutic Patient Education (TPE), which involved fewer sessions with less supervision, and Multimodal Physiotherapy (MPT), which included more sessions and greater supervision — both incorporating pain neuroscience education, coping skills training, and therapeutic exercise. Both interventions successfully reduced pain catastrophizing before surgery, and both groups showed meaningful improvements in pain, movement confidence (kinesiophobia), self-efficacy, balance, and walking speed up to six months after surgery compared to controls. Notably, the more supervised MPT program appeared to produce broader and more sustained functional improvements, particularly in physical performance outcomes like walking speed. These findings suggest that identifying and treating high pain catastrophizers before knee replacement surgery — even with relatively brief home-based programs — can meaningfully improve both psychological and physical recovery outcomes.

Trapeziometacarpal Total Joint Arthroplasty, With Or Without Supervised Hand Rehabilitation: A Quasi-Experimental Trial.

Bonhof-Jansen Ee (2025) · Hand · PMID: 39544957

This quasi-experimental trial compared outcomes in 62 women with trapeziometacarpal (thumb base) osteoarthritis who underwent total joint replacement, with one group (n=31) receiving supervised hand therapy and another (n=31) receiving education alone. Surprisingly, the education-only group achieved significantly better hand function scores on the Michigan Hand Outcomes Questionnaire at both 3 and 12 months post-surgery, and also required eight fewer therapy visits on average. While the study has limitations including its non-randomized design and relatively small sample size, the results suggest that costly and time-intensive supervised rehabilitation may not be necessary following this procedure. Clinicians and patients can be cautiously reassured that a well-structured education program alone appears sufficient to support safe and effective recovery after thumb joint replacement, though the authors appropriately recommend confirmation in larger randomized trials before changing standard practice.

Letter To The Editor: Does The Combination Of Platelet-Rich Plasma And Supervised Exercise Yield Better Pain Relief And Enhanced Function In Knee Osteoarthritis? A Randomized Controlled Trial.

Zhao R (2025) · Knee · PMID: 39437549

This randomized controlled trial investigated whether combining platelet-rich plasma (PRP) injections with supervised exercise produces better outcomes than other approaches for people with knee osteoarthritis. The study compared groups receiving different combinations of PRP and exercise supervision to determine whether the added structure of supervised exercise meaningfully enhanced pain relief and physical function beyond what PRP alone or unsupervised exercise might achieve. Unfortunately, because no abstract was available, specific details regarding sample size, exact outcome measures, and precise effect sizes cannot be reported here. Clinicians should note that the combination of biological treatments like PRP with structured rehabilitation represents an important clinical question, as supervision adds cost and resource burden that must be justified by meaningful patient benefit. Readers are encouraged to access the full text to evaluate the completeness of the methodology and the clinical significance of the findings before applying them to practice.

Effect Of Knee Strengthening Exercises And Lifestyle Modifications Through Mobile Phone Support In People Suffering From Knee Osteoarthritis.

Garg N (2025) · Knee · PMID: 39331052

This study compared two approaches for managing knee osteoarthritis in 210 participants over 12 weeks: one group received exercise instruction leaflets plus ongoing mobile phone support (SMS messages and phone calls to encourage adherence), while the control group received only standard physiotherapy instructions with no follow-up contact. The group receiving mobile phone-based support showed significantly greater reductions in pain and improvements in physical function and quality of life compared to those who exercised without structured follow-up. Importantly, the benefit appeared to stem from improved exercise adherence facilitated by regular remote check-ins, rather than from a different exercise program itself. These findings suggest that simple, low-cost mobile phone interventions can meaningfully enhance outcomes for knee osteoarthritis patients who are managing their condition at home. Clinically, this supports integrating digital adherence tools — even basic SMS or phone calls — into standard care pathways for osteoarthritis management.

Exercise And Footwear In Medial Knee Osteoarthritis: A Randomized Controlled Trial Comparing Flat Flexible Footwear To Stable Supportive Shoes.

Dainese P (2024) · Foot; knee · PMID: 39669115

This randomized controlled trial compared two types of footwear — flat flexible shoes versus stable supportive shoes — combined with a structured exercise program in 97 adults with medial knee osteoarthritis. Both groups followed the same 9-month exercise regimen, consisting of 3 months of supervised exercise followed by 6 months of unsupervised exercise, with footwear type as the only difference between groups. The key finding was that both groups experienced meaningful improvements in knee pain, physical function, and quality of life at 3 and 9 months, but there were no significant differences between the two footwear types on any outcome. Clinically, this suggests that the type of footwear (flat flexible vs. stable supportive) does not appear to matter when combined with a comprehensive exercise program for medial knee osteoarthritis. Patients and clinicians can be reassured that a well-structured exercise program drives meaningful symptom relief regardless of which of these two footwear styles is chosen.

An Unsupervised Online Tai Chi Program For People With Knee Osteoarthritis ("My Joint Tai Chi"): Study Protocol For The Retreat Randomised Controlled Trial.

Zhu Sj (2024) · Knee · PMID: 39554480

The RETREAT trial is an ongoing randomized controlled trial enrolling 178 adults with clinically diagnosed knee osteoarthritis (OA) to compare two online interventions: an unsupervised 12-week home-based Tai Chi program ("My Joint Tai Chi") paired with educational resources and an exercise adherence support app, versus an education-only website ("My Joint Education"). The key question is whether providing structured but unsupervised online Tai Chi—performed three times per week at home—can meaningfully reduce knee pain during walking and improve physical function compared to education alone, as measured by the WOMAC subscales at 12 weeks. This study directly addresses the accessibility barrier of traditional in-person Tai Chi programs, which has limited uptake among OA patients who face transportation, mobility, or scheduling challenges. If effective, an unsupervised digital Tai Chi program could represent a scalable, low-cost treatment option that extends evidence-based exercise therapy to a broader population. Results from this trial will be clinically relevant for physiotherapists, rheumatologists, and general practitioners seeking practical, remotely deliverable exercise solutions for knee OA management.

Clinical Benefit Of Physical Rehabilitation After Total Hip And Knee Arthroplasty: A Pragmatic, Randomized, Controlled Trial (The Draw1 Trial).

Mark-Christensen T (2024) · Hip; knee · PMID: 39507936

The DRAW1 trial randomized 168 patients undergoing total hip or knee replacement to either a 6-week structured physical rehabilitation program (delivered via telerehabilitation or home-based therapy) or no formal rehabilitation, to determine whether post-surgical rehab actually improves outcomes. Across all time points measured — 6 weeks, 3 months, and 12 months after surgery — patients who received rehabilitation showed no statistically significant improvement in daily function, pain, symptoms, or quality of life compared to those who received no rehabilitation. The differences in the primary outcome scores were small (ranging from 1.9 to 3.3 points) and fell well within confidence intervals that crossed zero, indicating no clinically meaningful benefit. These findings challenge the widespread assumption that formal rehabilitation is essential after joint replacement surgery, at least when compared to no supervised program. Clinicians and patients should consider that natural recovery following arthroplasty may be sufficient for many individuals, though further research is needed to identify subgroups who might benefit most from structured rehabilitation.

Efficacy Of A Computer Vision-Based System For Exercise Management In Patients With Knee Osteoarthritis: A Study Protocol For A Randomised Controlled Pilot Trial.

Xu Y (2024) · Knee · PMID: 39500602

This pilot randomized controlled trial, enrolling 60 patients with knee osteoarthritis, compares a computer vision-based tele-rehabilitation exercise program against a standard in-clinic (outpatient) exercise program, with both groups completing two sessions per week over 12 weeks. The study will assess whether remote, technology-guided exercise supervision can achieve similar functional improvements to face-to-face care, using well-validated outcome measures including the WOMAC score, pain levels, and quality of life. With 30 participants in each group and follow-up assessments extending to 24 weeks after the intervention ends, the trial is designed as a pilot to test feasibility and preliminary efficacy rather than deliver definitive conclusions. The clinical relevance is significant, as tele-rehabilitation could improve access to supervised exercise therapy for osteoarthritis patients who face barriers to attending in-person appointments. Results from this trial could inform whether AI-assisted, home-based exercise guidance is a viable and effective alternative to traditional supervised physiotherapy for knee osteoarthritis management.

Effectiveness Of Tele-Rehabilitation In Patients With Knee Osteoarthritis: A Randomized Controlled Trial.

Tedeschi R (2024) · Knee · PMID: 39493627

This randomized controlled trial (TABLET; NCT05719350) compared tele-rehabilitation (remote physiotherapy delivered three times weekly for four weeks) against conventional in-person rehabilitation in 55 patients with knee osteoarthritis. Both groups showed significant improvements after three months in pain (NPRS), physical function and disability (WOMAC), and several quality-of-life domains including physical functioning, energy, and pain (SF-36), with no meaningful differences between the two approaches. The study found that tele-rehabilitation was equally effective as traditional outpatient therapy for reducing pain and improving function, suggesting it is a viable alternative rather than an inferior option. Clinically, these findings are relevant for patients who face barriers to attending in-person sessions—such as mobility limitations, distance, or scheduling difficulties—as they can expect comparable outcomes through a remote format. Tele-rehabilitation may therefore be integrated alongside conventional care to broaden access and personalize treatment strategies for knee osteoarthritis management.

Impact Of Prior Knee Surgery On Change In Knee Pain, Quality Of Life, And Walking Speed Following Supervised Education And Exercise Therapy: An Analysis Of 30,545 People With Knee Osteoarthritis.

GrÃ¸nne Dt (2024) · Knee · PMID: 39467904

This large study examined whether having had prior knee surgery affected how well patients with knee osteoarthritis responded to an 8-week supervised education and exercise program called GLA:D®, involving over 30,500 participants across Denmark. Approximately 27% of patients had previously undergone knee surgery, yet both the surgical and non-surgical groups showed meaningful improvements in pain, quality of life, and walking speed after completing the program. The differences in outcomes between the two groups were statistically and clinically negligible, meaning prior surgery did not meaningfully change how much benefit patients received. These findings are clinically significant because they suggest that supervised exercise and education therapy is equally effective regardless of a patient's surgical history, removing a potential barrier to recommending this approach. Clinicians can therefore confidently refer patients with knee osteoarthritis to structured exercise programs like GLA:D®, whether or not they have had previous knee surgery.

A Remote Behaviorally Designed Intervention To Promote Physical Activity In Patients With Knee Osteoarthritis: Results Of A Pilot Randomized Clinical Trial.

Gillcrist Rl (2024) · Knee · PMID: 39412672

This pilot randomized controlled trial tested a digital, behaviorally-designed program using gamification and social support (via Fitbit and a web platform) against a control group receiving only weekly step-count updates in 31 veterans with knee osteoarthritis. While the intervention group walked approximately 1,119 more steps per day than controls, this difference did not reach statistical significance (p=0.19), likely due to the small sample size. However, participants in the intervention group showed a statistically significant improvement in knee symptoms as measured by the KOOS score (p=0.02), suggesting real-world clinical benefit. The findings are promising but preliminary, as the study was underpowered, predominantly included older Black male veterans with obesity, which may limit generalizability. Larger trials are needed to confirm whether gamification and social support can reliably increase physical activity and reduce osteoarthritis symptoms in broader patient populations.

Comparison The Effect Of Rehabilitation At Home And Outpatient Physiotherapy After Total Knee Arthroplasty Surgery On Quality Of Life And Knee Function: A Clinical Trial Study.

Haghpanah B (2024) · Knee · PMID: 39411689

This randomized controlled trial compared home-based rehabilitation (HBR) with traditional outpatient physiotherapy in 80 patients recovering from total knee replacement (TKA) surgery for osteoarthritis. Patients were assessed at 3 and 5 months post-surgery using the Knee Society Score (KSS) for knee function and the SF-36 questionnaire for quality of life. The key finding was that neither group showed a statistically significant advantage over the other — both approaches produced comparable outcomes in knee function and overall quality of life. These results suggest that supervised outpatient physiotherapy may not be superior to a structured home-based program, which has meaningful implications for patient convenience, healthcare costs, and accessibility. Clinicians may consider home-based rehabilitation as a viable, equally effective alternative for appropriately selected patients following knee replacement surgery.

Chatgpt-4 And Wearable Device Assisted Intelligent Exercise Therapy For Co-Existing Sarcopenia And Osteoarthritis (Gaiso): A Feasibility Study And Design For A Randomized Controlled Probe Non-Inferiority Trial.

You M (2024) · PMID: 39380108

This feasibility study describes the design of a randomized controlled trial comparing an AI-assisted home-based exercise program (using ChatGPT-4 and a wearable device) against traditional clinic-based, face-to-face exercise therapy for patients who have both osteoarthritis and sarcopenia — two common age-related conditions that worsen each other. A total of 278 patients will be enrolled and followed for six months, with exercise programs in both groups following established principles of frequency, intensity, type, and progression. The trial uses a non-inferiority design, meaning it aims to show whether the technology-assisted approach performs at least as well as supervised clinic care, rather than claiming it is superior. Key outcomes include pain scores (VAS), joint function (WOMAC, KOOS), quality of life (SF-12), and clinically meaningful thresholds such as the Minimal Clinically Important Difference. If successful, this approach could significantly expand access to personalized rehabilitation for a large and underserved aging population.

Validity Of An Exercise Log For Measuring Duration Of Exercise In Older Women With Knee Osteoarthritis.

Cheung C (2024) · Knee · PMID: 39347753

This study examined whether a simple paper exercise log could accurately track how long older women with knee osteoarthritis exercised at home, comparing log entries against video recordings of actual exercise sessions. In 23 women with an average age of 70 years participating in an 8-week yoga and aerobic/strength training trial, the paper logs showed a strong agreement with video recordings (correlation of 0.88), and participants consistently completed between 79–100% of their logs and video diaries. Both tracking methods were also linked to better overall physical activity scores at the end of the study. Clinically, this research supports the use of simple paper logs as a reliable and practical tool for monitoring home exercise adherence in older adults with osteoarthritis, without requiring costly or burdensome technology. It is important to note, however, that this study focused on measurement validity rather than directly comparing supervised versus unsupervised exercise outcomes.

Efficacy Of The Mhealth-Based Exercise Intervention Re.flex For Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial.

Dieter V (2024) · Knee · PMID: 39250181

This pilot randomized controlled trial (n=61) compared a 12-week fully automated, sensor-assisted smartphone app exercise program (with or without a supportive knee brace) against usual care in adults with moderate-to-severe knee osteoarthritis. Participants using the Re.flex app showed statistically significant and clinically meaningful improvements over controls in pain reduction, physical function, symptoms, sport/recreation activity, and both knee-related and general quality of life, with effect sizes ranging from small to medium (ES=0.47–0.76). Notably, adherence to the home exercise program was exceptionally high at 92.5%, suggesting that fully automated digital tools can support consistent exercise engagement without direct clinician supervision. No significant effects were found for psychological outcomes or objective performance measures such as strength and balance, which may warrant further investigation in larger trials. For clinicians and patients, these findings suggest that a well-designed, sensor-guided exercise app represents a viable and scalable option to bridge the well-recognized gap between exercise therapy guidelines and real-world practice in knee osteoarthritis management.

A Combined Program Of Education Plus Exercise Versus General Advice For Ankle Osteoarthritis: A Feasibility Randomised Controlled Trial.

Smith Md (2024) · Ankle · PMID: 39241692

This small feasibility study (30 participants, average age 66) tested whether a full-scale clinical trial comparing two physiotherapist-delivered treatments for ankle osteoarthritis — a structured education-plus-exercise program versus general health advice — could be practically conducted. Ankle osteoarthritis is a poorly studied condition with no dedicated clinical guidelines, making this an important gap to address. The trial demonstrated strong feasibility across key measures: 97% of eligible patients consented to participate, 71% adhered to their assigned treatment, 94% of sessions were delivered as intended, and 87% of participants completed outcome assessments at three months. While this study was not designed to detect differences in clinical outcomes between the two approaches, the high feasibility metrics provide the groundwork needed to design and justify a larger, definitive trial. Clinicians and patients can take note that structured physiotherapist-led exercise and education for ankle osteoarthritis is a viable and acceptable treatment avenue worth investigating at scale.

Home-Based Shi's Knee Daoyin Exercise For Knee Osteoarthritis: A Randomized Controlled Pilot Trial.

Xu K (2024) · Knee · PMID: 39224147

This pilot randomized controlled trial compared Shi's Knee Daoyin (SKD) exercise — a home-based Traditional Chinese exercise program specifically designed for knee health — against standard health education alone in 72 adults with knee osteoarthritis over 12 weeks. The study demonstrated strong feasibility, with an 80.9% recruitment rate and zero dropouts due to adverse events, suggesting the program is safe and acceptable to patients. Participants who performed SKD exercise showed greater improvements in pain, stiffness, and physical function (measured by WOMAC and VAS scores) compared to the health education group, and also walked faster on the 20-Meter Walk Test. While chair-stand performance improved in both groups, the difference between groups did not reach statistical significance. These promising results support the design of a larger, fully powered trial to confirm whether home-based SKD exercise can serve as a practical, low-cost, and effective self-management strategy for knee osteoarthritis.

Understanding Negative And Positive Feelings About Telerehabilitation In People With Chronic Knee Pain: A Mixed-Methods Study.

Lawford Bj (2024) · Knee · PMID: 39207737

This mixed-methods study examined how 122 people with knee osteoarthritis felt about receiving physiotherapist-delivered telerehabilitation, particularly when they were not expecting it. At the start, about half (49%) felt positive, while 36% had initial doubts, citing concerns about effectiveness, inability to be physically assessed, or discomfort with technology. Encouragingly, the majority of both initially positive (72%) and initially negative (61%) participants reported that telerehabilitation exceeded their expectations, highlighting benefits like convenience, effective communication, and strong therapeutic rapport. However, roughly one in four participants remained unwilling to use telerehabilitation in the future, even after experiencing it, primarily preferring hands-on, in-person care. These findings suggest telerehabilitation is acceptable to most patients with knee osteoarthritis, but clinicians should acknowledge that a meaningful minority will consistently prefer traditional in-person physiotherapy.

Varus Thrust Assessment Identified Responders To Quadriceps Exercise In Individuals At Risk Of Or With Knee Osteoarthritis.

Iijima H (2024) · Knee · PMID: 39086051

This study investigated whether a gait characteristic called "varus thrust" (an outward knee movement during walking) could predict who benefits from quadriceps strengthening exercises in people with or at risk of knee osteoarthritis, comparing unsupervised home-based exercise to supervised programs in a secondary analysis of an RCT (n=50) with meta-analytic cross-checking. The key finding was that patients without varus thrust experienced greater, clinically meaningful pain relief from quadriceps exercise, while those with varus thrust responded poorly — and this pattern held consistently for both home-based and supervised exercise programs. The pain improvement in non-thrust patients appeared to be partially explained by gains in knee flexion range of motion. Clinically, this means that a simple visual assessment of gait — watching for that outward knee wobble during walking — can help clinicians identify which patients are likely to respond to quadriceps exercise before prescribing a home program. This low-cost screening tool could meaningfully improve personalized self-management strategies for knee osteoarthritis.

A Pilot Study On The Efficacy Of An App-Based Rehabilitation Counselling Program After Total Knee Arthroplasty.

Han Sh (2024) · Knee · PMID: 38998864

This small pilot study (42 patients) compared three rehabilitation approaches after total knee replacement surgery: a standard guideline leaflet, an app-based counselling program with personalized exercise and psychological support, and the app-based program combined with continuous passive motion (CPM) therapy. After three months, patients who used the combined app plus CPM approach showed the greatest improvements in knee muscle strength, range of motion, and functional outcomes measured by the WOMAC score, though all comparisons were made across only 14 patients per group. The app-based program shows promise as a way to deliver individualized rehabilitation support remotely, which may be particularly relevant for patients with limited access to in-person care. However, the very small sample size and pilot nature of this study mean that findings should be interpreted cautiously, and larger randomized trials are needed before firm clinical recommendations can be made.

Letter To The Editor: Does The Combination Of Platelet-Rich Plasma And Supervised Exercise Yield Better Pain Relief And Enhanced Function In Knee Osteoarthritis? A Randomized Controlled Trial.

Han X (2024) · Knee · PMID: 38917056

This randomized controlled trial investigated whether combining platelet-rich plasma (PRP) injections with supervised exercise produces better pain relief and improved physical function compared to PRP alone or non-supervised exercise in patients with knee osteoarthritis. The study examined the added value of structured, professionally guided exercise programs over self-directed activity when paired with this emerging biological treatment. Unfortunately, no abstract was available to extract specific findings regarding sample size, outcome measures, or the magnitude of supervision effects. Based on the study's premise, clinicians should consider that the degree of exercise supervision may meaningfully influence treatment outcomes in osteoarthritis management, potentially affecting how PRP therapy protocols are designed in clinical practice. Patients and providers should look to the full publication for detailed results before drawing firm conclusions about the optimal combination of these interventions.

Reply To The Letter To The Editor: Does The Combination Of Platelet-Rich Plasma And Supervised Exercise Yield Better Pain Relief And Enhanced Function In Knee Osteoarthritis? A Randomized Controlled Trial.

Karaborklu Argut S (2024) · Knee · PMID: 38917050

This randomized controlled trial investigated whether combining platelet-rich plasma (PRP) injections with supervised exercise produced better outcomes than other approaches for people with knee osteoarthritis. The study compared supervised exercise combined with PRP against non-supervised exercise and/or PRP alone, measuring effects on pain relief and physical function. Based on the available information, the trial explored whether the added structure and guidance of supervised exercise enhanced the benefits of PRP treatment. The findings are clinically relevant because they help guide healthcare providers in deciding whether to recommend costly supervised exercise programs alongside PRP injections, or whether patients can achieve similar benefits through independent exercise. Unfortunately, without a full abstract, specific sample size and precise outcome data cannot be reported here, and clinicians are encouraged to consult the full publication for detailed results.

Feasibility And Acceptability Of A Telerehabilitation Intervention On Patients Undergoing Total Knee Arthroplasty In Iran: Randomised Controlled Trial Protocol.

Farrokhi N (2024) · Knee · PMID: 38858143

This randomized controlled trial protocol describes a study comparing telerehabilitation (virtual physiotherapy sessions) plus usual care against usual care alone in 30 patients aged 50–90 who have undergone total knee replacement surgery for severe knee osteoarthritis in Tehran, Iran. The primary focus is not on clinical superiority but on feasibility and acceptability — specifically whether telerehabilitation can be successfully delivered, whether patients will adhere to it, and whether the study design is practical in an Iranian healthcare setting. Over four weeks, patients in the intervention group will receive three virtual physiotherapy sessions per week (30–45 minutes each), with secondary outcomes including pain, symptoms, function, and quality of life measured by the KOOS questionnaire. With only 30 participants, this is a pilot study and is not powered to detect definitive differences in clinical outcomes between supervised and unsupervised approaches. The findings will be clinically relevant as a proof-of-concept for expanding accessible, remote rehabilitation options for post-surgical knee patients in resource-varied or geographically challenging settings.

Home-Based Circuit Training Improves Blood Lipid Profile, Liver Function, Musculoskeletal Fitness, And Health-Related Quality Of Life In Overweight/Obese Older Adult Patients With Knee Osteoarthritis And Type 2 Diabetes: A Randomized Controlled Trial During The Covid-19 Pandemic.

Al-Mhanna Sb (2024) · Knee · PMID: 38831437

This 12-week randomized controlled trial compared a structured home-based circuit training (HBCT) program against no exercise in 70 overweight or obese older adults (average age 62 years) who had both knee osteoarthritis and type 2 diabetes during the COVID-19 pandemic lockdown. Participants in the exercise group performed progressive circuit training at home, completing 7 exercises per session, 2–4 rounds, for 20–60 minutes. The HBCT group showed significant improvements in blood lipid profile (reduced LDL, triglycerides, and total cholesterol; increased HDL), liver function markers, fasting blood glucose, knee pain, lower body strength, mobility, and overall quality of life compared to the control group. These findings are clinically relevant because they demonstrate that unsupervised, home-based exercise can deliver meaningful cardiometabolic and musculoskeletal benefits in a complex, high-risk patient population — even without gym access or direct clinical supervision. Clinicians may consider prescribing structured home exercise protocols as a safe, accessible, and effective intervention for patients managing obesity, type 2 diabetes, and knee osteoarthritis simultaneously.

Exercise And Pain Neuroscience Education For Patients With Chronic Pain After Total Knee Arthroplasty: A Randomized Clinical Trial.

Larsen Jb (2024) · Knee · PMID: 38787559

This Danish randomized controlled trial (n=69) compared 12 weeks of supervised neuromuscular exercise combined with pain neuroscience education versus pain neuroscience education alone in patients experiencing chronic moderate-to-severe pain at least one year after total knee replacement. The key finding was that adding supervised exercise did not provide additional benefit over education alone, with both groups showing similar improvements in knee pain, symptoms, daily function, and quality of life at 12 months (mean difference of -1.33 points on the KOOS4 scale, well below clinical significance). Notably, approximately one-third of participants in both groups achieved a clinically meaningful improvement (≥10 points on KOOS4), suggesting that pain neuroscience education alone may be a viable and resource-efficient option for this challenging patient population. With only 69 participants across three clinics, the trial was relatively small, and results should be interpreted cautiously. Clinically, these findings highlight the need to better identify which patients are likely to respond to exercise or education-based interventions for chronic post-surgical knee pain.

Is Quadriceps-Strengthening Exercises (Qse) In Medial-Compartment Knee Osteoarthritis With Neutral And Varus Malalignment A Paradox? - A Risk-Appraisal Of Strength-Training On Disease Progression.

Garg R (2024) · Knee · PMID: 38638654

This 12-week study of 32 patients with medial knee osteoarthritis examined whether quadriceps-strengthening exercises (QSEs) might simultaneously relieve symptoms while worsening the underlying joint disease, comparing outcomes between patients with normal knee alignment and those with varus (bow-legged) malalignment. Both groups gained significant quadriceps strength, and patients with neutral alignment showed meaningful improvements across pain, function, and quality-of-life measures (VAS, WOMAC, TUGT, IKDC); however, patients with varus malalignment showed far less functional benefit, with several scores failing to reach statistical significance. Critically, radiological evidence suggested disease progression in both groups, but more prominently in the varus group, where 12 of 16 patients showed worsening joint space narrowing and shifting of the knee load line. These findings raise an important clinical concern: standard QSE protocols may paradoxically accelerate structural joint deterioration in patients with varus malalignment, even when symptoms appear to improve. Clinicians should carefully assess knee alignment before prescribing quadriceps-strengthening programs, and consider alignment-correcting interventions alongside or prior to exercise therapy in varus knee osteoarthritis.

Huang L (2024) · NA · PMID: 38617705

This feasibility study compared a traditional Chinese leg-swinging exercise called "KOA Pendulum Therapy" (KOAPT, targeting 1,000 swings per leg per day) against standard walking exercise (4,000 steps per day) in 50 patients with knee osteoarthritis over 12 weeks. Using minipig models and human volunteers, the researchers demonstrated that leg swinging produces dynamic changes in intra-articular pressure, increases local blood flow, and depletes synovial fluid contents — suggesting a plausible mechanical mechanism for symptom relief. Both groups showed significant improvements in knee pain and function scores, but no statistically significant difference was found between the two exercise approaches. The trial achieved excellent feasibility, with 100% participant retention and 95–98% adherence in both groups, supporting the practicality of a larger trial. The authors conclude that while KOAPT shows promise as a low-cost, accessible exercise option for knee osteoarthritis, a definitive randomized controlled trial of at least 524 participants is needed to establish whether it offers any meaningful advantage over walking.

Usability And Preliminary Effectiveness Of An App-Based Physical Activity And Education Program For People With Hip Or Knee Osteoarthritis - A Pilot Randomized Controlled Trial.

Weber F (2024) · Hip; knee · PMID: 38600607

This pilot randomized controlled trial (n=60) compared a smartphone app-based physical activity and education program (Join2Move) to usual care in people with hip or knee osteoarthritis over 12 weeks. Unlike traditional supervised exercise programs, Join2Move is a self-directed, stand-alone digital intervention requiring no in-person supervision. The app showed acceptable usability (average score 71.3/100), though scores varied widely between users, and the only statistically significant improvement favoring the app was in pain reduction compared to usual care. With a modest sample size and 18% dropout rate, these preliminary findings suggest digital self-management tools may have a role in osteoarthritis care, but are not yet conclusive. Clinicians should be aware that app-based programs may suit motivated, tech-comfortable patients, but usability limitations mean careful patient selection and further refinement of the technology are needed before broad recommendation.

Corr InsightsÂ®: Does The Combination Of Platelet-Rich Plasma And Supervised Exercise Yield Better Pain Relief And Enhanced Function In Knee Osteoarthritis? A Randomized Controlled Trial.

Boettner F (2024) · Knee · PMID: 38564793

This randomized controlled trial investigated whether combining platelet-rich plasma (PRP) injections with supervised exercise produces better outcomes than other approaches for knee osteoarthritis, comparing the added value of exercise supervision on pain and physical function. Based on the available title information, the study evaluated how structured, supervised exercise programs may enhance or modify the effects of PRP treatment in patients with knee osteoarthritis. A key clinical question was whether the oversight and guidance of a trained professional during exercise sessions meaningfully improves pain relief and functional ability beyond unsupervised or injection-only approaches. The findings are clinically relevant because they help inform shared decision-making between clinicians and patients regarding the resource investment of supervised rehabilitation programs. Notably, the full abstract was unavailable, so specific sample sizes and precise outcome data cannot be reported here; clinicians should access the full text for complete details.

The Effect Of Balance Exercises On Central Sensitization In Patients With Knee Osteoarthritis.

Tirasci E (2024) · Knee · PMID: 38492047

This randomized controlled trial compared a 6-week supervised balance exercise program (3 sessions per week) against an education-only control in 40 patients with knee osteoarthritis and central sensitization (20 per group). The supervised exercise group showed significantly greater improvements in central sensitization scores, pain during activity, physical function, and dynamic balance at both 6 and 12 weeks compared to the control group. Notably, improvements in central sensitization appeared to be driven primarily by pain relief rather than balance gains themselves, suggesting that reducing pain is the key mechanism behind exercise-related changes in central sensitization. With only 40 participants, the study is relatively small, which limits the generalizability of findings, but the results support the clinical relevance of incorporating supervised balance training into rehabilitation programs for knee osteoarthritis patients who exhibit central sensitization.

Telerehabilitation Consultations With A Physiotherapist For Chronic Knee Pain Versus In-Person Consultations In Australia: The Peak Non-Inferiority Randomised Controlled Trial.

Hinman Rs (2024) · Knee · PMID: 38461844

The PEAK trial compared video conferencing physiotherapy consultations to traditional in-person consultations for 394 Australian adults with chronic knee pain consistent with osteoarthritis, conducting five sessions over three months focused on strengthening exercises, physical activity, and education. Both groups showed meaningful improvements in pain (approximately 3 points on a 0–10 scale) and physical function, with telerehabilitation proving non-inferior to in-person care on both primary outcomes at three months. The study achieved excellent retention, with 97% of participants providing data at follow-up, and adverse event rates were similarly low in both groups (around 20%), with no serious events reported. These findings are clinically significant because they challenge the common assumption that telerehabilitation is less effective than face-to-face care, suggesting that video-based physiotherapy is a legitimate and equivalent alternative for managing knee osteoarthritis. This has important implications for expanding access to care, particularly for patients in rural or remote areas, those with mobility limitations, or those who prefer the convenience of home-based treatment.

A Preoperative Package Of Care For Osteoarthritis, Consisting Of Weight Loss, Orthotics, Rehabilitation, And Topical And Oral Analgesia (Opportunity): A Two-Centre, Open-Label, Randomised Controlled Feasibility Trial.

Simpson Ahrw (2024) · PMID: 38423028

This UK-based feasibility trial randomized 60 patients awaiting knee replacement surgery to either a 12-week preoperative package of care—combining exercise therapy, weight loss support, orthotic insoles, and analgesia adjustment—or standard care. The intervention group showed strong adherence (median 94%) and achieved a mean weight loss of 11.2 kg compared to just 1.3 kg in the control group, alongside clinically meaningful improvements in health-related quality of life and joint-specific scores. The trial successfully recruited and retained participants, with no adverse events attributable to the intervention, suggesting the preoperative period may be a valuable window for establishing healthy behavioral change. These promising feasibility findings, supported by positive feedback from both patients and clinicians, justify progression to a larger, definitive effectiveness trial.

Exercise Therapy, Education, And Cognitive Behavioral Therapy Alone, Or In Combination With Total Knee Arthroplasty, In Patients With Knee Osteoarthritis: A Randomized Feasibility Study.

RognsvÃ¥g T (2024) · Knee · PMID: 38419024

This small feasibility study (15 patients) tested whether it was practical to run a full-scale trial comparing three approaches for knee osteoarthritis patients scheduled for total knee replacement (TKA): exercise and education combined with internet-based cognitive behavioral therapy (iCBT) alone, the same program followed by TKA, or TKA with standard care. The study was not designed to compare clinical outcomes between supervised and unsupervised exercise, but rather to assess whether a larger trial was logistically possible. Key findings showed that recruitment was extremely challenging initially — only 1 of 146 screened patients enrolled in the first four months — requiring three major protocol amendments, including removing high-risk screening criteria and allowing nationwide participation. Once adjusted, retention was strong: 14 of 15 patients completed one-year follow-up, 9 of 10 finished the exercise program, though only 6 of 10 completed the iCBT component. Clinically, this study highlights that non-surgical multimodal treatment may be feasible as an alternative or complement to knee replacement, but a definitive large-scale trial is still needed to establish effectiveness.

Effectiveness Of A Web-Guided Self-Managed Telerehabilitation Program Enhanced With Outdoor Physical Activity On Physical Function, Physical Activity Levels And Pain In Patients With Knee Osteoarthritis: A Randomized Controlled Trial.

Moutzouri M (2024) · Knee · PMID: 38398248

This 6-week randomized controlled trial compared a blended web-based rehabilitation program combined with outdoor physical activity (BWR-OPA) against outdoor physical activity alone (usual care) in 44 patients with knee osteoarthritis. The web-guided, self-managed telerehabilitation program, which included online consultations, produced significantly greater improvements in knee pain, symptom control, and overall physical activity levels compared to usual care, with benefits still evident at 12 weeks post-intervention. Objective measures of physical function, such as the Timed Up-and-Go and 30-second Chair Rise tests, showed clinically meaningful improvements with large effect sizes (>2.0) in the telerehabilitation group. Both groups showed similar gains over time in quality of life, daily activities, and psychological functioning, suggesting that the addition of structured web-based guidance provides meaningful added value beyond exercise alone. For clinicians, these findings support telerehabilitation as a practical and effective tool to enhance self-management in knee osteoarthritis, particularly for improving pain and functional outcomes.

Effectiveness Of A Telehealth-Delivered Clinician-Supported Exercise And Weight Loss Program For Hip Osteoarthritis - Protocol For The Better Hip Randomised Controlled Trial.

Bennell Kl (2024) · Hip · PMID: 38350917

This randomized controlled trial (the "Better Hip" study) is comparing a telehealth-delivered, clinician-supported exercise and weight loss program against a web-based information-only control in 212 adults aged 45 and over with hip osteoarthritis. The supervised intervention involves six videoconferencing sessions with a physiotherapist covering individualized home exercise, education, and behavior change support, plus up to six dietitian sessions for eligible participants with overweight or obesity. The primary outcomes assessed at 6 and 12 months are hip pain during walking and physical function, with secondary outcomes including quality of life, physical activity levels, and rates of hip replacement surgery. This trial addresses an important evidence-to-practice gap by testing whether remote clinician supervision — rather than simply providing information — meaningfully improves outcomes for a condition that is a leading global cause of chronic pain and disability. Results could directly inform how health systems design scalable, accessible care models for hip osteoarthritis management.

The Effectiveness Of Preoperative Outpatient And Home Rehabilitation And The Impact On The Results Of Hip Arthroplasty: Introductory Report.

Zdziechowski A (2024) · Hip · PMID: 38338212

This small randomized trial (61 enrolled, 50 completed) compared three approaches before total hip replacement surgery: supervised outpatient rehabilitation, home-based exercise, and no preoperative intervention. The key finding was that neither supervised nor home-based prehabilitation produced statistically significant improvements in pain or physical function compared to doing nothing before surgery. Notably, patients exercising at home were more likely to discontinue their program than those attending supervised outpatient sessions, highlighting an important adherence challenge. All three groups received the same three-week supervised rehabilitation program after surgery, suggesting postoperative care may be the more critical factor. Clinicians should interpret these results cautiously given the small sample size and the study's introductory nature, but the findings raise questions about the routine use of prehabilitation for hip osteoarthritis patients awaiting arthroplasty.

Does The Combination Of Platelet-Rich Plasma And Supervised Exercise Yield Better Pain Relief And Enhanced Function In Knee Osteoarthritis? A Randomized Controlled Trial.

Karaborklu Argut S (2024) · Knee · PMID: 38323999

This three-arm randomized controlled trial of 84 patients with mild-to-moderate knee osteoarthritis compared supervised exercise alone, platelet-rich plasma (PRP) injections alone, and the combination of both over 24 weeks. The key finding was that adding PRP to supervised exercise provided no meaningful additional benefit in pain relief or physical function compared to supervised exercise alone. Notably, supervised exercise outperformed PRP injections alone on measures of function and health-related quality of life, with neither group reaching the clinically important pain reduction threshold of 2 points. These results suggest that a structured, 6-week supervised exercise program (12 individual sessions focused on strengthening and functional training) should be considered a first-line non-surgical approach for this patient population. Clinicians should carefully weigh the added cost, burden, and invasiveness of PRP injections against the evidence, as exercise alone appears to deliver comparable or superior outcomes.

Mediators Of The Effects Of Exercise And Manual Therapy For People With Knee And Hip Osteoarthritis: A Secondary, Exploratory Analysis Of The Moa Trial.

Ribeiro Dc (2024) · Knee; hip · PMID: 38304412

This study examined why manual therapy (hands-on joint treatment) and exercise therapy help people with hip or knee osteoarthritis feel better, using data from 206 participants in a randomized controlled trial called the MOA trial. Researchers investigated whether changes in pain beliefs (how patients think about their pain) or improvements in functional strength explained the benefits seen with these treatments. The key finding was that changes in pain beliefs — but not improvements in muscle strength — appeared to partially explain why both manual therapy and exercise therapy reduced pain and improved function scores (measured by the WOMAC questionnaire) over one year. However, these results are considered preliminary and could be sensitive to unmeasured factors, so they should be interpreted cautiously. Clinically, this suggests that addressing how patients think and feel about their pain may be an important component of why physical therapies work for osteoarthritis, pointing toward the value of combining physical treatment with pain education or psychological support.

Effectiveness Of An 11-Week Exercise Intervention For Patients With Hip Or Knee Osteoarthritis: Results Of A Quasi-Experimental Pragmatic Trial.

Krauss I (2024) · Hip; knee · PMID: 38245801

This pragmatic trial compared a structured hip/knee training (HKT) program—combining 8 weekly group exercise-and-education sessions with an 11-week home exercise program—against standard care alone in 1,030 patients with hip or knee osteoarthritis. Patients in the HKT group showed statistically significant improvements in pain and physical function (measured by the WOMAC index) at 3 months, with benefits sustained through 24 months of follow-up. However, the effect sizes were small (ES <0.22), raising questions about whether these differences are clinically meaningful in real-world practice, as they were notably smaller than those reported in more tightly controlled efficacy trials. A concerning finding was that HKT participants were 57% more likely to undergo joint replacement surgery during follow-up compared to the standard care group, though the reasons for this remain unclear and warrant further investigation. Overall, this study supports exercise and education as a valuable addition to standard osteoarthritis care, but highlights the need to identify which patients are most likely to benefit and to better understand the relationship between exercise therapy and subsequent joint replacement decisions.

Exercise- And Education-Based Prehabilitation Before Total Knee Arthroplasty: A Pilot Study.

GrÃ¤nicher P (2024) · Knee · PMID: 38192160

This small pilot randomized controlled trial (20 patients, average age 73) compared a personalized 4–8 week supervised exercise and education program ("prehabilitation") before total knee replacement surgery against usual care, to assess whether structured preparation could improve outcomes. The prehabilitation group showed significantly better results in sport-related knee function (Knee Osteoarthritis Outcome Score sport subscale) and overall physical activity levels (Tegner Activity Scale) compared to the usual care group over time. Notably, the supervised program proved both safe and highly feasible, with participants completing 90% of their planned exercise sessions and no adverse events reported. While the small sample size limits definitive conclusions, these promising findings suggest that supervised prehabilitation before knee replacement may meaningfully improve patients' functional capacity and activity levels around the time of surgery. The authors conclude that a larger, full-scale clinical trial is now warranted to confirm these early benefits.

Effects Of A Neuromuscular Joint-Protective Exercise Therapy Program For Treatment Of Wrist Osteoarthritis: A Randomized Controlled Trial.

Larsson Sl (2024) · PMID: 38183045

This 12-week randomized controlled trial enrolled 48 adults with confirmed wrist osteoarthritis to compare a neuromuscular joint-protective exercise program against a standard range-of-motion exercise program, both delivered as self-managed home programs. With 41 participants completing the study, the neuromuscular program did not significantly outperform range-of-motion exercises on the primary outcome of wrist pain and function (Patient-Rated Wrist Evaluation), though participants in the neuromuscular group showed some improvement in upper limb disability (DASH score) and pain during loading activities. Clinicians should note that both approaches produced within-group improvements, suggesting that exercise in any structured form may be beneficial for wrist OA — a condition where exercise-based first-line treatment has been largely overlooked. The modest sample size and self-managed format limit definitive conclusions, and larger trials with supervised exercise and longer follow-up are needed to establish the optimal exercise strategy for this population.

Upper-Limb High-Intensity Interval Training Or Passive Heat Therapy To Optimize Cardiorespiratory Fitness Prior To Total Hip Or Knee Arthroplasty: A Randomized Controlled Trial.

Roxburgh Bh (2024) · Hip; knee · PMID: 37728076

This randomized controlled trial (n=93) compared three low-impact prehabilitation approaches in patients with severe hip or knee osteoarthritis awaiting joint replacement surgery: supervised upper-limb high-intensity interval training (HIIT), passive heat therapy (warm water immersion followed by light exercise), and home-based light resistance exercise. HIIT produced the strongest improvements in cardiorespiratory fitness, increasing peak oxygen consumption by 16% — significantly more than both heat therapy and home exercise. Notably, heat therapy also improved the anaerobic threshold, a clinically meaningful marker of cardiovascular endurance, while home exercise did not. None of the interventions reduced the subjective severity of osteoarthritis symptoms. These findings are clinically relevant because they demonstrate that patients who cannot tolerate traditional lower-limb exercise can still meaningfully improve their fitness before surgery using upper-limb HIIT or heat therapy, potentially reducing perioperative risk.

Effect Of Telerehabilitation-Based Exercise And Education On Pain, Function, Strength, Proprioception, And Psychosocial Parameters In Patients With Knee Osteoarthritis: A Randomized Controlled Clinical Trial.

TÃ¼mtÃ¼rk Ä° (2024) · Knee · PMID: 37678215

This 8-week randomized controlled trial compared two home-based exercise approaches for 57 adults with early-stage knee osteoarthritis: one group received exercise and education through an online telerehabilitation platform, while the other received the same program via printed instruction materials only. After 8 weeks, the telerehabilitation group showed significantly greater improvements in pain, physical function, quality of life, and joint position sense (proprioception) compared to the paper-based group. However, the two approaches produced similar results for muscle strength and most physical performance tests, suggesting that live digital supervision may not be essential for building strength but may enhance adherence and technique for other outcomes. With a relatively small sample of 54–57 participants, these findings should be interpreted with caution, though they suggest that telerehabilitation offers a clinically meaningful advantage over unsupervised printed instructions. For clinicians and patients, this study supports the use of digital platforms to deliver exercise therapy for knee osteoarthritis, particularly when in-person care is limited.

A Smartphone Application-Based Remote Rehabilitation System For Post-Total Knee Arthroplasty Rehabilitation: A Randomized Controlled Trial.

Zhao R (2024) · Knee · PMID: 37572720

This randomized controlled trial of 100 patients compared smartphone app-guided remote rehabilitation against standard home-based rehabilitation with outpatient guidance following total knee replacement surgery. At 12 weeks post-surgery, patients using the smartphone app achieved meaningfully better knee range of motion (124° vs. 119°), better balance on one leg, and faster sit-to-stand performance compared to the control group. Quality of life measures related to physical functioning also favored the app-based group, while complication rates, readmission rates, and rehabilitation costs were similar between groups. These findings suggest that structured digital guidance through a smartphone app can meaningfully enhance short-term physical recovery after knee replacement without adding cost or risk. For clinicians and patients, this supports telerehabilitation as a viable and potentially superior alternative to traditional outpatient follow-up, particularly where access to in-person care may be limited.

Telerehabilitation Is As Effective As Outpatient Visits In The Management Of Early Osteoarthritis Knee And Mechanical Low Backache.

Das L (2024) · Knee · PMID: 37566137

This prospective comparative study enrolled 400 participants (100 per subgroup) to compare the effectiveness of telerehabilitation versus in-person outpatient visits for managing early knee osteoarthritis and mechanical low back pain over a 6-month period. The key finding was that teleconsultation performed equally well to face-to-face care across all measured outcomes, including pain (VAS), knee function (KOOS), and back disability (Modified Oswestry Disability Index), with no statistically significant differences between groups. Notably, outpatient consultations took significantly longer than telehealth appointments, suggesting a practical efficiency advantage for remote delivery. Patient satisfaction with teleconsultation was high, with 87% of participants rating the service favorably (Likert score ≥4). These findings are clinically relevant as they support telerehabilitation as a viable, equivalent alternative to in-person care for these common musculoskeletal conditions, particularly for patients facing geographic, mobility, or other access barriers.

Supervised Exercises Have Superior Effects Compared To Home-Based Exercises For Patients With Knee Osteoarthritis Following Platelet-Rich Plasma Injection.

Bozgeyik S (2024) · Knee · PMID: 35854659

This randomized controlled trial compared physiotherapist-supervised exercise with home-based exercise in 30 women with knee osteoarthritis who had all received a platelet-rich plasma (PRP) injection, with both groups completing an 18-session program over 6 weeks. Supervised exercise produced substantially greater pain reduction (median improvement of 3.8 points vs. 0.6 points) and meaningful gains in knee function, while the home-based group showed no significant improvement in function. Additionally, only the supervised group demonstrated significant increases in hip, quadriceps, and hamstring muscle strength. These findings suggest that physiotherapist oversight is a critical component in maximizing the benefits of post-PRP rehabilitation for knee osteoarthritis. Clinicians should consider recommending supervised exercise programs following PRP injection, though the small, all-female sample limits the generalizability of these results.

Short-Term And Long-Term Effectiveness Of Acupuncture And Tuina On Knee Osteoarthritis: Study Protocol For A Randomized Controlled Trial.

Zhao Rl (2023) · Knee · PMID: 38152644

This multicenter randomized controlled trial from China is comparing three treatments for knee osteoarthritis (KOA): acupuncture, tuina (traditional Chinese massage), and home-based exercise, enrolling 330 participants across five hospitals. The study measures whether each treatment achieves a clinically meaningful reduction in pain (at least 12% improvement on the WOMAC pain scale) at both 8 weeks and 26 weeks. Secondary outcomes include joint function, stiffness, quality of life, self-efficacy, and psychological wellbeing. Notably, this is a study protocol — the trial is planned or ongoing, and no results are yet available to assess effectiveness or clinical relevance. Clinicians should await published results before drawing conclusions about these treatments.

Effect Of Pain Neuroscience Education With Conventional Physiotherapy Via Telerehabilitation On Pain Catastrophizing And Function In Patients With Osteoarthritis Knee: A Randomized Controlled Trial.

Supe Hm (2023) · Knee · PMID: 38029040

This randomized controlled trial (n=70) investigated whether adding Pain Neuroscience Education (PNE) — a structured approach that teaches patients the biological basis of their pain — to conventional physiotherapy improved outcomes in Indian patients with knee osteoarthritis compared to conventional physiotherapy alone. After just two weeks, patients in the PNE group showed significantly greater reductions in pain catastrophizing (the tendency to fear and magnify pain) and self-reported pain intensity compared to the control group. However, no significant difference in patient-specific physical function was found between the two groups at this early timepoint. These findings suggest that educating patients about pain mechanisms may be a valuable addition to standard physiotherapy for knee osteoarthritis, particularly for addressing the psychological dimensions of pain. Clinicians should note the short follow-up period and relatively small sample size as limitations, and longer-term studies are needed to confirm durability of these benefits.

Net Cost Savings Arising From Patient Completion Of An Active Self-Management Program.

Gorniak M (2023) · PMID: 37967085

This study examined whether an education, exercise, and weight loss program for osteoarthritis could reduce participants' willingness to undergo total knee replacement (TKR) surgery and generate cost savings for private health insurers. In the randomized controlled trial, willingness for surgery dropped dramatically in the treatment group — from 39% at baseline to 16% at 12 months — compared to 36% remaining willing in the control group. Participants in the treatment group were nearly three times more likely to shift from willing to unsure or unwilling about surgery. Economic modeling suggests the intervention becomes cost-neutral for insurers when at least 60% of initially surgery-willing patients would otherwise proceed to surgery within five years. These findings indicate that structured self-management programs may simultaneously improve patient outcomes and deliver measurable financial returns by reducing costly surgical procedures.

Effects Of Tele-Prehabilitation On Clinical And Muscular Recovery In Patients Awaiting Knee Replacement: Protocol Of A Randomised Controlled Trial.

Guida S (2023) · Knee · PMID: 37793919

This randomized controlled trial (n=48 male patients, ages 65–80) compares a technology-assisted home exercise program (tele-prehabilitation) to a booklet-guided home exercise program in patients awaiting total knee replacement surgery. Both groups complete the same 6-week exercise regimen five times per week, but the supervised tele-prehabilitation group uses a tablet, accelerometers, and a balance board to guide and monitor their sessions remotely. The primary outcome is patient-reported pain and function (WOMAC score) at the end of the 6-week program, with secondary outcomes including physical performance tests and blood and muscle biomarkers. Clinically, this trial addresses a timely question: whether remote digital supervision can improve surgical readiness and post-operative recovery compared to unsupervised home exercise alone, potentially reducing healthcare costs and waitlist burden. Results will help clinicians determine whether investing in tele-rehabilitation technology offers meaningful advantages over simpler, low-cost prehabilitation approaches for knee osteoarthritis patients.

A Self-Managed Exercise Therapy Program For Wrist Osteoarthritis: Study Protocol For A Randomized Controlled Trial.

Larsson Sl (2023) · PMID: 37784197

This registered clinical trial is comparing two home-based exercise programs for people with post-traumatic wrist osteoarthritis: a neuromuscular exercise therapy program focusing on joint protection and movement control versus a standard range-of-motion exercise program. Both groups will receive a wrist brace and structured education about their condition. The primary outcome is pain and function measured by the Patient-Rated Wrist Evaluation (PRWE), with additional measures including grip strength, disability, self-efficacy, and whether patients ultimately require surgery, assessed over 12 months. Importantly, this is a study protocol — the trial has not yet reported results — so no conclusions about effectiveness can yet be drawn. If the neuromuscular program proves superior, it could reshape first-line conservative management for wrist osteoarthritis and reduce the need for surgical intervention.

Evaluation Of The Effect Of High-Intensity Laser Therapy (Hilt) On Function, Muscle Strength, Range Of Motion, Pain Level, And Femoral Cartilage Thickness In Knee Osteoarthritis: Randomized Controlled Study.

Ekici B (2023) · Knee · PMID: 37743421

This randomized controlled trial compared the effects of High-Intensity Laser Therapy (HILT) combined with conventional physiotherapy versus sham (placebo) laser combined with the same conventional physiotherapy in 60 patients with knee osteoarthritis over 3 weeks. The key finding was that adding HILT to a supervised exercise program provided no additional benefit over placebo laser — both groups showed equally significant improvements in pain, joint range of motion, function (WOMAC scores), muscle strength, and notably femoral cartilage thickness. Importantly, the supervised physiotherapy exercise program itself — delivered by a physiotherapist 5 days per week across 15 sessions — appeared to be the active driver of improvements across all measured outcomes. These results suggest that clinicians should prioritize well-structured, physiotherapist-supervised exercise programs for knee osteoarthritis, rather than adding costly laser interventions. The study's relatively small sample size (30 per group) and short follow-up (3 months) are limitations that warrant cautious interpretation of these findings.

[Return To Sports Wechat Applet For Evaluating The Rehabilitation Effects After Anterior Cruciate Ligament Reconstruction].

Shi Z (2023) · PMID: 37718420

This randomized controlled trial (n=80) compared a smartphone app-guided rehabilitation program (WeChat "Return to Sports" applet) against standard telephone follow-up in patients recovering from ACL reconstruction surgery. At 6 months post-surgery, patients using the app showed significantly better outcomes in functional scores (IKDC, KOOS, HSS, Tegner), psychological readiness (ACL-RSI), balance, and jumping ability compared to the standard care group. By 12 months, 67.5% of app-guided patients had returned to sport versus 52.5% in the regular group — a statistically significant difference. MRI-confirmed ACL healing was comparable between groups, suggesting the app enhanced rehabilitation engagement without compromising structural outcomes. These findings suggest that digitally guided, self-monitored rehabilitation may be a clinically valuable tool to support return-to-sport outcomes after ACL reconstruction.

Combined Digital Interventions For Pain Reduction In Patients Undergoing Knee Replacement: A Randomized Clinical Trial.

Duong V (2023) · Knee · PMID: 37713201

This randomized clinical trial of 102 adults recovering from total knee replacement surgery compared a digital technology package (exercise app, fitness tracker, and online health coaching) added to usual care against usual care alone across three Australian rehabilitation hospitals. At the primary endpoint of 3 months, the digital intervention group showed statistically significant but clinically small improvements in knee pain scores compared to the control group (mean difference of 0.84 points on a 0–10 scale), falling below the threshold considered meaningful to patients. However, secondary outcomes measured over 12 months suggested additional benefits in pain intensity, pain-related disability, and reduced sedentary behavior favoring the digital intervention group. Clinicians should note that while digital tools may offer modest supplementary benefits after knee replacement, the improvements did not reach the level of clinical significance typically required to justify adoption as a standalone enhancement to care. The authors recommend future research tailor digital interventions to individual patient preferences and functional abilities to maximize long-term self-management potential.

Home-Based Remote Rehabilitation Leads To Superior Outcomes For Older Women With Knee Osteoarthritis: A Randomized Controlled Trial.

Lee El (2023) · Knee · PMID: 37699531

This randomized controlled trial compared an 8-week home-based remote rehabilitation exercise program against no intervention in 36 older women (aged 60+) with mild-to-moderate knee osteoarthritis. Women in the exercise group showed meaningful improvements in functional mobility — including faster sit-to-stand and timed up-and-go test performance — along with increased knee flexor strength, better quadriceps muscle activation, and notably lower blood pressure compared to the control group. The control group showed a small reduction in pain scores, but no functional gains were observed. While the sample size is small (18 per group), the findings suggest that remotely supervised home exercise using a dedicated rehabilitation device can be an effective and accessible alternative to clinic-based programs for this population. For clinicians and patients, this supports the use of technology-assisted home exercise as a practical option to improve strength and mobility in older women managing knee osteoarthritis.

Face-To-Face And Telerehabilitation Delivery Of Circuit Training Have Similar Benefits And Acceptability In Patients With Knee Osteoarthritis: A Randomised Trial.

Aily Jb (2023) · Knee · PMID: 37684147

This randomized controlled trial compared 14 weeks of periodized circuit training delivered either via telerehabilitation (video recordings plus phone coaching) or face-to-face in 100 adults aged 40 and older with symptomatic knee osteoarthritis. The key finding was that telerehabilitation was non-inferior to in-person supervised exercise across all primary and secondary outcomes, including pain, physical function, muscle strength, and pain catastrophising. Adherence was excellent in both groups, and participants reported high satisfaction with their respective delivery format. These results are clinically meaningful because they suggest that patients with knee OA can achieve equivalent benefits from a home-based telerehabilitation program, removing barriers such as travel and clinic access. For clinicians, this supports telerehabilitation as a viable, patient-acceptable alternative to traditional supervised exercise programs for knee OA management.

Comparison Of Neuromuscular Joint Facilitation And Quadriceps Strengthening Exercise In Knee Osteoarthritis: A Randomized Controlled Trial.

Lall S (2023) · Knee · PMID: 37662633

This randomized controlled trial of 60 patients with knee osteoarthritis compared neuromuscular joint facilitation (NJF) — a specialized hands-on therapy targeting joint mechanics — against standard quadriceps strengthening exercises over six weeks. Both groups received a home exercise program alongside their assigned treatment. The key finding was that both interventions produced clinically meaningful and statistically significant improvements in pain, physical function, balance, and static posture within each group, but there were no significant differences between the two approaches at six weeks. This suggests that for clinicians and patients, supervised quadriceps strengthening exercises may be just as effective as the more specialized NJF technique in the short term, making it a practical and accessible first-line option. However, the relatively small sample size and short follow-up period mean that longer-term studies are needed before firm conclusions can be drawn about which approach offers more durable benefits.

Effects Of A Foot-Ankle Muscle Strengthening Program On Pain And Function In Individuals With Knee Osteoarthritis: A Randomized Controlled Trial.

Dantas Gaf (2023) · Foot; ankle; knee · PMID: 37603935

This randomized controlled trial compared a supervised 8-week foot-ankle muscle strengthening program (three sessions per week) against usual care in individuals with clinically and radiographically confirmed knee osteoarthritis (KOA). The supervised exercise group showed meaningful improvements in knee pain, self-reported function, and physical performance on the 30-second chair stand test compared to the control group receiving standard healthcare recommendations. The confidence intervals around these differences suggest the results are potentially clinically meaningful, not just statistically significant. These findings are notable because they highlight an often-overlooked treatment target — the foot and ankle — as a potentially valuable addition to KOA management. Clinicians may consider incorporating supervised foot-ankle strengthening into rehabilitation programs for KOA patients, though larger trials are needed to confirm these promising results.

Effects Of Self-Management Program As Adjunctive To Usual Rehabilitation Exercise On Pain And Functional Outcomes In Knee Osteoarthritis: A Randomized Controlled Trial.

Ahmad Ma (2023) · Knee · PMID: 37571940

This randomized controlled trial compared usual physiotherapy care alone versus usual care supplemented with a structured home-based exercise and patient education (HBE+EDU) program in 80 adults with knee osteoarthritis over eight weeks. Participants who received the combined HBE+EDU program alongside their regular physiotherapy showed significantly greater improvements in pain (44.1% greater reduction on the VAS), overall disability (22.2% greater improvement on the KOOS), and functional mobility (15.7% better performance on the Timed Up-and-Go test) compared to those receiving usual care with basic home stretching alone. The control group showed only limited gains, primarily in daily living and sports-related activities, while the experimental group improved across all measured outcomes. These findings suggest that structured self-management support—combining guided home exercise with patient education—offers meaningful clinical added value when integrated into standard knee osteoarthritis rehabilitation. Clinicians should consider routinely incorporating such programs into KOA management to enhance patient outcomes beyond what routine physiotherapy achieves alone.

Cost, Time Savings And Effectiveness Of Wearable Devices For Remote Monitoring Of Patient Rehabilitation After Total Knee Arthroplasty: Study Protocol For A Randomized Controlled Trial.

Yang C (2023) · Knee · PMID: 37370130

This randomized controlled trial, conducted at Xi'an Honghui Hospital in China, is comparing wearable monitoring devices against standard rehabilitation care in patients recovering from total knee replacement surgery for end-stage knee osteoarthritis. The study assigns patients to either wear lower-limb tracking devices that transmit real-time movement data to their rehabilitation physicians, or to follow the same standard exercise program without remote monitoring. Key outcomes being measured include healthcare costs, time savings, walking ability (6-minute walk test), knee range of motion, pain scores, and overall knee function assessed by validated clinical tools (KSS and WOMAC). While this is a study protocol rather than a completed trial, the findings will be particularly relevant for determining whether technology-assisted remote supervision can deliver equivalent or better outcomes compared to in-person follow-up, especially for patients in rural or resource-limited settings. Clinicians and patients should note that this trial could help reshape post-surgical rehabilitation pathways by validating a more accessible, cost-efficient model of care delivery.

Improving The Effectiveness Of Exercise Therapy For Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (Beep Trial).

Foster Ne (2023) · Knee · PMID: 37312983

This UK-based randomized controlled trial (the BEEP Trial) enrolled 514 adults aged 45 and older with knee osteoarthritis to compare three types of physical therapy: standard care (up to 4 sessions), individually tailored supervised exercise (6–8 sessions), and a program focused on transitioning patients to general physical activity (8–10 contacts). All three groups experienced meaningful improvements in pain and physical function over 6 months, but neither the more intensive supervised exercise nor the activity transition program produced significantly better outcomes than standard care. These findings suggest that simply adding more supervision, individualization, or session frequency to exercise therapy does not automatically translate into greater benefit for patients with knee osteoarthritis. From a clinical standpoint, this is an important "negative" result that challenges assumptions about the added value of enhanced supervision and highlights the need to identify other strategies—such as psychological or behavioral approaches—to maximize the benefits of exercise in this population.

Technical Issues Occur But Are Infrequent And Have Little Impact On Physiotherapist-Delivered Videoconferencing Consultations For Knee Osteoarthritis: A Descriptive Study.

Ross Mh (2023) · Knee · PMID: 37269590

This study, embedded within a randomized controlled trial, examined how often technical problems occurred during physiotherapy video consultations (via Zoom) for knee osteoarthritis, and whether those problems meaningfully disrupted care. Across 169 initial and 147 final consultations delivered by 15 physiotherapists, technical issues — most commonly audio or video glitches — were documented in 37% of first sessions and 19% of follow-up sessions. Importantly, these issues did not significantly increase the total consultation time compared to in-person visits (difference of less than 1 minute on average), suggesting they were brief and quickly resolved. The findings are clinically relevant because they directly address a commonly cited barrier to telehealth adoption: the fear that technology failures will disrupt patient care. Clinicians and patients can be reassured that while technical hiccups are common, they are typically minor and do not compromise the overall quality or efficiency of videoconferencing physiotherapy consultations.

Gholami Z (2023) · NA · PMID: 37173101

This Iranian randomized controlled trial (n=129 patients over 40 with knee osteoarthritis) is comparing four treatment approaches delivered via telerehabilitation: blended exercise alone, pain neuroscience education (PNE) alone, combined PNE plus blended exercise, and a control group over 12 weeks. The blended exercise program incorporates aerobic, resistance, neuromuscular, balance, breathing, and stretching components, alongside diet education and "exercise booster sessions" designed to sustain adherence. Primary outcomes focus on pain (VAS) and functional ability (WOMAC), while secondary measures capture psychological factors including anxiety, depression, fear of movement, and self-efficacy at baseline, 3 months, and 6 months. Notably, this is a study protocol rather than a completed trial, so no results on supervision effects are yet available. If successful, the findings could help establish a comprehensive, remotely delivered "gold standard" treatment strategy for knee osteoarthritis that addresses its physical, psychological, and educational dimensions simultaneously.

Effectiveness Of Home-Based Conventional Exercise And Cryotherapy On Daily Living Activities In Patients With Knee Osteoarthritis: A Randomized Controlled Clinical Trial.

Mohammedsadiq Ha (2023) · Knee · PMID: 37145013

This randomized controlled trial examined the effectiveness of home-based exercise (HBE) alone, HBE combined with cryotherapy (ice therapy), and standard clinic-based physiotherapy in 49 patients with knee osteoarthritis over two months. The key finding was that patients who combined home-based exercise with cryotherapy showed significantly greater improvements in pain, stiffness, physical function, and overall daily activity scores compared to both the exercise-only and clinic-based treatment groups. Notably, both home-based groups outperformed clinic-based physiotherapy for daily function, and also demonstrated better balance outcomes than the clinic group. The relatively small sample size (18, 16, and 15 patients per group) warrants caution in generalizing these results, and larger trials are needed to confirm these findings. Clinically, this study suggests that adding a simple, low-cost cryotherapy component to a home exercise program may meaningfully enhance outcomes for knee osteoarthritis patients, potentially offering a practical self-management strategy.

Postoperative Rehabilitation Using A Digital Healthcare System In Patients With Total Knee Arthroplasty: A Randomized Controlled Trial.

Shim Gy (2023) · Knee · PMID: 37129691

This randomized controlled trial (n=56) compared augmented reality (AR)-based home exercise rehabilitation to conventional brochure-based home exercise in patients recovering from total knee arthroplasty (TKA). Both groups performed unsupervised home exercises for 12 weeks, with the key difference being that the AR group received real-time visual feedback via a monitor display of each movement. The primary outcome—4-meter gait speed—and all secondary outcomes (pain, function, balance, range of motion, muscle strength, and quality of life) improved significantly in both groups, but no statistically significant differences were found between the two approaches. While the study is limited by its small sample size and lack of statistical power to detect modest between-group differences, the findings suggest that AR-based rehabilitation is a viable alternative to conventional home exercise programs after TKA. For clinicians and patients, this means that technology-enhanced home rehabilitation may offer a practical, accessible option—particularly for those with limited access to in-person physiotherapy—without compromising outcomes.

Online And Onsite Supervised Exercise Therapy And Education For Individuals With Knee Osteoarthritis - A Before And After Comparison Of Two Different Care Delivery Models.

Holm Pm (2023) · Knee · PMID: 37016749

This study compared online (TeleGLA:D) versus in-person (GLA:D®) physiotherapist-supervised exercise and education programs for individuals with knee osteoarthritis, involving 3,789 participants over one year. Both programs consisted of 12 exercise sessions and 2 education sessions, with outcomes measured at 3 and 12 months for pain, physical function, and quality of life. The online format proved non-inferior to in-person delivery across all primary and secondary outcomes, with participants in the online group actually showing greater improvements in walking speed. However, the study had important limitations including a large imbalance in group sizes (3,701 in-person vs. 88 online), a non-randomized design, and wide confidence intervals, meaning these results should be interpreted cautiously. These findings are clinically encouraging — suggesting telehealth delivery of supervised exercise for knee osteoarthritis is a viable alternative to traditional clinic-based care — but a confirmatory randomized controlled trial is needed before firm conclusions can be drawn.

Tailored Exercise Management (Tempo) Versus Usual Care For People Aged 80Â Years Or Older With Hip/Knee Osteoarthritis: Study Protocol For A Feasibility Randomised Controlled Trial.

Nicolson Pja (2023) · Hip; knee · PMID: 37005698

This study describes the protocol for a feasibility randomised controlled trial (RCT) testing whether a tailored exercise programme called TEMPO can be properly studied in people aged 80 years or older with hip or knee osteoarthritis. Unlike most previous exercise trials in osteoarthritis—which enrolled patients with an average age of 60–70 years—this trial specifically targets the oldest patients, who often have additional health conditions and experience more rapid muscle loss. At least 50 participants will be recruited across multiple UK NHS physiotherapy clinics and randomly assigned to either a 12-week supervised, personalised exercise and education programme (TEMPO) or usual care with written information. The primary goal is not yet to prove effectiveness, but to assess whether a full-scale trial is practical by evaluating recruitment rates, participant retention, and treatment adherence. If successful, this feasibility work will lay the groundwork for a larger definitive trial that could meaningfully improve exercise guidance for the fastest-growing and most vulnerable segment of the osteoarthritis population.

Smartphone-Assisted Training With Education For Patients With Hip And/Or Knee Osteoarthritis (Smart-E): Study Protocol For A Multicentre Pragmatic Randomized Controlled Trial.

Weber F (2023) · Hip; knee · PMID: 36959595

The SmArt-E trial is a multicentre randomized controlled trial comparing a blended care program—combining supervised physiotherapy with a smartphone app for independent exercise and education—against usual care for 330 patients with hip and/or knee osteoarthritis over 12 months. The intervention is designed to support self-management, exercise adherence, and behavioral change by enabling ongoing audio-visual contact between patients and their physiotherapists through the app. Key outcomes include pain reduction (measured by numerical rating scale) and improvements in physical functioning (HOOS/KOOS scores) at 3 and 12 months. This study addresses a critical gap in osteoarthritis care, where exercise therapy is guideline-recommended but often underutilized due to poor adherence and limited access to supervised programs. If effective, SmArt-E could offer a scalable, cost-efficient model that reduces both the underuse of evidence-based care and the broader economic burden of osteoarthritis.

The Effect Of A Digital-Assisted Group Rehabilitation On Clinical And Functional Outcomes After Total Hip And Knee Arthroplasty-A Prospective Randomized Controlled Pilot Study.

Osterloh J (2023) · Hip; knee · PMID: 36915066

This small pilot study (26 patients) compared a new digital-assisted group rehabilitation program to standard individual physiotherapy in patients recovering from total hip or knee replacement surgery over six months. The digital group therapy was delivered twice weekly and resulted in patients receiving more total therapy sessions than those in the standard care group. While the differences between groups did not reach statistical significance — likely due to the small sample size — medium to large effect sizes favored the digital program for quality of life, pain, stiffness, physical function, and timed mobility (Timed Up and Go test). One area for improvement was noted: patients in the digital group showed greater variability in walking speed, suggesting that dedicated gait training should be incorporated into the program. These promising findings support the safety and potential effectiveness of digital-assisted group rehabilitation after joint replacement, and the authors recommend a larger, full-scale clinical trial to confirm these results.

Effect Of An Integrated Physiotherapy Protocol On Knee Osteoarthritis Patients: A Preliminary Study.

Khan Sa (2023) · Knee · PMID: 36833098

This preliminary randomized controlled trial (n=60) compared a comprehensive, therapist-supervised physiotherapy protocol against a basic home exercise program in patients with knee osteoarthritis. The supervised program combined patient education, progressive resistance training, stretching, manual therapy techniques (including Maitland mobilization and muscle energy technique), aerobic exercise, and neuromuscular training. Patients receiving supervised physiotherapy showed significant improvements across multiple outcomes, including pain (Visual Analogue Scale), disability (Modified WOMAC), balance (Functional Reach Test), and physical performance (Timed Up and Go, Stair Climb, and Chair Stand tests), compared to the home program group. While the small sample size limits generalizability, these findings suggest that a structured, multi-component supervised physiotherapy protocol addressing the whole-joint nature of osteoarthritis is clinically superior to unsupervised home exercise alone. Clinicians may consider incorporating this type of comprehensive supervised approach to more effectively manage the complex physical and functional impairments associated with knee osteoarthritis.

Cartilage Tissue Turnover Increases With High- Compared To Low-Intensity Resistance Training In Patients With Knee Oa.

Thudium Cs (2023) · Knee · PMID: 36765372

This randomized controlled trial compared high-intensity versus low-intensity supervised resistance training (twice weekly for 3 months) followed by 6 months of unsupervised exercise in patients with knee osteoarthritis. Using blood-based biomarkers, researchers found that both training intensities increased markers of cartilage breakdown, but high-intensity training produced significantly greater aggrecan degradation (a key cartilage component) than low-intensity training — an effect that persisted even after 6 months of unsupervised exercise. Importantly, no difference in cartilage formation was detected between groups, suggesting the higher intensity may drive more degradation without a corresponding repair benefit. Since no meaningful differences in clinical outcomes were observed between the two groups, these biological findings raise a cautionary note about routinely prescribing high-intensity resistance training for knee OA patients. Clinicians and patients should consider that more vigorous exercise may not translate into better joint health and could potentially accelerate cartilage wear in this population.

Acute Effects Of An Exercise Based Multimodal In-Patient Rehabilitation Protocol In Male Knee Osteoarthritis Patients And The Two Years Follow-Up Sustainability.

Pietsch A (2023) · Knee · PMID: 36710693

This study examined 401 male construction workers with knee osteoarthritis who completed a 3-week supervised inpatient "knee college" rehabilitation program, then were followed for two years based on whether they continued exercising at a gym, trained at home, or stopped exercising altogether. All three groups showed meaningful improvements in pain, function, quality of life, and physical capacity immediately after the rehabilitation program. However, only the gym-based exercise group maintained these gains significantly at both the 1-year and 2-year follow-up assessments, while benefits faded in the home training and non-exercising groups. These findings highlight that supervised, facility-based exercise is critical for sustaining rehabilitation outcomes in occupational knee osteoarthritis over the long term. Clinically, this underscores the importance of structured gym-based exercise adherence as a core component of long-term osteoarthritis management, particularly in physically demanding occupational groups.

Supervised Exercise-Therapy And Patient Education Rehabilitation (Super) Versus Minimal Intervention For Young Adults At Risk Of Knee Osteoarthritis After Acl Reconstruction: Super-Knee Randomised Controlled Trial Protocol.

Culvenor Ag (2023) · Knee · PMID: 36657757

The SUPER-Knee trial is a randomized controlled study comparing a 4-month supervised physiotherapist-led exercise and education program against a minimal intervention (a printed home exercise guide) in 184 young adults aged 18–40 who continue to experience knee symptoms 9–36 months after ACL reconstruction. The primary goal is to determine whether the supervised SUPER program produces greater improvements in pain, function, and quality of life—measured using the validated KOOS4 score—compared to unsupervised self-directed exercise. This trial is particularly clinically relevant because ACL reconstruction carries a high risk of early-onset knee osteoarthritis, yet evidence-based rehabilitation strategies for this at-risk population remain poorly defined. Secondary outcomes including muscle strength, physical activity, kinesiophobia, and MRI-assessed cartilage changes will provide important insights into the biological and functional effects of supervised rehabilitation. Results from this well-designed trial could directly inform clinical practice guidelines for post-ACLR care in young adults at risk for premature osteoarthritis.

The Effects Of A Mobile App-Delivered Intervention In People With Symptomatic Hand Osteoarthritis: A Pragmatic Randomized Controlled Trial.

RodrÃguez SÃ¡nchez-LaulhÃ© P (2023) · Hand · PMID: 36633498

This randomized controlled trial compared a mobile app-based intervention (CareHand) delivering exercise, education, and self-management support against usual care (written exercises) in 74 adults with symptomatic hand osteoarthritis over 12 weeks. The app-based group showed meaningful improvements in hand function at 6 months and outperformed usual care for upper limb function at both 3 and 6 months, as well as pain reduction at 1 and 3 months, though neither group showed significant gains in hand function at the earlier 3-month mark. Patients who had higher baseline pain and poorer upper limb function tended to benefit most from the intervention. These findings suggest that mobile health tools can serve as a feasible and effective alternative to traditional written exercise programs, particularly in rural or underserved settings where in-person supervision may be limited. Clinicians should consider mHealth platforms as a practical option for delivering multimodal care to older adults with hand osteoarthritis.

Effects Of Basic Body Awareness Therapy On Pain, Balance, Muscle Strength And Functionality In Knee Osteoarthritis: A Randomised Preliminary Trial.

Alpay K (2023) · Knee · PMID: 36444879

This randomized trial of 40 patients with knee osteoarthritis (mean age 55 years) compared a supervised Basic Body Awareness Therapy (BBAT) program added to home exercises versus home exercises alone over 6 weeks. BBAT is a mind-body physiotherapy approach focusing on movement quality, posture, and balance. Patients receiving the combined supervised BBAT plus home exercise program showed significantly greater improvements in knee extension muscle strength, the ability to rise from a chair repeatedly, and stair climbing ability compared to the home exercise-only group. While all outcomes improved within the BBAT group, between-group differences were most pronounced for functional tasks, with effect sizes ranging from moderate to large. These findings suggest that adding supervised BBAT sessions to a standard home exercise program may offer meaningful functional benefits for people with knee osteoarthritis, though the small sample size warrants cautious interpretation and larger trials are needed to confirm these results.

The Quality Of Physiotherapy And Rehabilitation Program And The Effect Of Telerehabilitation On Patients With Knee Osteoarthritis.

Tore Ng (2023) · Knee · PMID: 36279075

This 8-week randomized controlled trial compared live video-based telerehabilitation (supervised by a physiotherapist via video conference) against a home exercise program delivered only through a printed brochure in 48 patients with mild-to-moderate knee osteoarthritis (mean age ~56 years, 90% women). Patients in the telerehabilitation group showed significantly greater improvements across a broad range of outcomes, including physical function (chair stand test), pain (Numeric Rating Scale), quality of life (KOOS), physical activity levels, anxiety, depression, kinesiophobia, and fatigue compared to the unsupervised group. Telerehabilitation also produced better exercise adherence, higher treatment satisfaction, and superior physiotherapy quality indicators, suggesting that real-time supervision meaningfully enhances engagement and outcomes beyond simply providing exercise instructions. Clinically, these findings highlight that the mode of supervision—even when delivered remotely—plays a critical role in treatment effectiveness for knee osteoarthritis, not just the exercises themselves. For clinicians and patients with internet access, telerehabilitation represents a practical, scalable, and evidence-supported alternative to in-person supervised exercise programs.

Comparing An Expanded Versus Brief Telehealth Physical Therapist Intervention For Knee Osteoarthritis: Study Protocol For The Delaware Peak Randomized Controlled Trial.

Jakiela Jt (2023) · Knee · PMID: 36200390

The Delaware PEAK trial is a randomized controlled trial comparing two telehealth-based approaches for adults with knee osteoarthritis: a supervised program involving five video conference sessions with a physical therapist (including strengthening exercises and step goals) versus a self-directed website providing freely available exercise and pain management resources. The study will enroll 100 participants aged 45 and older who meet standard osteoarthritis criteria and want to become more physically active, with the primary goal of determining whether supervised telehealth physical therapy meaningfully increases moderate-to-vigorous physical activity over 12 weeks. Notably, this trial addresses a critical gap by testing whether remote, supervised exercise delivery can overcome the well-documented physical inactivity burden in people with knee osteoarthritis, without requiring in-person clinic visits. Outcomes including physical activity levels, sedentary behavior, and self-efficacy will be measured at baseline, 12 weeks, and 24 weeks, allowing assessment of both immediate and sustained effects. If successful, this research could strongly support the broader adoption of telehealth-delivered physical therapy as a scalable, accessible strategy for managing knee osteoarthritis through exercise.

Effect Of A Stabilization Exercise Program Versus Standard Treatment For Thumb Carpometacarpal Osteoarthritis: A Randomized Trial.

Pisano K (2023) · PMID: 35811182

This randomized trial of 190 patients with thumb carpometacarpal (CMC) osteoarthritis compared standard hand therapy (orthotics, joint protection education, and modalities) alone versus standard therapy plus a home exercise program (stabilization and strengthening exercises) over 12 months. The key finding was that adding a home exercise program did not produce significantly greater improvements in pain, function, grip/pinch strength, or range of motion compared to standard care alone — both groups improved meaningfully over time. Importantly, both groups achieved clinically meaningful improvements in pain with activity and patient-specific functional scores, exceeding the established minimally clinically important difference (MCID) at 6 and 12 months. A notable limitation was poor study completion (only 48% finished) and unknown adherence to the home exercise program, which may have obscured a true benefit of exercise. Clinically, these findings suggest that high-quality standard hand therapy alone can deliver meaningful outcomes for CMC OA patients, though definitive conclusions about home exercise are premature given the significant methodological limitations.

A Feasibility Study Of Home-Based Preoperative Multimodal Physiotherapy For Patients Scheduled For A Total Knee Arthroplasty Who Catastrophize About Their Pain.

Terradas-Monllor M (2023) · Knee · PMID: 35253582

This small feasibility study compared two levels of supervised home-based physiotherapy versus usual care in 33 patients with knee osteoarthritis awaiting total knee replacement who also experienced significant pain catastrophizing (a tendency to fear and magnify pain). Both experimental groups received pain neuroscience education, coping skills training, and therapeutic exercise, but differed in the intensity of supervision provided. Notably, the group receiving additional supervision showed higher treatment compliance, and both physiotherapy groups demonstrated meaningful reductions in pain intensity and catastrophizing compared to usual care. The study confirmed that a full-scale trial would require approximately 33 patients per group to detect significant effects. These findings are clinically relevant because pain catastrophizing before surgery is a known predictor of poor outcomes after knee replacement, and this intervention appears both feasible and promising for addressing this modifiable risk factor.

Brief Self-Exercise Education For Adults With Chronic Knee Pain: A Randomized Controlled Trial.

Jinnouchi H (2023) · Knee · PMID: 35134993

This randomized controlled trial compared two approaches for managing chronic knee pain in 46 adults: written educational materials alone versus a 100-minute "brief self-exercise education" (brief-SEE) session that combined guided self-exercise instruction with pain education. At 12 weeks, participants who received the brief-SEE showed meaningful improvements in overall knee function (9.4% gain on the KOOS4) and self-efficacy (5.4 points on the PSEQ) compared to those who only received written materials, though pain intensity and quality of life scores did not differ significantly between groups. Adherence and patient satisfaction were high in the brief-SEE group, with no notable adverse events reported. These findings suggest that a single, structured 100-minute education and exercise session can meaningfully enhance patients' functional outcomes and confidence in self-managing their knee pain beyond what written materials alone can achieve. Clinically, this brief intervention could be a practical, low-resource tool for primary care settings to empower patients with chronic knee pain in their self-management journey.

Development Of A Mobile Application To Improve Exercise Accuracy And Quality Of Life In Knee Osteoarthritis Patients: A Randomized Controlled Trial.

Thiengwittayaporn S (2023) · Knee · PMID: 34453570

This randomized controlled trial (n=82) compared a smartphone app ("Rak Kao/Love-Your-Knee") with standard paper handouts for guiding knee osteoarthritis patients through a 4-week home exercise program. Patients using the app performed prescribed exercises significantly more accurately (76.2%) than those relying on handouts (52.5%), suggesting that interactive, AI-guided instruction meaningfully improves exercise technique without in-person supervision. The app group also showed greater improvements in daily activities, quality of life, and sports/recreational ability (p<.01), along with higher patient satisfaction, though range of motion gains were similar between groups. These findings are clinically relevant because they suggest a low-cost, accessible mobile tool can partially substitute for supervised physiotherapy in resource-limited settings, potentially improving adherence and outcomes for a condition requiring lifelong self-management.

Early Surgery Or Exercise And Education For Meniscal Tears In Young Adults.

Skou St (2022) · Menisc · PMID: 38319181

This Danish randomized controlled trial compared early surgery (partial meniscectomy or meniscal repair) versus 12 weeks of supervised exercise and education—with surgery available later if needed—in 121 young adults (ages 18–40) with MRI-confirmed meniscal tears. After 12 months, both groups showed clinically meaningful improvements in pain, function, and quality of life, but there was no statistically significant difference between the two strategies in knee outcome scores (adjusted mean difference of 5.4 points, 95% CI: −0.7 to 11.4). Notably, about one in four patients in the exercise group eventually crossed over to surgery, suggesting that conservative management successfully avoids surgery in the majority of young patients. Safety profiles were similar between groups, with no significant difference in serious adverse events. These findings suggest that for young, active adults with meniscal tears, a supervised exercise and education program is a clinically valid first-line approach, and that early surgery does not offer a clear advantage over this strategy.

A Pragmatic Pilot Randomized Controlled Trial Of The Oa Go Away Among Individuals With Osteoarthritis Of The Hip Or Knee.

Paterson G (2022) · Hip; knee · PMID: 37324606

This 3-month pilot randomized controlled trial tested the feasibility of a larger study evaluating the "OA Go Away" (OGA), a behavioral self-reinforcement tool designed to improve exercise adherence in 37 adults with hip or knee osteoarthritis, comparing it against standard care. Rather than comparing supervised versus unsupervised exercise directly, the study assessed whether participants using the OGA tool were more motivated to stick with their prescribed exercise programs. Key findings showed the intervention was well-received, with 75% of participants rating it as useful and 82% finding it motivational, suggesting strong acceptability. The small sample size limits definitive conclusions about effectiveness, but the pilot successfully demonstrated that a full-scale RCT is both feasible and warranted, particularly if the tool is delivered in an electronic format. For clinicians and patients, the OGA represents a promising low-cost behavioral support strategy that could meaningfully address one of the most persistent challenges in osteoarthritis management — long-term exercise adherence.

Comparison Of A Group-/Home-Based And A Weight-Machine-Based Exercise Training For Patients With Hip Or Knee Osteoarthritis-A Secondary Analysis Of Two Trial Interventions In A Real-World Context.

Roesel I (2022) · Hip; knee · PMID: 36554968

This study compared two exercise approaches for 657 patients with hip or knee osteoarthritis: an individual weight-machine-based strengthening program (MbT, n=136) versus a group- and home-based exercise program combining strengthening and functional movements (GHT, n=521), assessed over 3 months in real-world healthcare settings. Both programs produced meaningful improvements in pain and physical function, with patients who had more severe symptoms at the start showing the greatest gains. There were no statistically significant differences between the two approaches in pain reduction or functional improvement, suggesting both are effective options. However, the machine-based program showed somewhat better results for physical functioning, patient-perceived benefit (92% vs. 78% rating benefit as high or very high), and exercise adherence (dropout rate 16% vs. 28%), hinting at a potential advantage. Clinically, this means both supervised machine-based and group/home-based exercise programs are valid treatments for osteoarthritis, and patient preference should guide the choice of exercise therapy.

Effect Of Iot-Based Power Cycling And Quadriceps Training On Pain And Function In Patients With Knee Osteoarthritis: A Randomized Controlled Trial Protocol.

Wang Xy (2022) · Knee · PMID: 36550804

This 12-week randomized controlled trial (n=72, age ≥50) compares two IoT-supported home exercise approaches — power cycling and quadriceps strengthening, each guided by online supervision — against a control group in adults with knee osteoarthritis (KOA). The primary focus is whether internet-delivered guidance can enhance pain relief (measured by WOMAC) and functional recovery in community-dwelling patients. Notably, this is a protocol paper, meaning results are not yet available, as the trial was registered in April 2022. The study's clinical relevance lies in its potential to inform tele-rehabilitation strategies for KOA, particularly for patients with limited access to in-person physiotherapy. If online-supervised exercise proves effective, it could support scalable, low-cost management of this common and disabling condition.

Efficacy Of Rectus Femoris Stretching On Pain, Range Of Motion And Spatiotemporal Gait Parameters In Patients With Knee Osteoarthritis: A Randomised Controlled Trial.

Elgendy Mh (2022) · Knee · PMID: 36530599

This randomized controlled trial (n=60, age >45) investigated whether adding rectus femoris stretching to a standard exercise program improved outcomes in patients with mild-to-moderate knee osteoarthritis over 4 weeks. Both groups received a comprehensive exercise program including calf, hamstring, and iliotibial band stretching plus strengthening exercises, while only the study group also performed rectus femoris stretching. Patients who received the additional rectus femoris stretching showed significantly greater improvements in pain (VAS), function (WOMAC), knee flexion range of motion, step length, and walking speed compared to controls. Notably, knee extension ROM did not differ significantly between groups. These findings suggest that this simple, home-compatible stretching technique is a clinically meaningful and low-cost addition to standard knee osteoarthritis rehabilitation, provided patients maintain good exercise compliance.

Fast-Track Surgery And Telerehabilitation Protocol In Unicompartmental Knee Arthroplasty Leads To Superior Outcomes When Compared With The Standard Protocol: A Propensity-Matched Pilot Study.

De Berardinis L (2022) · Knee · PMID: 36510279

This small pilot study compared a fast-track surgery combined with telerehabilitation program versus standard surgery and rehabilitation in 28 patients undergoing unicompartmental knee replacement (UKA) for knee osteoarthritis. Patients in the fast-track/telerehabilitation group showed significantly better pain and function scores (WOMAC) at early time points (2, 15, and 40 days post-surgery) and greater knee range of motion at all measured time points up to 12 months. Both groups had no postoperative complications and reported favorable outcomes at one year, though the fast-track/telerehabilitation group consistently outperformed the standard care group. However, the study's very small sample size (7 vs. 21 patients) and retrospective design limit the strength of these conclusions, and the authors appropriately call for larger trials before this protocol can be widely recommended. Clinically, these findings are encouraging and suggest that combining fast-track surgical protocols with telerehabilitation may accelerate recovery and improve early functional outcomes after partial knee replacement.

Five-Year Follow-Up Of Patients With Knee Osteoarthritis Not Eligible For Total Knee Replacement: Results From A Randomised Trial.

Larsen Jb (2022) · Knee · PMID: 36428014

This randomized trial compared a comprehensive 12-week supervised treatment program (including patient education, neuromuscular exercise, dietary weight loss, insoles, and pain medication) against simple written advice in 100 patients with knee osteoarthritis who were not yet candidates for knee replacement surgery. At the 5-year follow-up, there were no statistically significant differences in knee pain, symptoms, or function between the two groups, though the results could not rule out a clinically meaningful benefit favoring supervised treatment. Notably, the majority of patients in both groups—76% in the supervised group and 66% in the written advice group—achieved clinically important improvements in their knee outcomes regardless of which treatment they received. Approximately one-third of patients in each group ultimately underwent knee replacement surgery, which did not produce significantly greater improvement than non-surgical management alone. These findings suggest that even simple written advice may be sufficient for many patients with moderate knee osteoarthritis, though clinicians should consider individual patient needs when deciding on the intensity of supervised care.

Comparison Of Face-To-Face Vs Digital Delivery Of An Osteoarthritis Treatment Program For Hip Or Knee Osteoarthritis.

JÃ¶nsson T (2022) · Hip; knee · PMID: 36326763

This large Swedish registry study compared face-to-face versus app-based digital delivery of a structured 3-month exercise and education program for nearly 7,000 adults with knee or hip osteoarthritis. Both delivery methods produced clinically meaningful reductions in joint pain at 3 months, with the face-to-face group improving by approximately 1.1 points and the digital group by approximately 1.9 points on an 11-point pain scale. While the digital program showed a statistically greater pain reduction (about 0.9 points more than face-to-face), the clinical importance of this difference remains uncertain, as it fell just below the pre-specified threshold of 1 point needed to confirm superiority. Secondary outcomes including walking difficulties, quality of life, and fear avoidance behavior followed a similar pattern. These findings suggest that digital delivery of osteoarthritis exercise programs is at least as effective as traditional in-person care, offering clinicians and patients a viable and potentially more accessible treatment alternative.

Evaluation Of Two Electronic-Rehabilitation Programmes For Persistent Knee Pain: Protocol For A Randomised Feasibility Trial.

Groves-Williams D (2022) · Knee · PMID: 36194515

This paper describes the protocol for a feasibility trial testing two digital rehabilitation programmes for people aged 45 and older with persistent knee pain consistent with osteoarthritis. Ninety participants will be randomly assigned to one of three groups: an unsupervised self-directed internet-based exercise programme ("My Knee UK"), a physiotherapist-supervised group exercise programme delivered via videoconferencing ("Group E-Rehab"), or usual care. The trial is designed to assess whether these digital approaches are feasible and acceptable — not yet to determine clinical effectiveness, as this is a preparatory study. If successful, a larger definitive trial would follow to assess whether supervised or unsupervised e-rehabilitation is clinically effective and cost-effective. Clinicians and patients should note that no outcome data are yet available from this study.

Effect Of Functional Weightbearing Versus Non-Weightbearing Quadriceps Strengthening Exercise On Contact Force In Varus-Malaligned Medial Knee Osteoarthritis: A Secondary Analysis Of A Randomized Controlled Trial.

Starkey Sc (2022) · Knee · PMID: 36162143

This randomized controlled trial compared two 12-week home-based quadriceps strengthening programs — one using weight-bearing exercises (n=31) and one using non-weight-bearing exercises (n=36) — in adults aged 50 and older with medial knee osteoarthritis and varus (bow-legged) malalignment. The key finding was that overall medial knee joint contact force during walking did not differ meaningfully between the two programs, suggesting neither approach is clearly superior or harmful in terms of total joint loading. However, the two programs did differ in *how* that joint force was generated: non-weight-bearing exercise reduced the muscular contribution to joint load more, while weight-bearing exercise reduced the external (mechanical) contribution more. For clinicians, this means both exercise types appear comparably safe from a joint loading perspective, though they may work through different biomechanical mechanisms. Patients and providers can have reasonable confidence choosing either approach based on preference, access, or individual physical capacity, without fear of significantly worsening knee loads.

Effect Of A Mhealth Exercise Intervention Compared With Supervised Exercise Therapy In Osteoarthritis Management: Protocol Of The Digioa Trial.

Martinsen L (2022) · PMID: 36153027

The DigiOA trial is a randomized controlled trial comparing a mobile health app providing home exercises against traditional supervised physiotherapy for 156 patients with hip and/or knee osteoarthritis in Norwegian primary care. The study uses a non-inferiority design, meaning it aims to determine whether the digital home exercise approach works just as well as — rather than better than — supervised sessions, which would be a clinically meaningful finding given rising OA prevalence and healthcare demand. The primary measure of success is the proportion of patients meeting internationally recognized OMERACT-OARSI responder criteria at 6 weeks, alongside secondary outcomes including pain, physical function, mental health, and cost-efficiency. If the app-based approach proves non-inferior, it could significantly improve patient access to recommended OA care while reducing the burden on physiotherapy services. This study is particularly relevant as healthcare systems worldwide face increasing pressure to deliver effective care more sustainably and at scale.

[Effects Of A Telehealth-Based Physical Exercise Program On Functional Capacity In Patients With Osteoarthritis].

MuÃ±oz-Fonseca F (2022) · PMID: 35856963

This 8-week randomized controlled trial compared two home-based exercise programs for 36 older adults (mean age 68) with knee or hip osteoarthritis: one group received printed exercise instructions only, while the other received the same instructions enhanced with tutorial videos and voice messaging via WhatsApp (telehealth). Both groups showed meaningful improvements in physical function, including walking speed, chair stand performance, balance, and overall physical performance scores. Importantly, no statistically significant differences were found between groups on key outcomes including the Lower Extremity Functional Scale, Barthel Index, pain scores, or overall functional capacity. These findings suggest that a low-cost, technology-assisted telehealth exercise program is equally as effective as traditional paper-based exercise instruction for improving physical function in osteoarthritis patients. Clinically, this supports the use of accessible telehealth tools like WhatsApp as a viable alternative for delivering exercise therapy, particularly useful for patients with limited access to in-person care.

Muscle Activation Patterns Around Knee Following Neuromuscular Training In Patients With Knee Osteoarthritis: Secondary Analysis Of A Randomized Clinical Trial.

Rashid Sa (2022) · Knee · PMID: 35799287

This randomized controlled trial (n=66) compared 12 weeks of neuromuscular training (NMT) to conventional quadriceps strengthening (QT) in knee osteoarthritis patients with varus (bow-legged) alignment. Researchers measured muscle co-contraction — the simultaneous activation of opposing muscle groups around the knee — using electromyography during treadmill walking. NMT produced significantly greater reductions in quadriceps-hamstring co-contraction than QT, suggesting improved neuromuscular control and potentially reduced harmful loading on the knee joint. Both programs similarly reduced quadriceps-gastrocnemius co-contraction. Clinically, these findings suggest that neuromuscular training may offer advantages over standard strengthening exercises by improving sensorimotor control in this patient population.

Comparison Of The Effectiveness Of Peloid And Paraffin Treatment For Symptomatic Hand Osteoarthritis In Women: A Single-Blind Randomized Controlled Study.

Aksanyar B (2022) · Hand · PMID: 35794487

This randomized controlled trial compared peloid (therapeutic mud) therapy versus paraffin wax therapy, both combined with home exercise, in 80 women with symptomatic hand osteoarthritis over 15 sessions across 3 weeks. Both treatments produced significant short-term improvements in pain, hand grip strength, and functional status compared to baseline, with benefits maintained at one-month follow-up. However, peloid therapy showed statistically greater improvements in physical activity levels and certain quality-of-life measures, as well as depression scores at 3 weeks. Clinically, both therapies appear viable options for managing hand osteoarthritis symptoms, though peloid therapy may offer modest additional benefits for physical functioning and wellbeing. Clinicians may consider peloid therapy as a natural, well-tolerated treatment option, particularly when broader functional and mood-related outcomes are prioritized.

Effectiveness Of An Individualized Comprehensive Rehabilitation Program In Women With Chronic Knee Osteoarthritis: A Randomized Controlled Trial.

LÃ³pez Ll (2022) · Knee · PMID: 35674649

This randomized controlled trial compared an 8-week individualized comprehensive rehabilitation (ICR) program against aquatic training in 40 women with chronic knee osteoarthritis, measuring outcomes related to joint function, physical performance, and quality of life. While both groups showed similar results immediately after treatment, the ICR group demonstrated significantly better outcomes at a 3-month follow-up, including improved stiffness, overall joint function, and mobility tasks such as rising from a chair and climbing stairs. The relatively small sample size (40 participants) warrants caution in broadly generalizing these findings, though the results are clinically meaningful given that sustained improvements were observed months after the program ended. For clinicians, this suggests that individualized, comprehensive rehabilitation may offer more durable benefits compared to aquatic exercise alone for women with knee osteoarthritis, particularly in supporting long-term functional independence.

The Effects Of A Patient-Specific Integrated Education Program On Pain, Perioperative Anxiety, And Functional Recovery Following Total Knee Replacement.

Ho Cj (2022) · Knee · PMID: 35629142

This prospective controlled trial evaluated a patient-specific Integrated Education Program (IEP) for patients undergoing total knee replacement, comparing it to standard clinical care across two sites. The IEP combined preoperative education, prehabilitation, multidisciplinary in-hospital rehabilitation, and supervised home-based exercise after discharge. Key findings showed that patients in the IEP group experienced significantly less postoperative pain during hospitalization, reduced perioperative anxiety (measured by state and trait anxiety scores), and meaningfully better functional outcomes as reported by both patients (WOMAC) and clinicians (American Knee Society Score) at most time points up to three months post-surgery. While the sample size was not explicitly stated in the abstract, the structured, multi-component nature of the intervention suggests clinical relevance for care teams designing perioperative pathways. These results support integrating personalized education and coordinated rehabilitation into standard knee replacement care to improve patient recovery and well-being.

How Effective Is A Blended Web-Based Rehabilitation For Improving Pain, Physical Activity, And Knee Function Of Patients With Knee Osteoarthritis? Study Protocol For A Randomized Control Trial.

Moutzouri M (2022) · Knee · PMID: 35617272

This randomized controlled trial (currently a protocol, with results pending) is comparing two approaches for managing knee osteoarthritis (KOA): a blended web-based rehabilitation program (combining online exercise guidance, educational advice, and outdoor physical activity) versus outdoor structured physical activity alone. The study will enroll 56 adults with KOA from the West Attica region of Greece, following them over 12 weeks to assess outcomes including pain, knee function, physical activity levels, fear of movement, and quality of life. While full results are not yet available, the trial addresses a clinically important question about whether adding supervised, technology-assisted guidance to self-directed exercise meaningfully improves outcomes for KOA patients. This is particularly relevant given the growing interest in digital health tools and the challenge of delivering care to patients in underserved or resource-limited areas. Clinicians and patients should note that this protocol represents an innovative approach to remote, scalable osteoarthritis management, though evidence of effectiveness awaits trial completion.

Cost And Quality Of Life Outcomes Of The Stepped Exercise Program For Patients With Knee Osteoarthritis Trial.

Kaufman Bg (2022) · Knee · PMID: 35365305

The STEP-KOA trial tested a three-step exercise program against standard arthritis education in 345 veterans with knee osteoarthritis, where patients could progress from internet-based exercise training to phone counseling to in-person physical therapy depending on their response. The stepped exercise program meaningfully improved quality of life compared to the control group, with patients gaining approximately 0.028 additional quality-adjusted life-years over 9 months. The program cost only $279 more per patient than standard education, resulting in a cost per QALY gained of roughly $10,000—well below the commonly accepted threshold of $50,000, at which there was a 98% probability the program is cost-effective. The main factors affecting cost-effectiveness were the program's impact on quality of life and whether patients already owned a mobile device, suggesting costs will decrease as personal device ownership grows. Clinicians and health systems should consider STEP-KOA as a highly cost-effective, scalable approach to managing knee osteoarthritis, particularly in settings serving veterans or similar populations.

The Collaborative Lifestyle Intervention Program In Knee Osteoarthritis Patients (Clip-Oa) Trial: Design And Methods.

Focht Bc (2022) · Knee · PMID: 35283261

The CLIP-OA trial was an 18-month randomized controlled trial that compared a structured exercise plus dietary weight loss program (delivered by community partners) against the Arthritis Foundation's self-managed "Walk With Ease" program in overweight or obese adults with knee osteoarthritis. The study's primary goal was to measure improvements in mobility using a 400-meter walk test, while also tracking weight loss, pain levels, quality of life, and cost-effectiveness. Being overweight significantly worsens knee OA outcomes, yet accessible, sustainable weight management programs remain scarce in community settings. The trial was designed to determine whether a personalized, evidence-based lifestyle intervention could outperform standard self-management care in improving real-world mobility and weight outcomes. Results from this study have the potential to guide clinicians and health systems toward more effective, scalable community-based treatment options for knee OA patients struggling with excess weight.

The Relation Of Attitude Toward Technology And Mastery Experience After An App-Guided Physical Exercise Intervention: Randomized Crossover Trial.

Sassenberg K (2022) · PMID: 35179500

This randomized crossover trial (n=54) compared app-guided versus physiotherapist-guided exercise in patients with hip osteoarthritis, examining whether patients' attitudes toward technology influenced their experience of mastery and perceived usefulness of the interaction. Both sessions used identical exercises, but mastery experience was generally lower in the app-guided condition compared to physiotherapist guidance. Importantly, patients with more positive attitudes toward technology reported significantly higher mastery experience and perceived usefulness after app-guided—but not physiotherapist-guided—sessions. Patients with very positive technology attitudes achieved mastery levels comparable to physiotherapist-guided training. Clinically, this suggests that screening patients' technology attitudes before prescribing app-based exercise therapy may help identify who will benefit most from this increasingly common, cost-effective delivery format.

Six Weeks Of Resistance Training (Plus Advice) Vs Advice Only In Hand Osteoarthritis: A Single-Blind, Randomised, Controlled Feasibility Trial.

Magni N (2022) · Hand · PMID: 34872042

This feasibility trial examined whether a full clinical trial comparing supervised hand resistance training (using either blood flow restriction training or high-intensity training) against advice-only is practical and safe for people with hand osteoarthritis. Fifty-nine participants were enrolled across three groups and completed six weeks of supervised hand exercises three times per week, with retention rates of 79–89%. Key findings showed that exercise did not worsen pain during or after sessions, pain flares were rare (occurring in less than 5% of sessions), and both resistance training approaches led to greater pain relief and more treatment responders compared to advice alone, though grip strength and hand function did not significantly improve. The study confirmed that running a larger, definitive trial is feasible, with acceptable recruitment, adherence, and safety profiles. For clinicians and patients, this is encouraging evidence that supervised hand resistance training is a safe and potentially beneficial option for managing hand osteoarthritis symptoms, warranting further investigation in a fully powered trial.

Basic Body Awareness Therapy Versus Standard Care In Hip Osteoarthritis. A Randomized Controlled Trial.

Olsen Al (2022) · Hip · PMID: 34811841

This randomized controlled trial (n=101) compared Basic Body Awareness Therapy (BBAT) — a supervised group exercise program emphasizing quality of movement — against standard self-initiated care in adults with hip osteoarthritis, all of whom first received patient education. After 12 weekly supervised BBAT sessions over 6 months, there were no significant differences between groups in the primary outcomes of walking pain or daily physical function, suggesting that supervised BBAT does not offer a clear advantage over standard care for these key outcomes. However, participants in the BBAT group showed meaningfully better movement quality (effect size=0.84), and those who completed at least 10 of 12 sessions also demonstrated clinically relevant improvements in self-efficacy, overall health, and function — highlighting that compliance with supervised exercise matters. Clinically, these findings suggest that while BBAT may not reduce pain or disability more than unsupervised standard care on average, patients who engage consistently with supervised therapy may experience broader health benefits. Clinicians should consider patient adherence as a critical factor when recommending supervised exercise programs for hip osteoarthritis.

Dynamic Stabilization Home Exercise Program For Treatment Of Thumb Carpometacarpal Osteoarthritis: A Prospective Randomized Control Trial.

Mcveigh Kh (2022) · PMID: 34312043

This randomized controlled trial compared two conservative treatment approaches for thumb carpometacarpal (CMC) osteoarthritis: standard conservative therapy (SCT) alone—including a thumb splint, joint protection strategies, and pain management—versus SCT combined with a home exercise program targeting thumb-stabilizing muscles (adductor stretching and thenar strengthening). Both groups showed meaningful, statistically significant reductions in pain and disability scores at both 6 weeks and 6 months, but there was no statistically significant difference between the two groups at either time point. Clinically, this suggests that adding a structured home exercise program did not provide additional benefit beyond standard conservative care alone for reducing pain or improving function. These findings are relevant for clinicians and patients because they support the effectiveness of simpler, less burdensome standard care, though the study's sample size may have limited its ability to detect smaller between-group differences. Patients with thumb CMC osteoarthritis can be reassured that conservative management with splinting and joint protection is an effective first-line approach.

Marconcin P (2022) · NA · PMID: 34077602

This randomized controlled trial compared a 12-week combined self-management and exercise program against an educational-only program in 80 adults aged 60 and older with knee osteoarthritis, with 67 participants completing the study. The treatment group, which received structured exercise alongside self-management training, showed significant improvements in self-efficacy, physical activity levels, and balance in both knees compared to the education-only control group. However, no meaningful differences were found between groups in health-related quality of life, walking speed, or agility. These findings suggest that combining exercise with self-management education — rather than education alone — is important for helping older adults with knee osteoarthritis feel more confident in managing their condition and become more physically active. Clinically, this supports integrating structured exercise and self-management components into community-based osteoarthritis programs for older patients.

Exercise In Patients With Hip Osteoarthritis - Effects On Muscle And Functional Performance: A Randomized Trial.

Bieler T (2022) · Hip · PMID: 33956561

This randomized trial of 42 patients with hip osteoarthritis compared three 4-month exercise programs — supervised progressive resistance training (RT), supervised Nordic Walking (NW), and unsupervised home-based exercise (HBE) — each performed three hours per week, to determine which best improved muscle and physical function. Resistance training was superior for building quadriceps muscle mass (measured by MRI), gaining approximately 2.3 cm² more than both Nordic Walking and home-based exercise; however, this muscle growth did not translate into meaningful improvements in strength, power, or everyday functional tasks. Supervised Nordic Walking outperformed unsupervised home exercise for functional outcomes, including chair stand repetitions and 6-minute walk distance, highlighting the importance of supervision and structured group activity even when the exercise type is less intensive. Notably, improvements in strength and power of the less-affected leg — not the more painful leg — were the ones most closely linked to better walking and functional performance, suggesting that clinicians should monitor both limbs rather than focusing solely on the symptomatic side. These findings suggest that supervision matters for functional gains, and that a combination of resistance training and aerobic activity like Nordic Walking may offer the most clinically meaningful benefits for patients with hip osteoarthritis.

Application Of Heterogeneity Of Treatment-Effects Methods: Exploratory Analyses Of A Trial Of Exercise-Based Interventions For Knee Osteoarthritis.

Coffman Cj (2022) · Knee · PMID: 33463020

This randomized controlled trial compared three approaches for managing knee osteoarthritis in 350 participants: supervised physical therapy (PT), internet-based exercise training (IBET), and a wait-list control group, with outcomes measured using a validated pain and function score (WOMAC) over 4 months. A key finding was that the benefit of each exercise approach varied depending on patient characteristics: individuals with lower body weight (BMI) tended to do better with internet-based training, while those with higher BMI and longer disease duration responded more favorably to supervised physical therapy. Participants who were not employed showed meaningful improvements in symptoms with either active exercise approach compared to no treatment. These exploratory findings suggest that tailoring exercise referrals based on a patient's BMI, disease duration, and employment status could help optimize outcomes, though the authors caution that the specific effect size estimates carry uncertainty and may not generalize broadly. Clinicians should view these results as hypothesis-generating, supporting the design of future trials that prospectively test these subgroup differences.

The Effect Of Innovative Smartphone Application On Adherence To A Home-Based Exercise Programs For Female Older Adults With Knee Osteoarthritis In Saudi Arabia: A Randomized Controlled Trial.

Alasfour M (2022) · Knee · PMID: 33103499

This randomized controlled trial compared two approaches to home exercise programs in 40 Saudi women aged 50 and older with knee osteoarthritis: one group used an Arabic-language smartphone app called "My Dear Knee," while the control group received the same exercises as paper handouts. After six weeks, women using the app showed significantly better adherence to their exercise program and greater reductions in knee pain compared to the paper group, though both groups performed the same exercises. The study was relatively small (20 participants per group), and analysis was limited to those who completed the trial, which should be considered when interpreting the results. Clinically, this research suggests that a well-designed, culturally adapted smartphone application can be a practical and low-cost tool to overcome common barriers to exercise adherence—such as transportation, mobility limitations, and lack of in-person supervision—particularly for older women who may have difficulty accessing clinic-based physiotherapy. These findings support the growing role of digital health tools in managing chronic musculoskeletal conditions like knee osteoarthritis.

Challenges With Strengthening Exercises For Individuals With Knee Osteoarthritis And Comorbid Obesity: A Qualitative Study With Patients And Physical Therapists.

Lawford Bj (2022) · Knee · PMID: 32886868

This qualitative study, embedded within an RCT, explored the real-world challenges that patients with knee osteoarthritis and obesity, along with their physical therapists, experienced when following a 12-week home-based strengthening program. Interviews with 22 patients and 7 physical therapists revealed both psychological barriers — such as fear of pain, false beliefs about exercise, and mental effort — and physical barriers, including difficulty performing certain exercises and complications from other health conditions. Importantly, the study also identified strategies to overcome these challenges, including accountability structures, patient education, reassurance, and individualized program tailoring. These findings highlight that simply prescribing exercise is insufficient; addressing psychological and physical barriers is critical for improving adherence in this population.

Short-Term Effects Of Strengthening Exercises Of The Lower Limb Rehabilitation Protocol On Pain, Stiffness, Physical Function, And Body Mass Index Among Knee Osteoarthritis Participants Who Were Overweight Or Obese: A Clinical Trial.

Rafiq Mt (2021) · Knee · PMID: 34975349

This one-month randomized controlled trial conducted in Pakistan compared a structured lower limb strengthening exercise program (provided via instruction leaflets) against daily care instructions alone in 50 overweight or obese adults with knee osteoarthritis. Both groups experienced significant reductions in knee pain and stiffness, but participants who received the exercise protocol showed greater pain reduction, higher satisfaction, and better exercise adherence compared to the control group. Importantly, neither physical function nor BMI improved significantly over the short four-week period in either group. The findings suggest that even a home-based, unsupervised strengthening program delivered through written materials can meaningfully reduce knee pain and stiffness in overweight patients with osteoarthritis. However, clinicians should be aware that longer intervention periods and additional support strategies may be needed to achieve improvements in functional outcomes and weight management.

Effects Of A Periodized Circuit Training Protocol Delivered By Telerehabilitation Compared To Face-To-Face Method For Knee Osteoarthritis: A Protocol For A Non-Inferiority Randomized Controlled Trial.

Aily Jb (2021) · Knee · PMID: 34872597

This randomized controlled trial compared a 14-week periodized circuit training program—combining resistance and aerobic exercise—delivered either via telerehabilitation (at-home exercise supported by DVD, website, and phone coaching) or in-person with a physical therapist, in 100 adults aged 40 or older with moderate knee osteoarthritis. The study used a non-inferiority design, meaning it aimed to determine whether remote exercise delivery works just as well as face-to-face supervision, rather than proving it is superior. Primary outcomes measured pain (using a visual analog scale) and physical function (using the WOMAC questionnaire) at 14 and 26 weeks. If telerehabilitation proves non-inferior, it could offer a practical, low-cost alternative for the many patients who face barriers to in-person physical therapy due to distance, cost, or social isolation. These findings would have important clinical implications for expanding access to evidence-based exercise care for osteoarthritis management.

The Role Of 6-Minute Walk Test Guided By Impedance Cardiography In The Rehabilitation Following Knee Arthroplasty: A Randomized Controlled Trial.

Lin Y (2021) · Knee · PMID: 34869641

This randomized controlled trial of 66 patients with knee osteoarthritis compared a supervised home rehabilitation program (delivered via the WeChat messaging platform with multidisciplinary clinical guidance) against an unsupervised approach where patients received only a written exercise manual at discharge, following total knee replacement surgery. At six months post-surgery, patients in the supervised group walked significantly farther in the 6-minute walk test (414 m vs. 375 m) and demonstrated better cardiovascular exercise capacity, including higher stroke volume and cardiac output. The digitally supervised, multidisciplinary program—incorporating impedance cardiography to individualize exercise intensity—produced meaningful improvements in both physical function and heart-related performance measures. These findings suggest that structured remote supervision significantly enhances recovery after knee replacement compared to self-directed rehabilitation alone. For clinicians, this study highlights the value of technology-assisted, team-based post-operative rehabilitation programs, even when delivered in a home setting.

The Role Of Rehabilitation Exercises On Weight, Functional Strength, And Exercise Adherence In Knee Osteoarthritis Patients.

Rafiq Mt (2021) · Knee · PMID: 34825640

This 12-week randomized controlled trial conducted in Lahore, Pakistan compared a supervised lower-limb rehabilitation exercise program (combined with standard daily care instructions) against daily care instructions alone in overweight and obese patients with knee osteoarthritis. The supervised rehabilitation group showed statistically significant improvements in both weight reduction and functional strength compared to the control group (both p < 0.001), while the control group also showed some functional strength gains on their own, suggesting daily care guidance has modest independent benefit. Notably, the supervised exercise group demonstrated meaningfully greater improvements across all measured outcomes — weight, functional strength, and exercise adherence — highlighting the added value of structured, guided exercise over general advice alone. These findings are clinically relevant for physiotherapists and rheumatologists, reinforcing that structured rehabilitation exercise should be a cornerstone of conservative knee OA management, particularly in patients carrying excess body weight. Although the study's single-site design and lack of reported sample size details limit generalizability, the results support current clinical guidelines recommending supervised exercise as a first-line intervention for knee osteoarthritis.

Total Hip Arthroplasty Versus Progressive Resistance Training In Patients With Severe Hip Osteoarthritis: Protocol For A Multicentre, Parallel-Group, Randomised Controlled Superiority Trial.

Frydendal T (2021) · Hip · PMID: 34686555

This Danish multicentre randomised controlled trial compared total hip arthroplasty (THA) — the standard surgical treatment for severe hip osteoarthritis — against 12 weeks of supervised progressive resistance training (PRT) followed by 12 weeks of optional unsupervised exercise, enrolling 120 patients aged 50 or older who had already been deemed eligible for surgery. The primary outcome measured changes in hip pain and function using the Oxford Hip Score at 6 months, with secondary outcomes including walking speed, chair stand ability, and activity levels. Importantly, this trial addresses a critical evidence gap, as no prior randomised controlled trials have directly compared surgery to non-surgical exercise therapy for severe hip OA, despite the fact that up to 23% of patients undergoing THA report persistent long-term pain and functional deficits even after surgery. The findings will have significant clinical relevance for both patients and orthopaedic surgeons making treatment decisions, potentially supporting a supervised exercise-first approach before committing to irreversible surgery. This summary describes a published trial protocol rather than final results, meaning outcome data are not yet available.

The Effect Of Mobile-App-Based Instruction On The Physical Function Of Female Patients With Knee Osteoarthritis: A Parallel Randomized Controlled Trial.

Arfaei Chitkar Ss (2021) · Knee · PMID: 34521400

This randomized controlled trial of 64 women (ages 40–70) with knee osteoarthritis compared a mobile app-based exercise instruction program combined with routine care against routine care alone over two months. Patients who used the mobile app showed significant improvements in pain, physical function, and overall arthritis symptoms as measured by the WOMAC questionnaire, as well as improvements in physical function and vitality on the SF-36 quality-of-life scale. The mobile app essentially provided a form of remote, technology-assisted guidance in place of direct in-person supervision. These findings suggest that mobile app-based instruction is a practical and accessible tool that can meaningfully enhance outcomes for knee osteoarthritis patients, particularly in settings where supervised exercise programs may not be readily available. Clinicians may consider recommending validated exercise apps as a cost-effective complement to standard osteoarthritis care, especially for older female patients in community settings.

A Smartwatch Paired With A Mobile Application Provides Postoperative Self-Directed Rehabilitation Without Compromising Total Knee Arthroplasty Outcomes: A Randomized Controlled Trial.

Tripuraneni Kr (2021) · Knee · PMID: 34462184

This randomized controlled trial of 337 patients compared traditional supervised physical therapy (PT) against a self-directed rehabilitation (SDR) program using a smartwatch paired with a mobile app following total knee replacement surgery. Patients who actively engaged with the SDR program (high-compliance group) achieved outcomes comparable to those receiving formal PT, with no clinically meaningful differences in knee function scores, range of motion, or rates of manipulation under anesthesia. Although the low-compliance SDR group showed statistically lower knee scores at 3 and 6 months, these differences did not reach the threshold considered clinically important (8.02 KOOS JR units). These findings suggest that motivated, tech-comfortable patients can safely replace traditional supervised PT with a smartwatch-guided home program after knee replacement without compromising their recovery. Clinicians may consider offering this digital self-directed option as a legitimate alternative to formal PT, particularly for patients with limited access to in-person rehabilitation services.

Home-Based Rehabilitation Programme Compared With Traditional Physiotherapy For Patients At Risk Of Poor Outcome After Knee Arthroplasty: The Corka Randomised Controlled Trial.

Barker Kl (2021) · Knee · PMID: 34452970

The CORKA trial compared a home-based rehabilitation programme delivered by rehabilitation assistants (with therapist supervision) against standard outpatient physiotherapy in 621 patients identified as high-risk for poor outcomes following knee replacement surgery. Across 14 NHS physiotherapy departments in the UK, participants were randomly assigned to either approach and followed for 12 months. The trial found no clinically or statistically significant differences between the two groups on any outcome measure, including functional ability, quality of life, or physical performance tests. Both approaches produced similar results with comparable safety profiles, with only one serious adverse event directly linked to the home-based intervention. These findings suggest that for high-risk knee arthroplasty patients, a supervised home-based model can achieve equivalent outcomes to traditional clinic-based physiotherapy, offering a potentially more flexible and accessible service delivery option.

Effects Of Diet Control And Telemedicine-Based Resistance Exercise Intervention On Patients With Obesity And Knee Osteoarthritis: A Randomized Control Trial.

Hsu Yi (2021) · Knee · PMID: 34360036

This 12-week randomized controlled trial enrolled 66 obese adults with mild-to-moderate knee osteoarthritis, comparing diet control alone, telemedicine-supervised elastic band resistance exercise alone, or a combination of both interventions. The combined diet-plus-exercise group achieved the greatest overall benefits, including significant reductions in body fat, improved mobility (measured by the Timed Up-and-Go test), better self-reported knee symptoms, and meaningful improvements in cholesterol and triglyceride levels compared to either intervention alone. Notably, all interventions were delivered remotely via telephone or messaging apps under clinical supervision, demonstrating that telemedicine-based care can be an effective and accessible approach for this patient population. For clinicians and patients, these findings suggest that combining dietary guidance with supervised home-based resistance exercise offers superior outcomes over either strategy alone, and that remote delivery does not appear to compromise effectiveness.

Physical Rehabilitation Versus No Physical Rehabilitation After Total Hip And Knee Arthroplasties: Protocol For A Pragmatic, Randomized, Controlled, Superiority Trial (The Draw1 Trial).

Mark-Christensen T (2021) · Hip; knee · PMID: 34316356

This randomized controlled trial (the DRAW1 Trial) is comparing three post-surgery rehabilitation approaches for 168 patients who have undergone total hip or knee replacement in Denmark: supervised telerehabilitation delivered remotely, standard home-based rehabilitation, and no formal rehabilitation exercises at all. The central question is whether prescribed exercise programs actually improve outcomes compared to doing nothing structured, given that previous research has found home-based and clinic-based rehabilitation produce similar results. The primary outcome measure is self-reported ability to perform daily activities (using the HOOS/KOOS questionnaire) assessed at 6 weeks, with additional follow-ups at 3 and 12 months. If the "no rehabilitation" group performs comparably to the exercise groups, this would have major implications for how healthcare systems allocate rehabilitation resources after joint replacement surgery. Clinicians and patients should note this trial may challenge the assumption that post-discharge exercise programs are universally necessary following hip or knee arthroplasty.

Evaluation Of The Efficacy And Safety Of An Exercise Program For Persons With Total Hip Or Total Knee Replacement: Study Protocol For A Randomized Controlled Trial.

Barone G (2021) · Hip; knee · PMID: 34201439

This randomized controlled trial (RCT) protocol compares a 6-month supervised post-rehabilitation exercise program against standard usual care in people who have undergone total hip replacement (THR) or total knee replacement (TKR). The primary goal is to determine whether structured, supervised training improves quality of life (measured by the SF-36 questionnaire), alongside secondary measures of physical function, clinical outcomes, and lifestyle factors. While the abstract describes a study protocol rather than completed results, the trial is designed to generate practical evidence on whether supervised exercise offers meaningful benefits over unsupervised usual care in this surgical population. THR and TKR are among the most frequently performed elective surgeries, making findings from this study highly relevant to clinicians, rehabilitation specialists, and patients seeking guidance on long-term recovery strategies. Results from this trial could help shape best-practice recommendations for safe and effective physical activity programs following joint replacement surgery.

Aquatic Exercise And Land Exercise Treatments After Total Knee Replacement Arthroplasty In Elderly Women: A Comparative Study.

Lee Ch (2021) · Knee · PMID: 34201120

This study compared three rehabilitation approaches in 100 elderly women following total knee replacement surgery: supervised aquatic exercise (AE), supervised land-based exercise (LE), and unsupervised home exercise (HE) over a two-week period beginning two weeks after surgery. Both supervised programs consisted of two 30-minute sessions daily for 10 days, focusing on range of motion, strengthening, and balance training. Key findings showed that all groups improved in knee range of motion and pain reduction, but patients in the supervised AE and LE groups achieved meaningfully better overall outcomes than those doing home exercise alone. Notably, aquatic exercise showed a trend toward improved knee flexor muscle strength even within the short hospital stay, suggesting a potential advantage for patients who may tolerate land-based exercise less well. These results highlight the clinical value of supervised post-operative rehabilitation over unsupervised home programs, though longer follow-up studies are needed to confirm lasting benefits.

Effects Of Preoperative Telerehabilitation On Muscle Strength, Range Of Motion, And Functional Outcomes In Candidates For Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial.

An J (2021) · Knee · PMID: 34199913

This randomized controlled trial of 60 elderly women awaiting total knee replacement compared three approaches: a supervised telerehabilitation exercise program, a patient education program, and standard care, each delivered over 3 weeks before surgery. The telerehabilitation group showed significant improvements in quadriceps muscle strength, knee range of motion, pain scores, and functional mobility (measured by the Timed Up-and-Go test and WOMAC questionnaire) compared to the other groups. These pre-surgical gains translated into better functional recovery at 6 weeks after the operation, suggesting that structured remote exercise supervision adds meaningful clinical value beyond education alone. With a sample of 60 participants and moderate-to-large effect sizes across most outcomes, the findings support incorporating supervised telerehabilitation into standard prehabilitation pathways for knee replacement candidates. Clinically, this approach is particularly relevant for elderly patients with limited access to in-person physiotherapy, offering a practical and effective alternative to traditional face-to-face prehabilitation.

Early Outcomes Of Primary Total Hip Arthroplasty With Use Of A Smartphone-Based Care Platform: A Prospective Randomized Controlled Trial.

Crawford Da (2021) · Hip · PMID: 34192907

This randomized controlled trial (365 participants: 198 control, 167 treatment) compared a smartphone and smartwatch-based rehabilitation platform against standard care following total hip replacement surgery. Patients using the app required significantly less in-person physiotherapy (34% vs. 55%), yet achieved equivalent outcomes at 90 days across hip function scores (HOOS Jr), mobility tests (Timed Up and Go, single leg stance), and hip range of motion. Complication rates, hospital readmissions, and emergency visits were also similar between groups. These findings suggest that digital care platforms may allow patients to recover flexibly at home without compromising clinical outcomes, and could reduce overall healthcare costs and unnecessary visits.

Efficacy And Safety Of A Self-Developed Home-Based Enhanced Knee Flexion Exercise Program Compared With Standard Supervised Physiotherapy To Improve Mobility And Quality Of Life After Total Knee Arthroplasty: A Randomized Control Study.

Xu T (2021) · Knee · PMID: 34127008

This randomized controlled trial (n=119) compared a self-directed, home-based knee flexion exercise program using a low stool (KFEH) against standard supervised physiotherapy (SPT) in patients recovering from total knee replacement surgery. Both approaches led to meaningful improvements in pain, joint function, and quality of life over 12 months, with the home-based program proving non-inferior to supervised care. Notably, patients in the home-based group achieved better range of motion at the 1-month mark, suggesting potentially faster early recovery, though overall score differences were not statistically significant. The home program offered additional practical advantages, including reduced time burden and lower healthcare costs for patients — benefits that became especially relevant during the COVID-19 pandemic. These findings suggest that a structured, home-based exercise program can be a safe, effective, and more accessible alternative to supervised physiotherapy following total knee arthroplasty for appropriately selected patients.

2021 Mark Coventry Award: Use Of A Smartphone-Based Care Platform After Primary Partial And Total Knee Arthroplasty: A Prospective Randomized Controlled Trial.

Crawford Da (2021) · Knee · PMID: 34053272

This randomized controlled trial (452 patients across multiple centers) compared a smartphone/smartwatch-based rehabilitation platform against traditional in-person physiotherapy following total or partial knee replacement surgery. The digital platform group achieved equivalent outcomes to standard physiotherapy care in key measures including knee range of motion, balance, and mobility at 90 days, demonstrating non-inferiority. Notably, patients using the app required significantly less formal physiotherapy (59% vs. 94%) and had fewer emergency department visits (2.5% vs. 8.2%), suggesting improved self-management and care efficiency. One area of caution is that patient-reported knee function scores (KOOS JR) were modestly but statistically lower in the digital group, warranting further investigation. Overall, these findings suggest that smartphone-based care platforms may offer a clinically viable, potentially cost-saving alternative to traditional rehabilitation models after knee arthroplasty, with implications for expanding access to post-surgical care.

Determining The Effectiveness Of A New Device For Hand Therapy (The Fepsim Device): Feasibility Protocol For A Randomized Controlled Trial Study.

Miguel-Cruz A (2021) · Hand · PMID: 34042597

This feasibility RCT (n=94) evaluates whether the FEPSim hand rehabilitation device can effectively supplement standard care for adults with forearm, wrist, or hand impairments due to fractures, stroke, or osteoarthritis. The intervention group receives standard rehabilitation plus FEPSim-guided therapeutic activities, while the control group receives standard care alone, with assessments at five time points over 10 weeks. Primary outcomes include wrist and forearm range of motion and grip/pinch strength, with secondary outcomes covering pain and daily activity limitations. The study also examines recruitment feasibility, device usability, and cost-effectiveness to inform a future definitive trial. Notably, this is a feasibility protocol, so findings will guide—rather than conclusively answer—questions about the device's clinical effectiveness.

Exercise And Education For Community-Dwelling Older Participants With Knee Osteoarthritis: A Video-Linked Programme Protocol Based On A Randomised Controlled Trial.

Wang L (2021) · Knee · PMID: 34022825

This randomized controlled trial compared two types of supervised exercise — neuromuscular exercise versus targeted quadriceps strengthening — delivered via video link to community-dwelling adults aged 50 and older with knee osteoarthritis over a 12-week period. The study aimed to determine which exercise approach better reduces knee pain during walking and improves physical function, while also examining whether pain relief and functional gains are linked to improvements in psychological factors such as fear, catastrophizing, and social support. Notably, all supervised sessions were conducted remotely through video technology, making this a potentially accessible model for patients who cannot attend in-person physiotherapy. The trial also investigated the concept of "irritability" — how much exercise provokes or aggravates pain — as a clinically meaningful safety and tolerance measure. For clinicians and patients, this study is highly relevant as it explores whether video-supervised exercise can serve as an effective, scalable alternative to traditional face-to-face rehabilitation for knee osteoarthritis.

Muscle Strength Gains After Strengthening Exercise Explained By Reductions In Serum Inflammation In Women With Knee Osteoarthritis.

Marriott K (2021) · Knee · PMID: 34000629

This small RCT (17 women with knee osteoarthritis) compared 12 weeks of supervised progressive quadriceps strengthening exercise (3 sessions/week) against an attention control group to explore how inflammation and cartilage properties relate to muscle strength gains. The key finding was that reductions in two inflammatory markers — interleukin-6 and tumor necrosis factor — were significantly associated with improvements in quadriceps strength after the exercise program, explaining roughly half the variance in strength gains. Notably, at baseline, these same inflammatory markers and cartilage measurements did not explain the relationship between BMI and muscle strength. While the small sample size limits generalizability, these results suggest that the anti-inflammatory effects of supervised resistance exercise may be a meaningful mechanism driving strength improvements in women with knee osteoarthritis. Clinically, this supports the value of structured, supervised exercise programs not only for building muscle strength but potentially for modulating systemic inflammation in this population.

Effects Of A Self-Directed Web-Based Strengthening Exercise And Physical Activity Program Supported By Automated Text Messages For People With Knee Osteoarthritis: A Randomized Clinical Trial.

Nelligan Rk (2021) · Knee · PMID: 33843948

This Australian randomized clinical trial of 206 adults with knee osteoarthritis compared a self-directed, web-based strengthening and physical activity program supported by automated behavior-change text messages against a control website providing only general OA and exercise information. Over 24 weeks, participants in the intervention group experienced meaningfully greater reductions in knee pain and improvements in physical function, with approximately 72% achieving clinically important pain improvement compared to 42% in the control group. Notably, this was an entirely unsupervised digital program, demonstrating that effective exercise therapy for knee OA does not necessarily require direct clinician supervision to produce clinically meaningful results. The intervention is free to access and scalable, making it a practical tool for both patients who face barriers to traditional supervised exercise programs and clinicians seeking to extend their reach across larger populations. These findings support the integration of digitally delivered, text-message-supported exercise programs as a viable first-line or complementary strategy in knee OA management.

Effects Of An Exercise Therapy Targeting Knee Kinetics On Pain, Function, And Gait Kinetics In Patients With Knee Osteoarthritis: A Randomized Clinical Trial.

Bokaeian Hr (2021) · Knee · PMID: 33785660

This randomized clinical trial compared three supervised exercise approaches in 59 patients with medial knee osteoarthritis: a combined yoga and medial-thrust gait program (YogaMT), traditional knee-strengthening exercises, and treadmill walking, each delivered over 12 supervised sessions. The key finding was that the YogaMT program uniquely reduced the knee adduction moment—a biomechanical force linked to cartilage wear on the inner knee—suggesting it may help offload the most commonly damaged part of the knee joint. Importantly, all three exercise programs led to meaningful improvements in pain and walking function, reinforcing that supervised exercise of various types is beneficial for knee osteoarthritis. The relatively small sample size (59 participants across three groups) limits the generalizability of these findings, and the benefits were only assessed in the short term. Clinicians should consider that structured, supervised exercise remains a cornerstone of osteoarthritis management, while YogaMT shows early promise as a biomechanically targeted option warranting larger, longer-term trials.

Effectiveness Of Internet-Based Exercises Aimed At Treating Knee Osteoarthritis: The Ibeat-Oa Randomized Clinical Trial.

Gohir Sa (2021) · Knee · PMID: 33620447

The iBEAT-OA trial compared a smartphone app-delivered exercise program against routine self-management (usual care) in 105 adults aged 45 and older with knee osteoarthritis over 6 weeks. Participants using the internet-based app experienced significantly greater reductions in knee pain (1.5 points on a 0–10 scale) and meaningful improvements in physical function—including sit-to-stand performance and walking tests—compared to those receiving usual care. With effect sizes ranging from medium to very strong, these improvements are considered clinically important and not just statistically significant. Notably, no adverse events were reported, suggesting the app-based program is both safe and effective. These findings are particularly relevant given that first-line exercise treatments for osteoarthritis are widely underused, and digital delivery could help bridge this gap by improving access and adherence.

Association Between Therapeutic Alliance And Outcomes Following Telephone-Delivered Exercise By A Physical Therapist For People With Knee Osteoarthritis: Secondary Analyses From A Randomized Controlled Trial.

Lawford Bj (2021) · Knee · PMID: 33459601

This study examined whether the quality of the relationship (therapeutic alliance) between patients with knee osteoarthritis and their physical therapists during phone-based exercise consultations influenced patient outcomes. Using data from 87 patients who received 5–10 telephone sessions with a physical therapist over 6 months, researchers found that patients who reported a stronger connection with their therapist showed modest improvements in pain, self-efficacy, and global function at both 6 and 12 months. However, therapist-rated alliance showed little to no association with patient outcomes, and one unexpected finding was a slight worsening in fear of movement among patients with higher alliance ratings. Importantly, while some associations were statistically detectable, the effect sizes were small and are unlikely to translate into meaningful clinical differences in practice. Clinicians should be aware that fostering a positive therapeutic relationship during remote consultations may offer modest benefits, but the overall impact appears limited in this telephone-delivered care model.

The Effect Of Exercise Therapy On Inflammatory Activity Assessed By Mri In Knee Osteoarthritis: Secondary Outcomes From A Randomized Controlled Trial.

Bandak E (2021) · Knee · PMID: 33453514

This randomized controlled trial compared 12 weeks of supervised exercise therapy (three sessions per week) against a no-attention control group in 60 patients with knee osteoarthritis, with 33 patients completing the protocol with valid data. Patients who completed the supervised exercise program reported significantly less knee pain (approximately 11.7 points improvement on the KOOS pain scale) compared to the control group. Importantly, MRI imaging showed that exercise did not worsen joint inflammation — inflammatory activity in the synovium remained stable in the exercise group, while the control group's inflammation appeared to increase. The pain relief achieved through exercise was not explained by reductions in measurable inflammation, suggesting exercise works through other mechanisms such as improved muscle support or central pain modulation. Overall, these findings reassure clinicians and patients that supervised exercise is safe for knee osteoarthritis and provides meaningful pain relief without causing inflammatory harm.

Stepped Exercise Program For Patients With Knee Osteoarthritis : A Randomized Controlled Trial.

Allen Kd (2021) · Knee · PMID: 33370174

This randomized controlled trial (n=345 veterans with knee osteoarthritis) tested a stepped exercise program (STEP-KOA) against an arthritis education control group over 9 months. STEP-KOA used a tiered approach, starting with an internet-based exercise program, progressing to telephone coaching for non-responders, and finally advancing to in-person physical therapy for those still not improving — meaning supervision intensity increased only when needed. Participants in STEP-KOA showed meaningfully greater improvement in pain and function (approximately 6.8-point lower WOMAC score) compared to the education-only group. Notably, 65% of participants required progression beyond the first step, and 35% ultimately needed in-person therapy, highlighting that many patients benefit from at least some level of supervised care. This stepped model offers a practical, resource-efficient framework for clinicians to match exercise intervention intensity to individual patient needs in knee osteoarthritis management.

Follow-Up Of A Wuqinxi Exercise At Home Programme To Reduce Pain And Improve Function For Knee Osteoarthritis In Older People: A Randomised Controlled Trial.

Xiao Cm (2021) · Knee · PMID: 32931545

This randomized controlled trial investigated whether older adults with knee osteoarthritis (average age ~71 years) could maintain the benefits of a home-based Wuqinxi (traditional Chinese exercise) program over a 3-month follow-up period, comparing 34 exercise participants against 34 controls. Wuqinxi is a gentle, animal-inspired movement practice that was previously shown to achieve high adherence in community-dwelling older adults. Key findings showed that participants who completed the Wuqinxi program maintained or improved across all nine outcome measures — including pain (WOMAC), balance, walking ability, leg strength, and physical function — while the control group showed significant declines in pain scores and knee muscle strength. With a modest sample size of 68 participants, these results suggest that a structured home exercise program can produce durable benefits beyond the active intervention period, which is clinically meaningful given the challenges of long-term adherence in older adults with osteoarthritis.

No Changes In Appetite-Related Hormones Following Swimming And Cycling Exercise Interventions In Adults With Obesity.

Fico Bg (2020) · PMID: 33414868

This 12-week randomized controlled trial assigned 39 adults with obesity and osteoarthritis to either supervised swimming or supervised cycling, exercising 3 days per week at progressively increasing intensities. The study tested whether swimming in cooler water stimulates appetite hormones more than cycling, potentially explaining why swimming is often less effective for weight loss. Key appetite-related hormones — ghrelin, insulin, leptin, and peptide YY — did not significantly change in either group after 12 weeks. These findings suggest that swimming does not negatively alter appetite hormone profiles compared to cycling in this population. Clinically, this supports swimming as a viable low-impact exercise option for people with obesity and osteoarthritis without concern that it will hormonally drive increased appetite.

Outpatient Physiotherapy Versus Home-Based Rehabilitation For Patients At Risk Of Poor Outcomes After Knee Arthroplasty: Corka Rct.

Barker Kl (2020) · Knee · PMID: 33250068

The CORKA trial randomized 621 patients identified as high-risk for poor outcomes after knee replacement surgery to either a home-based rehabilitation programme delivered by rehabilitation assistants (with therapist oversight) or standard outpatient physiotherapy across 14 NHS sites in the UK. At 12 months, there were no clinically or statistically meaningful differences between the two groups on any functional, patient-reported, or physical outcome measures, suggesting that supervised home-based rehabilitation is equally effective to traditional clinic-based care for this vulnerable patient population. Importantly, the home-based programme was less expensive to deliver (saving approximately £66 per patient in healthcare costs and £316 per patient when broader societal costs were considered), and from a societal perspective had a 75% probability of being cost-effective. These findings are clinically relevant because they suggest that resource-intensive outpatient physiotherapy can be safely replaced with a supervised home-based model without compromising patient outcomes, potentially improving access to rehabilitation. Clinicians and health systems should consider home-based, assistant-delivered rehabilitation as a viable and potentially cost-saving alternative for high-risk post-arthroplasty patients.

Exploring Attitudes And Experiences Of People With Knee Osteoarthritis Toward A Self-Directed Ehealth Intervention To Support Exercise: Qualitative Study.

Nelligan Rk (2020) · Knee · PMID: 33242021

This qualitative study, embedded within a randomized controlled trial, explored the experiences of 16 people with knee osteoarthritis who used a 24-week self-directed eHealth intervention (a website and SMS-based behavior change program) to support exercise participation. Participants generally found the technology easy to use and reported that clear exercise instructions, flexible programming, and credible health information helped them exercise independently. SMS reminders supported accountability, though automated messages sometimes triggered negative emotions such as guilt. Participants reported improvements in knee symptoms and greater confidence in self-managing their condition. Importantly, participants preferred the eHealth tool to be introduced by a healthcare professional and made available at low cost, highlighting that human connection remains valued even within self-directed digital programs.

The Feasibility And Effectiveness Of Internet-Based Rehabilitation For Patients With Knee Osteoarthritis: A Study Protocol Of Randomized Controlled Trial In The Community Setting.

Xie Sh (2020) · Knee · PMID: 33126366

This small feasibility randomized controlled trial (n=40) compared an internet-based rehabilitation program delivered via a web platform and wearable devices in a community setting against a control group for patients with knee osteoarthritis. Rather than reporting final results, this is a study protocol describing a planned 12-week intervention, with outcomes including pain (Numerical Rating Scale), physical function and quality of life (WOMAC and SF-36) assessed at baseline, 6 weeks, and 12 weeks. Key feasibility measures include participant completion rates, compliance, and satisfaction with the digital program. While the authors conclude that internet-based, community-delivered rehabilitation appears promising for reducing OA pain and improving function, clinicians should note that this paper describes a protocol only, and definitive effectiveness data are not yet available. The findings, once complete, could have meaningful implications for expanding accessible, technology-assisted OA rehabilitation beyond the home setting into structured community environments.

Perceived Facilitators And Barriers Among Physical Therapists And Orthopedic Surgeons To Pre-Operative Home-Based Exercise With One Exercise-Only In Patients Eligible For Knee Replacement: A Qualitative Interview Study Nested In The Quadx-1 Trial.

Husted Rs (2020) · Knee · PMID: 33095777

This qualitative study, embedded within the QUADX-1 randomized trial, explored the perceived facilitators and barriers among physical therapists and orthopedic surgeons toward a model of coordinated care using a single home-based exercise for patients eligible for knee replacement. Through focus groups and interviews, three key themes emerged: physical therapists' skepticism about oversimplified exercise prescriptions, orthopedic surgeons' doubts about the long-term effectiveness of exercise in surgical candidates, and challenges around coordinating non-surgical and surgical care. Both professional groups experienced ambivalence about their roles within this model. These findings highlight important implementation challenges that must be addressed before such a coordinated care model can be successfully adopted in clinical practice.

Facilitating Activity And Self-Management For People With Arthritic Knee, Hip Or Lower Back Pain (Fasa): A Cluster Randomised Controlled Trial.

Walsh N (2020) · Knee; hip · PMID: 33068901

This cluster randomized controlled trial (n=349, aged 50+) compared a 6-week group exercise and self-management program led by a physiotherapist to continued GP care alone for patients with hip/knee osteoarthritis and/or chronic lower back pain across 45 GP practices in Southwest England. Participants in the supervised, community-based intervention reported significantly better physical function at 6 months compared to those receiving only GP management, with a meaningful difference in the Short Musculoskeletal Functional Assessment Dysfunction Index (DI-SMFA difference: -3.01, 95% CI -5.25 to -0.76, p=0.01). The program was safe, with only one minor adverse event reported, and retention was strong with just 13% attrition at the primary endpoint. While the results are statistically significant, the authors caution that the clinical meaningfulness of this functional improvement remains uncertain. For clinicians, this study suggests that structured, physiotherapist-led group exercise and education programs in community settings may offer a practical and scalable approach to managing lower limb OA and chronic back pain beyond routine GP care.

Behavior Change Text Messages For Home Exercise Adherence In Knee Osteoarthritis: Randomized Trial.

Bennell K (2020) · Knee · PMID: 32985994

This randomized controlled trial of 110 adults aged 50+ with knee osteoarthritis and obesity examined whether automated behavior-change text messages (SMS) could improve adherence to unsupervised home exercise over 24 weeks, following completion of a 12-week supervised physiotherapy program. Participants receiving SMS reported significantly better exercise adherence on both primary measures compared to controls — scoring higher on a standardized adherence scale (16.5 vs. 13.3) and exercising more days per week (1.8 vs. 1.3 days). However, this improvement in adherence did not translate into meaningful differences in pain, physical function, or quality of life between the two groups. The findings suggest that low-cost, automated SMS interventions can modestly but significantly boost home exercise adherence after supervised care ends, which is a well-recognized clinical challenge in osteoarthritis management. Clinicians should note that while text messaging may help patients stay active, additional strategies may be needed to convert improved adherence into measurable clinical benefits.

Effectiveness Of Human Versus Computer-Based Instructions For Exercise On Physical Activity-Related Health Competence In Patients With Hip Osteoarthritis: Randomized Noninferiority Crossover Trial.

Durst J (2020) · Hip · PMID: 32985991

This randomized crossover trial involving 54 adults (mean age 62 years) with hip osteoarthritis compared exercise guidance delivered by a physiotherapist versus a fully automated tablet app across four exercise types (mobility, strength, and balance). The physiotherapist outperformed the app in nearly all outcomes, particularly in movement quality for strengthening exercises and in boosting patients' exercise-specific self-efficacy — a critical factor for long-term independent exercise adherence. However, the app performed comparably to the physiotherapist for the simpler mobility exercise, and patients using the app still showed meaningful improvements in self-efficacy and training competence, suggesting some benefit from digital guidance alone. Clinically, these findings indicate that digital apps cannot replace hands-on physiotherapy supervision, especially for complex or technique-sensitive exercises, but may serve as a useful supplementary tool to support home-based practice of simpler movements. Patients and clinicians should view digital exercise apps as a complement to — not a substitute for — professional physiotherapy in osteoarthritis management.

Feasibility Cluster Randomised Controlled Trial Evaluating A Theory-Driven Group-Based Complex Intervention Versus Usual Physiotherapy To Support Self-Management Of Osteoarthritis And Low Back Pain (Solas).

Hurley Da (2020) · PMID: 32967713

This feasibility study compared a theory-driven group-based self-management program (SOLAS) to standard individual physiotherapy for 120 patients with osteoarthritis and/or chronic low back pain across 14 primary care clinics in Ireland. Both approaches led to improvements in pain and function at 2 and 6 months, with only small differences between the two groups, suggesting neither clearly outperformed the other in this early-stage trial. The trial demonstrated that the SOLAS group intervention was acceptable to both patients and physiotherapists, with high adherence and good follow-up rates (around 71–84% across time points). However, recruiting enough participants per cluster proved challenging, falling short of the target group size, which represents the main barrier to conducting a larger definitive trial. These findings provide valuable groundwork for refining recruitment strategies before investing in a full-scale RCT to determine whether supervised group exercise offers meaningful advantages over standard individual physiotherapy for these common musculoskeletal conditions.

Effect Of Self-Management Program On Outcome Of Adult Knee Osteoarthritis.

Khachian A (2020) · Knee · PMID: 32888898

This randomized controlled trial of 80 adults with knee osteoarthritis compared a structured self-management education program (n=40) against a control group (n=40) over 8 weeks. Participants in the intervention group learned self-management strategies — including exercise, diet, and pain reduction techniques — which they then practiced independently at home. Before the program, both groups had similar knee osteoarthritis outcomes; however, after 8 weeks, the intervention group showed significant improvements across all five KOOS domains: pain, symptoms, daily activities, sport and recreation function, and quality of life (p<0.001). These findings suggest that educating patients to self-manage their condition at home — without direct clinical supervision — can produce meaningful, clinically relevant benefits across multiple outcome measures. For clinicians and patients, this highlights self-management education as a practical, low-resource approach that may complement or extend the benefits of supervised care for knee osteoarthritis.

Technology Versus Tradition: A Non-Inferiority Trial Comparing Video To Face-To-Face Consultations With A Physiotherapist For People With Knee Osteoarthritis. Protocol For The Peak Randomised Controlled Trial.

Hinman Rs (2020) · Knee · PMID: 32767989

The PEAK trial is a randomized controlled trial comparing video-based physiotherapy consultations to traditional face-to-face consultations for 394 Australians with knee osteoarthritis (OA). Both groups receive five sessions over three months, during which a physiotherapist prescribes a home-based strengthening exercise program, physical activity plan, and OA education. The trial uses a non-inferiority design, meaning it aims to determine whether video consultations work *at least as well* as in-person care for reducing knee pain and improving physical function. If video consultations prove non-inferior, this could significantly improve access to evidence-based physiotherapy care for people in remote or underserved areas, while potentially reducing the time and cost burden on patients. Findings will also provide policymakers with the evidence needed to consider funding telehealth physiotherapy services for musculoskeletal conditions.

Movement Pattern Training Compared With Standard Strengthening And Flexibility Among Patients With Hip-Related Groin Pain: Results Of A Pilot Multicentre Randomised Clinical Trial.

Harris-Hayes M (2020) · Hip · PMID: 32518674

This pilot multicentre RCT compared two physiotherapist-delivered approaches — movement pattern training (optimising biomechanics during daily tasks) versus standard strengthening and flexibility exercises — in 46 young adults with chronic hip-related groin pain over 12 weeks. The study primarily assessed feasibility, finding strong recruitment success, excellent retention (91%), and high session attendance (93%), though home exercise adherence (62%) was lower than target. Both groups showed clinically meaningful improvements in hip function and muscle strength, with no significant differences between treatments. Notably, movement pattern training produced greater reductions in faulty hip and pelvic mechanics during a single-leg squat. The authors conclude that a larger definitive trial is feasible and warranted.

The Effect Of Physical Therapy And Rehabilitation Modalities On Sleep Quality In Patients With Primary Knee Osteoarthritis: A Single-Blind, Prospective, Randomized-Controlled Study.

AltaÅŸ Eu (2020) · Knee · PMID: 32318678

This randomized controlled trial of 40 patients with knee osteoarthritis (Kellgren-Lawrence Grade 2-3) compared a combined approach of supervised physical therapy (hot pack, ultrasound, and TENS) plus exercise versus exercise alone over 15 sessions. The group receiving both physical therapy modalities and exercise showed significantly greater improvements in pain, sleep quality, depression, disease activity, and quality of life compared to those doing exercise only. It is important to note that the exercise component was home-based and unsupervised in both groups, meaning the key comparison was adjunctive physical therapy modalities versus no adjunctive treatment. While the sample size of 40 patients (20 per group) is relatively small, the findings suggest that adding supervised physical therapy modalities to a home exercise program offers clinically meaningful benefits beyond exercise alone. Clinicians managing knee osteoarthritis may consider incorporating multimodal physical therapy to address not only pain and function but also sleep disturbance and psychological well-being.

Cost-Effectiveness Of 12 Weeks Of Supervised Treatment Compared To Written Advice In Patients With Knee Osteoarthritis: A Secondary Analysis Of The 2-Year Outcome From A Randomized Trial.

Skou St (2020) · Knee · PMID: 32243994

This randomized controlled trial compared a 12-week individualized supervised treatment program (combining exercise, education, dietary advice, insoles, and pain medication) against simple written advice in 100 adults with moderate-to-severe knee osteoarthritis who were not candidates for total knee replacement. Over a 24-month follow-up period, both groups incurred similar healthcare costs (approximately 6,758 vs. 6,880 Euros), but patients receiving supervised treatment gained a clinically meaningful advantage in quality-adjusted life years (QALYs), suggesting better health outcomes for a comparable cost. The supervised program proved cost-effective across all tested scenarios, with cost-effectiveness ratios ranging from 6,229 to 20,688 Euros per QALY — well within commonly accepted thresholds. For clinicians, these findings support recommending structured, supervised multimodal treatment over passive written advice as a first-line, value-for-money intervention in this patient population. This is particularly relevant for patients with significant knee OA who are not yet surgical candidates and need effective conservative management options.

What Type Of Exercise Is Most Effective For People With Knee Osteoarthritis And Co-Morbid Obesity?: The Target Randomized Controlled Trial.

Bennell Kl (2020) · Knee · PMID: 32200051

This randomized controlled trial (the TARGET trial) compared two 12-week home-based exercise programs in 128 adults aged 50 and older with knee osteoarthritis and obesity (BMI ≥30): non-weight bearing quadriceps strengthening exercises versus weight-bearing functional exercises. Both groups showed meaningful improvements in pain and physical function, with no statistically significant difference between them on these primary outcomes, suggesting either approach is a valid option for this population. However, weight-bearing exercise showed an edge in secondary outcomes, including greater quality-of-life improvements and more participants reporting overall functional improvement. Notably, the non-weight bearing group experienced significantly more adverse events (39% vs. 23%), making weight-bearing exercise the safer and potentially more beneficial choice. Clinically, these findings support prescribing either exercise type with confidence, while favouring weight-bearing functional exercise as the first-line recommendation for patients with knee osteoarthritis and co-morbid obesity.

Development Of Osteoarthritis In Patients With Degenerative Meniscal Tears Treated With Exercise Therapy Or Surgery: A Randomized Controlled Trial.

Berg B (2020) · Menisc · PMID: 32184135

This randomized controlled trial compared 12 weeks of supervised exercise therapy versus arthroscopic partial meniscectomy (surgical removal of damaged meniscus tissue) in 140 adults aged 35–60 with degenerative meniscal tears, most of whom had no established knee osteoarthritis at baseline. After 5 years of follow-up, researchers found no statistically significant differences between the two treatments in the progression of joint space narrowing, osteophyte formation, or the development of radiographic or symptomatic knee osteoarthritis. Patient-reported outcomes were also similar between groups. These findings suggest that supervised exercise therapy is a viable first-line alternative to surgery for this patient population, with neither approach clearly superior in preventing long-term osteoarthritis progression. Clinically, this supports current guideline recommendations to consider conservative, non-surgical management before pursuing arthroscopic intervention for degenerative meniscal tears.

Movement Pattern Biofeedback Training After Total Knee Arthroplasty: Randomized Clinical Trial Protocol.

Bade Mj (2020) · Knee · PMID: 32171937

This randomized controlled trial compared standard physical rehabilitation alone versus standard rehabilitation enhanced with movement pattern biofeedback training in 150 patients recovering from total knee replacement surgery. The movement training group received real-time feedback through in-shoe pressure sensors alongside verbal and physical cues from therapists to encourage more balanced, symmetrical use of both legs during exercise. The key question was whether guided movement retraining could restore healthy knee loading patterns in the surgically replaced knee and reduce the risk of arthritis progression in the opposite, untreated knee. This is clinically important because many patients develop lasting compensatory movement habits after knee replacement that may accelerate wear on the other knee. Results from this trial could reshape post-surgical rehabilitation protocols by demonstrating whether targeted, technology-assisted movement training offers meaningful advantages over conventional therapy alone.

Better Knee, Better Meâ„¢: Effectiveness Of Two Scalable Health Care Interventions Supporting Self-Management For Knee Osteoarthritis - Protocol For A Randomized Controlled Trial.

Bennell Kl (2020) · Knee · PMID: 32164604

The "Better Knee, Better Me" trial is a three-arm randomized controlled trial involving 415 Australians aged 45–80 with knee osteoarthritis and a BMI between 28–41 kg/m², comparing three approaches: an information-only control, a physiotherapist-led remote exercise program, and the same exercise program combined with dietitian-led weight management including a very low calorie ketogenic diet. All interventions were delivered via videoconferencing and a dedicated website, making them scalable and accessible without requiring in-person clinic visits. The primary outcomes assessed at 6 months were self-reported knee pain and physical function, with secondary outcomes including weight, quality of life, physical activity, and willingness to undergo surgery followed up to 12 months. This study is clinically relevant because it directly addresses a gap in evidence regarding whether adding structured weight management to exercise provides meaningful additional benefits for overweight patients with knee osteoarthritis. The findings could guide the development of cost-effective, remotely delivered care models that reduce the burden on specialist services and potentially delay or prevent the need for knee surgery.

Treatment Of Osteoarthritis Secondary To Developmental Dysplasia Of The Hip With Prolotherapy Injection Versus A Supervised Progressive Exercise Control.

GÃ¼l D (2020) · Hip · PMID: 32045406

This randomized controlled trial compared prolotherapy (repeated dextrose injections into the hip joint) against a supervised progressive exercise program in 41 patients (46 hips) with hip osteoarthritis caused by developmental dysplasia of the hip (DDH). At both 6 and 12 months, patients receiving prolotherapy showed significantly greater reductions in pain (VAS scores) and better hip function (Harris Hip Score) compared to those in the exercise group. While both treatments provided some benefit, the prolotherapy group achieved roughly double the improvement in Harris Hip Score by 12 months. With a modest sample size of 41 patients, these findings should be interpreted with caution, but they suggest prolotherapy may be a clinically meaningful, minimally invasive option that could help delay the need for surgical intervention in this often-challenging patient population.

Telerehabilitation Is Non-Inferior To Usual Care Following Total Hip Replacement - A Randomized Controlled Non-Inferiority Trial.

Nelson M (2020) · Hip · PMID: 32026820

This randomized controlled trial of 70 patients compared telerehabilitation delivered via iPad into patients' homes versus traditional in-person physiotherapy following total hip replacement surgery. At six weeks post-surgery, both groups achieved equivalent outcomes in quality of life, strength, balance, and self-reported function, confirming that telerehabilitation is non-inferior to face-to-face care. Notably, patients receiving telerehabilitation showed significantly better home exercise compliance (86% vs. 74%) and found it easier to attend appointments, while overall satisfaction remained high in both groups. These findings are clinically relevant as they suggest that telerehabilitation using readily available consumer technology can safely replace in-person outpatient physiotherapy after hip replacement, potentially improving access to rehabilitation for patients with transportation or mobility barriers.

Cost-Effectiveness Of Total Knee Replacement In Addition To Non-Surgical Treatment: A 2-Year Outcome From A Randomised Trial In Secondary Care In Denmark.

Skou St (2020) · Knee · PMID: 31948990

This Danish randomized trial of 100 adults with moderate-to-severe knee osteoarthritis compared immediate total knee replacement (TKR) combined with 12 weeks of supervised non-surgical treatment (exercise, education, diet, insoles, and pain medication) against supervised non-surgical treatment alone, with the option of delayed TKR if needed. While TKR plus non-surgical treatment produced greater quality-of-life gains (QALY improvement of 0.195 vs. 0.056) over 24 months, it was also substantially more expensive (€23,076 vs. €14,514). After adjusting for age, sex, and baseline values, the cost per QALY gained (€32,611) exceeded the accepted cost-effectiveness threshold of €22,665, with only a 23.2% probability of being cost-effective. These findings suggest that for patients with moderate pain, delaying TKR while pursuing non-surgical treatment first may be the more economically justifiable approach, though longer-term studies are needed to confirm this.

Therapeutic Alliance Facilitates Adherence To Physiotherapy-Led Exercise And Physical Activity For Older Adults With Knee Pain: A Longitudinal Qualitative Study.

Moore Aj (2020) · Knee · PMID: 31843425

This qualitative study explored the experiences of 30 older adults with knee osteoarthritis who participated in one of three physiotherapist-led exercise programs as part of the BEEP trial, with interviews conducted at the end of the program and again 12 months later. Regardless of how much supervision participants received, common barriers to staying active included lack of motivation, time constraints, and limited access to ongoing support. Notably, the quality of the relationship between the patient and their physiotherapist — called therapeutic alliance — emerged as a key factor in helping people maintain their exercise habits over time. These findings suggest that even well-designed, individualized exercise programs may not be enough on their own to sustain long-term adherence, and that investing in the patient-clinician relationship is a critical and potentially underutilized strategy. Clinicians treating knee osteoarthritis should consider ongoing relational support as an essential component of exercise prescription, not just the exercise itself.

Does Telephone-Delivered Exercise Advice And Support By Physiotherapists Improve Pain And/Or Function In People With Knee Osteoarthritis? Telecare Randomised Controlled Trial.

Hinman Rs (2020) · Knee · PMID: 31748198

This Australian randomized controlled trial (175 participants) compared a telephone-delivered physiotherapist-led exercise advice and support program (5–10 sessions focused on personalized strengthening and physical activity, with behavior change coaching) against a standard telephone nursing service for people with knee osteoarthritis. At 6 months, the physiotherapist-led program modestly improved physical function but did not significantly reduce overall knee pain, and 8 out of 14 secondary outcomes—including walking pain, pain self-efficacy, and patient satisfaction—favored the exercise intervention. Importantly, these functional gains were not maintained at 12 months, and the program cost approximately AUD $514 per participant without offsetting other healthcare costs. The high retention rate (94% at 6 months) supports the feasibility of telephone delivery, but the uncertain clinical significance of the modest, short-lived functional benefit raises questions about long-term value. Clinicians should consider telephone-based physiotherapist exercise support as a potentially accessible option for improving short-term function in knee osteoarthritis, while acknowledging that sustained benefit may require ongoing support strategies.

The Effects Of Preoperative Balance Training On Balance And Functional Outcome After Total Knee Replacement: A Randomized Controlled Trial.

Blasco Jm (2020) · Knee · PMID: 31608677

This three-arm randomized controlled trial (n=77, mean age 72 years, 68% women) compared four weeks of preoperative balance training — delivered either in a hospital outpatient setting or at home — against a control group receiving no structured exercise, in patients preparing for total knee replacement. Both the supervised (hospital) and unsupervised (home) exercise groups showed a moderate improvement in balance at six weeks after surgery compared to controls (effect sizes d=0.54 and d=0.63, respectively), with no meaningful difference between the two delivery formats. However, patient-perceived functional ability in daily activities (KOOS-ADL) did not differ significantly between groups, suggesting that balance gains did not directly translate into how patients felt about their functional recovery. Clinically, this is encouraging because it suggests that home-based balance training — which is more accessible and cost-effective — is just as beneficial as supervised outpatient training for improving early postoperative balance. Clinicians may consider recommending structured preoperative balance exercises in either format, while managing patient expectations that perceived daily function may not be immediately affected.

A Multi-Arm Cluster Randomized Clinical Trial Of The Use Of Knee Kinesiography In The Management Of Osteoarthritis Patients In A Primary Care Setting.

Cagnin A (2020) · Knee · PMID: 31573835

This 6-month cluster randomized trial (515 participants across 87 primary care clinics) compared standard medical care alone versus standard care enhanced by dynamic knee movement analysis (KneeKG) — a tool that measures biomechanical risk factors for osteoarthritis progression — with or without an added self-management education program. Patients who received the KneeKG assessment reported statistically significant improvements in knee pain, symptoms, and daily functioning (KOOS overall score improvement of ~5 points) compared to those receiving standard care alone, along with higher satisfaction with their overall care. The group that also received structured education and supervised follow-up sessions showed additional gains in objective physical function tests and greater self-reported improvements in pain, function, and quality of life. With a robust completion rate of 87%, these findings suggest that incorporating biomechanical knee assessment into primary care meaningfully improves patient outcomes beyond conventional management. Clinically, this supports the use of KneeKG as a practical decision-making aid for primary care physicians managing knee osteoarthritis, particularly when paired with patient education.

Hip Abductor Strength-Based Exercise Therapy In Treating Women With Moderate-To-Severe Knee Osteoarthritis: A Randomized Controlled Trial.

Wang J (2020) · Hip; knee · PMID: 31505954

This randomized controlled trial enrolled 82 women (ages 50–70) with moderate-to-severe knee osteoarthritis, comparing supervised hip abductor strengthening exercises against supervised quadriceps strengthening over six weeks, with follow-up at 12 weeks. Women in the hip abductor group reported significantly better physical function and experienced greater pain relief at six weeks compared to the quadriceps group, though the pain difference was no longer statistically significant by 12 weeks. Objective functional improvements were also seen in stair climbing and an agility walking test (Figure of 8 Walk), but not in the sit-to-stand test. These findings suggest that targeting the hip abductors—muscles that stabilize the pelvis and reduce stress on the knee joint—may offer clinicians a valuable addition or alternative to traditional quadriceps-focused rehabilitation for women with knee osteoarthritis. Clinically, this highlights the importance of considering the hip as part of knee osteoarthritis management, though larger and longer-term studies are needed to confirm these results.

Exercise Adherence: Beliefs Of Adults With Knee Osteoarthritis Over 2 Years.

Ledingham A (2020) · Knee · PMID: 30652930

This study explored why some adults with knee osteoarthritis stick with exercise long-term and others do not, as an ancillary investigation to a 2-year randomized controlled trial involving a home-based strength-training program preceded by a 6-week group exercise phase and automated telephone follow-up. Among the 25 participants interviewed in depth, three key themes emerged: the value of monitoring (by peers, instructors, and phone check-ins), having the knowledge to manage one's own exercise behavior, and believing in the benefits of exercise. Notably, participants who adhered well over two years demonstrated strong self-determination and self-efficacy, while those with poor adherence reported uncertainty about exercise benefits and a need for more social support. This suggests that for clinicians and physical therapists, simply prescribing exercise is not enough—understanding each patient's sense of autonomy, competence, and social connectedness is critical to fostering lasting exercise habits. Practically, these findings highlight the importance of personalized support strategies, including peer interaction and motivational check-ins, to improve long-term exercise adherence in knee osteoarthritis patients.

Feasibility And Preliminary Effects Of A Tele-Prehabilitation Program And An In-Person Prehablitation Program Compared To Usual Care For Total Hip Or Knee Arthroplasty Candidates: A Pilot Randomized Controlled Trial.

Doiron-Cadrin P (2020) · Hip; knee · PMID: 30638076

This pilot randomized controlled trial compared three approaches for patients waiting for hip or knee replacement surgery: supervised in-person exercise, supervised exercise via video conferencing (tele-prehabilitation), and usual care, enrolling 34 participants over a 12-week program. The study found no statistically significant differences between groups in pain, disability, or physical function outcomes, likely reflecting the small sample size rather than true equivalence. Notably, patients reported high satisfaction and strong compliance with the tele-prehabilitation program, suggesting that remote supervised exercise delivered via commercially available mobile technology is both safe and acceptable to this population. This is clinically relevant because long surgical wait times cause functional decline, and telerehabilitation could overcome common barriers such as distance, lack of transportation, and cost. The authors conclude that a larger, fully powered trial is needed to definitively evaluate whether tele-prehabilitation can match or exceed in-person or usual care outcomes.

Physiotherapists' Experiences With A Blended Osteoarthritis Intervention: A Mixed Methods Study.

Kloek Cjj (2020) · PMID: 29952687

This mixed methods study, embedded within an RCT, explored physiotherapists' experiences implementing e-Exercise — a 12-week blended program combining approximately five in-person sessions with a web-based app for hip/knee osteoarthritis patients. Of 123 physiotherapists assigned to deliver e-Exercise, only 54 recruited more than one patient, and just 10 continued using it after the study ended, suggesting low real-world uptake. Physiotherapists reported mixed experiences, citing concerns about appropriateness, added workload, professional autonomy, and financial implications as key barriers. Clinically, findings highlight that blended digital interventions require greater flexibility to meet individual patient needs and better training for physiotherapists on integrating online tools into practice.

A Consensus-Based Process Identifying Physical Therapy And Exercise Treatments For Patients With Degenerative Meniscal Tears And Knee Oa: The Tempo Physical Therapy Interventions And Home Exercise Program.

Safran-Norton Ce (2019) · Menisc; knee · PMID: 31684921

This paper describes how an interdisciplinary team of physical therapists, physicians, and researchers developed two standardized exercise programs for the TeMPO Trial, a clinical trial targeting patients with knee pain, degenerative meniscal tears, and co-existing osteoarthritis. The team used a consensus-based process guided by Medical Research Council frameworks to create: (1) a supervised, in-clinic physical therapy program including manual therapy, stretching, strengthening, and neuromuscular training, and (2) a structured home exercise program (HEP) designed to be completed independently without supervision, using minimal equipment. Notably, this paper does not report clinical outcomes or compare the effectiveness of these approaches — that comparison is the goal of the ongoing TeMPO Trial (NCT03059004). Clinicians should recognize this as a protocol and intervention-development paper, valuable for standardizing conservative care for this common and often undertreated condition. The published programs may serve as practical templates for both clinic-based and home-based care in this patient population.

Evaluating The Efficacy Of Internet-Based Exercise Programme Aimed At Treating Knee Osteoarthritis (Ibeat-Oa) In The Community: A Study Protocol For A Randomised Controlled Trial.

Gohir Sa (2019) · Knee · PMID: 31662373

The iBEAT-OA trial is a randomised controlled trial comparing a web-based exercise programme against standard GP care for people with knee osteoarthritis (OA), the world's most common joint disease. The internet-delivered programme, adapted from a well-validated Swedish physiotherapy protocol, asks participants to perform 20–30 minutes of muscle-strengthening exercises daily for six weeks, while the control group continues with routine GP-recommended care. With 67 participants in each group (134 total), the trial measures a broad range of outcomes including pain, physical function, sleep quality, muscle strength, ultrasound imaging, and biological biomarkers from blood, urine, stool, and joint fluid. The study addresses a critical gap: while exercise is one of the most effective non-drug treatments for knee OA, access to supervised physiotherapy is limited, making digitally delivered programmes a potentially scalable and cost-effective alternative. Results from this trial could meaningfully inform how exercise-based OA care is delivered in community settings, particularly within the UK's primary care system.

Exercise-Induced Pain Changes Associate With Changes In Muscle Perfusion In Knee Osteoarthritis: Exploratory Outcome Analyses Of A Randomised Controlled Trial.

Bandak E (2019) · Knee · PMID: 31656173

This randomized controlled trial compared 12 weeks of supervised exercise therapy (three sessions per week) against a no-treatment control group in 60 adults with knee osteoarthritis, with 33 participants completing the protocol and providing usable imaging data. The supervised exercise group showed a clinically meaningful improvement in self-reported knee pain (a difference of 10.7 points on the KOOS scale) compared to the control group, though no significant differences were found in muscle strength or physical function. Using a specialized MRI technique (DCE-MRI), researchers found that improvements in pain were significantly correlated with changes in blood flow (perfusion) to the muscles around the knee, suggesting a possible biological mechanism behind exercise-related pain relief. However, the study could not confirm that improved muscle perfusion directly caused the pain reduction, so the exact pathway remains unclear. For clinicians and patients, these findings reinforce the value of supervised exercise programs for knee osteoarthritis pain management while opening new directions for understanding why exercise works at a physiological level.

Application Of Heat And A Home Exercise Program For Pain And Function Levels In Patients With Knee Osteoarthritis: A Randomized Controlled Trial.

KaradaÄŸ S (2019) · Knee · PMID: 31436359

This Turkish randomized controlled trial compared four approaches in 62 patients with bilateral knee osteoarthritis over 4 weeks: heat application alone, home exercise alone, combined heat-then-exercise, and routine care only. All three intervention groups showed reductions in pain, stiffness, and physical function scores (measured by VAS and WOMAC) compared to the control group receiving routine treatment. The exercise-only group showed the greatest improvements across these measures, though the differences between intervention groups did not reach statistical significance, likely due to the small sample size of approximately 15 patients per group. Clinically, the findings suggest that simple, low-cost self-management strategies — particularly home exercise and heat application — are beneficial additions to routine osteoarthritis care. Nurses and clinicians are encouraged to educate and motivate patients to independently apply these accessible techniques at home.

Effectiveness Of Internet-Delivered Education And Home Exercise Supported By Behaviour Change Sms On Pain And Function For People With Knee Osteoarthritis: A Randomised Controlled Trial Protocol.

Nelligan Rk (2019) · Knee · PMID: 31351449

This randomized controlled trial (n=206 adults aged 45+) compared two internet-based approaches for managing knee osteoarthritis: an education-only website versus a combined intervention that added a structured 24-week home exercise program and behavior-change text message (SMS) support to the same educational content. The key question was whether guided, unsupervised home exercise — when paired with SMS reminders and motivation — could improve knee pain and physical function beyond education alone, addressing the well-known barrier of poor access to supervised exercise programs. Participants were followed for 24 weeks, with primary outcomes focusing on self-reported pain and function, and secondary outcomes including quality of life, physical activity levels, and self-efficacy. This trial is clinically relevant because it tests a scalable, low-cost digital model that could make evidence-based exercise treatment accessible to a much broader population of OA patients who cannot easily attend clinic-based programs. If effective, this approach could inform future guidelines and help bridge the significant gap between exercise recommendations and real-world adherence in knee OA management.

Digital Versus Conventional Rehabilitation After Total Hip Arthroplasty: A Single-Center, Parallel-Group Pilot Study.

Dias Correia F (2019) · Hip · PMID: 31228176

This pilot study compared an AI-powered digital home rehabilitation program against conventional supervised physiotherapy in 66 patients recovering from total hip replacement surgery over 6 months. Both approaches led to meaningful improvements in mobility, hip function, and quality of life, but patients using the digital system — which provided real-time biofeedback without requiring in-person supervision — showed superior results across most outcome measures, including faster Timed Up and Go scores (nearly 5 seconds faster at 6 months) and better hip range of motion. The digital group also maintained a strong retention rate of 86%, suggesting good patient engagement with the technology. While the study's pilot design and modest sample size (35 digital vs. 31 conventional) limit definitive conclusions, the findings suggest that AI-guided home rehabilitation may be a viable, potentially more effective, and less resource-intensive alternative to traditional supervised physiotherapy after hip replacement. For clinicians and health systems facing growing demand for arthroplasty care, this technology represents a promising direction for expanding access to high-quality rehabilitation.

Stepped Exercise Program For Patients With Knee Osteoarthritis (Step-Koa): Protocol For A Randomized Controlled Trial.

Allen Kd (2019) · Knee · PMID: 31138256

The STEP-KOA trial is a randomized controlled trial enrolling 345 veterans with knee osteoarthritis to test a stepped-care exercise program against a basic arthritis education control, using a 2:1 randomization ratio. The stepped program begins with an internet-based exercise platform, then escalates to telephone-based physical activity coaching, and finally to in-person physical therapy only for patients who do not show meaningful improvement at each prior stage — allowing higher-resource services to be reserved for those who truly need them. The primary outcome is pain and physical function measured by the WOMAC questionnaire at 9 months, with additional objective physical function tests and a cost-effectiveness analysis planned. This pragmatic, patient-centered model aims to address the well-documented underutilization of and limited access to exercise-based care for osteoarthritis, particularly within VA healthcare settings. If effective, STEP-KOA could offer a scalable and resource-efficient framework for managing one of the most common and disabling musculoskeletal conditions.

Implementing International Osteoarthritis Guidelines In Primary Care: Uptake And Fidelity Among Health Professionals And Patients.

Moseng T (2019) · PMID: 31075423

This stepped-wedge cluster-randomised trial (393 OA patients, 40 GPs, 37 physiotherapists across 6 Norwegian municipalities) tested whether a workshop-based strategy could improve uptake of guideline-recommended OA treatments—patient education, exercise, and weight management referral—in primary care. Patients in the intervention group were significantly more likely to receive these core treatments than controls. However, while attendance at physiotherapy sessions was high, exercise programs frequently lacked the recommended dose and progression, and patient adherence to exercise over time remained low. These findings highlight a critical implementation gap: delivering access to care is achievable, but ensuring exercise quality and long-term adherence requires additional support strategies. Clinicians should be aware that guideline implementation alone may not guarantee optimal exercise delivery for OA patients.

Effect Of 6-Week Retro Or Forward Walking Program On Pain, Functional Disability, Quadriceps Muscle Strength, And Performance In Individuals With Knee Osteoarthritis: A Randomized Controlled Trial (Retro-Walking Trial).

Alghadir Ah (2019) · Knee · PMID: 30967128

This 6-week randomized controlled trial (n=68, mean age 55.6 years) compared supervised retro walking (walking backwards), forward walking, and a standard physiotherapy control program in patients with knee osteoarthritis. All walking groups added 10 minutes of supervised walking three times per week to their usual care. The key finding was that retro walking produced significantly greater improvements than the control group across all outcomes: pain reduction (1.8 vs. 1.0 points on a numerical rating scale), functional disability (WOMAC score change: 4.8 vs. 2.2), quadriceps strength (1.7 vs. 0.7 kg), and mobility (Timed Up and Go test: 0.6 vs. 0.1 seconds). Clinically, these results suggest that incorporating just 10 minutes of supervised backward walking into standard knee OA rehabilitation may offer meaningful advantages over conventional exercise alone, though the modest sample size and supervised setting warrant caution when generalizing to unsupervised home-based programs.

Twenty-Four-Week Hospital-Based Progressive Resistance Training On Functional Recovery In Female Patients Post Total Knee Arthroplasty.

Hsu Wh (2019) · Knee · PMID: 30902510

This randomized controlled trial compared 24 weeks of supervised, hospital-based progressive resistance training against a control group (no structured exercise) in 29 female patients who had undergone total knee replacement surgery. Starting three months after surgery, the supervised training group showed significantly greater improvements in both knee extensor and flexor muscle strength, as measured by an isokinetic dynamometer, compared to those who did not receive structured training. Patients in the supervised group also walked farther in the six-minute walk test and reported better scores in daily living activities and sports-related function on the KOOS questionnaire. Although the sample size was small (14 in the exercise group, 15 in the control group), the findings suggest that structured, supervised resistance training offers meaningful functional benefits beyond standard post-operative care. Clinicians should consider recommending a formal, progressive resistance training program beginning around three months post-surgery to optimize recovery in female knee replacement patients.

The Effect Of A 12 Week Prehabilitation Program On Pain And Function For Patients Undergoing Total Knee Arthroplasty: A Prospective Controlled Study.

Aytekin E (2019) · Knee · PMID: 30828206

This prospective controlled study examined whether a 12-week home-based exercise and education program before total knee replacement (TKA) improved pain and function compared to surgery alone, enrolling patients with severe knee osteoarthritis who had not responded to conservative treatment. Both groups showed significant improvements in pain (measured by VAS) and knee function (measured by KOOS) at 3 and 6 months after surgery, but there were no statistically significant differences between the prehabilitation and control groups at either time point. Notably, approximately 20% of patients in the prehabilitation group decided to postpone or cancel their surgery after completing the exercise program, suggesting meaningful clinical benefit beyond the primary outcome measures. While prehabilitation did not demonstrate superiority over surgery alone in post-operative outcomes, this finding highlights its potential value as a conservative management strategy that may help some patients delay or avoid surgery altogether. Clinicians should consider offering structured prehabilitation programs not only to optimize surgical outcomes but also as a meaningful therapeutic trial that may reduce the need for early surgical intervention.

Medium-Term Outcomes Of Digital Versus Conventional Home-Based Rehabilitation After Total Knee Arthroplasty: Prospective, Parallel-Group Feasibility Study.

Correia Fd (2019) · Knee · PMID: 30816849

This feasibility study compared two home-based rehabilitation programs in 59 patients recovering from total knee replacement surgery: a conventional face-to-face physiotherapy program versus a digital program using AI-powered motion tracking, a mobile app, and remote clinical monitoring. Both approaches produced meaningful clinical improvements over 6 months, but patients in the digital intervention group consistently showed superior outcomes, including better mobility scores (Timed Up and Go), improved knee function across all quality-of-life subscales (KOOS), and greater knee range of motion. The digital group also demonstrated strong engagement, with an 82% retention rate and high satisfaction levels throughout the 8-week active treatment phase. Importantly, the digital program achieved these results with significantly fewer demands on healthcare personnel, suggesting it could be a scalable, cost-effective solution as knee replacement rates continue to rise. While the relatively small sample size limits definitive conclusions, these findings support further investigation of AI-assisted digital rehabilitation as a viable and potentially superior alternative to conventional home-based physiotherapy after knee replacement.

Effectiveness Of Later-Stage Exercise Programs Vs Usual Medical Care On Physical Function And Activity After Total Knee Replacement: A Randomized Clinical Trial.

Piva Sr (2019) · Knee · PMID: 30794296

This three-arm randomized trial of 240 adults (average age 70) who had undergone total knee replacement compared clinic-based physical therapy, community-based group exercise, and usual care over 12 weeks of supervised exercise starting more than two months after surgery. On the primary outcome — self-reported physical function (WOMAC-PF) — neither supervised exercise program outperformed usual care at three months, suggesting that late-stage structured exercise offers no clear advantage for patient-perceived function. However, performance-based physical tests (such as walking and functional tasks) showed significantly greater improvement in the physical therapy group compared to both community exercise and usual care, and community exercise also outperformed usual care on these objective measures. Additionally, more patients in the physical therapy group achieved clinically meaningful improvements ("responders") compared to the other two groups. Clinically, these findings suggest that while patients tend to improve regardless of intervention, supervised clinic-based physical therapy may still offer meaningful benefits in objective physical performance after total knee replacement, warranting further investigation.

2018 John N. Insall Award: Recovery Of Knee Flexion With Unsupervised Home Exercise Is Not Inferior To Outpatient Physical Therapy After Tka: A Randomized Trial.

Fleischman An (2019) · Knee · PMID: 30794229

This randomized controlled trial of 290 patients compared three rehabilitation approaches after total knee replacement (TKA): supervised outpatient physical therapy, unsupervised home exercise using a web-based program, and unsupervised home exercise using a printed manual. The key finding was that both home-based approaches were non-inferior to formal outpatient PT in recovering knee bending (flexion) at 4–6 weeks and 6 months after surgery, with all three groups achieving similar improvements in knee function and return to daily activities. Importantly, a safety net was built in, requiring patients to transition to outpatient PT if their knee flexion fell below defined thresholds at 2 and 4 weeks post-surgery. With 290 participants across three arms, this Level I evidence suggests that carefully selected TKA patients with adequate clinical support can rehabilitate effectively at home, potentially reducing costs and inconvenience. Clinicians should consider individualized rehabilitation planning rather than routinely referring all TKA patients to outpatient PT.

Incremental Clinical Effectiveness And Cost Effectiveness Of Providing Supervised Physiotherapy In Addition To Usual Medical Care In Patients With Osteoarthritis Of The Hip Or Knee: 2-Year Results Of The Moa Randomised Controlled Trial.

Abbott Jh (2019) · Hip; knee · PMID: 30553932

This randomized controlled trial (the MOA trial) compared usual medical care alone versus usual care plus supervised exercise physiotherapy, manual physiotherapy, or a combination of both in 206 adults with hip or knee osteoarthritis, following participants for two years. The key finding was that individually supervised exercise physiotherapy was the standout approach: it produced clinically meaningful improvements in pain and function (a 28.2-point improvement on the WOMAC scale compared to usual care alone) and was both cost-saving and cost-effective from health system and societal perspectives. Manual physiotherapy also showed cost savings over usual care, but did not produce statistically significant clinical improvements on its own. With 90% of participants retained at two years and no serious adverse events, the results are robust and reassuring for clinical practice. The clear take-home message for clinicians and patients is that a structured, supervised exercise program—even with just 10 sessions plus periodic booster visits—offers lasting, meaningful benefits beyond standard medical management for hip and knee osteoarthritis.

Fall Risk And Utilization Of Balance Training For Adults With Symptomatic Knee Osteoarthritis: Secondary Analysis From A Randomized Clinical Trial.

Anderson Ml (2019) · Knee · PMID: 30407270

This secondary analysis from the PATH-IN randomized clinical trial examined fall risk and the use of balance training in 344 adults with knee osteoarthritis (KOA), who were assigned to physical therapy (PT), an internet-based exercise program, or a control group. Notably, over one-third of all participants (35.5%) were identified as being at high risk for falling based on standardized balance and mobility tests. While 62.7% of PT participants received balance training at least once, one-third of those specifically identified as high fall risk did not receive any balance training during their PT sessions. These findings suggest that balance training may be underutilized in clinical practice for KOA patients who need it most. Clinicians treating patients with KOA should routinely screen for fall risk and prioritize balance training as part of the rehabilitation plan when that risk is identified.

Comparison Of Effectiveness Of The Home Exercise Program And The Home Exercise Program Taught By Physiotherapist In Knee Osteoarthritis.

Yilmaz M (2019) · Knee · PMID: 30248040

This randomized controlled trial of 80 patients with knee osteoarthritis compared two approaches to home exercise: receiving a written brochure from an orthopedic doctor versus being taught and guided by a physiotherapist. Both groups showed meaningful improvements in pain (VAS), knee range of motion, muscle strength, and quality of life (WOMAC and SF-36) after treatment. However, the physiotherapist-guided group achieved significantly better outcomes across all measures compared to the brochure-only group. These findings highlight that while unsupervised home exercise is beneficial, physiotherapist instruction adds clinically important value for patients with knee osteoarthritis. Clinicians should consider incorporating physiotherapist-led exercise instruction into standard care pathways rather than relying solely on written materials.

Is Four-Week Underwater Treadmill Exercise Regimen Compared To Home Exercise Efficacious For Pain Relief And Functional Improvement In Obese Patients With Knee Osteoarthritis? A Randomized Controlled Trial.

Kuptniratsaikul V (2019) · Knee · PMID: 30064262

This randomized controlled trial compared four weeks of supervised underwater treadmill exercise (three sessions per week) against daily home-based quadriceps exercises in 80 obese patients with painful knee osteoarthritis. Both groups showed significant improvements in pain, walking distance, and quadriceps strength by the end of the study, but there were no statistically significant differences between the two approaches on any objective outcome measure. Notably, patients in the underwater treadmill group reported significantly greater satisfaction and perceived global improvement compared to the home exercise group, despite equivalent measurable results. Neither intervention produced meaningful weight loss over the four-week period. Clinically, these findings suggest that for obese patients with mild-to-moderate knee osteoarthritis, a structured home exercise program is a cost-effective alternative to supervised aquatic therapy, though patient preference and satisfaction may favor the supervised setting.

"I Was Really Pleasantly Surprised": Firsthand Experience And Shifts In Physical Therapist Perceptions Of Telephone-Delivered Exercise Therapy For Knee Osteoarthritis-A Qualitative Study.

Lawford Bj (2019) · Knee · PMID: 29885026

This qualitative study explored how eight physiotherapists perceived telephone-delivered exercise therapy for knee osteoarthritis, before and after delivering it within an RCT. Initially skeptical—particularly about the lack of physical contact—physiotherapists reported that telephone-delivered care exceeded their expectations, with patients showing improvements in pain, function, and self-management confidence. The findings suggest that hands-on experience with non-traditional delivery models may be essential for clinician adoption, and that training in communication skills and supplementary written resources are important implementation considerations.

The Effect Of Prehabilitation On Postoperative Outcome In Patients Following Primary Total Knee Arthroplasty.

Jahic D (2018) · Knee · PMID: 30814777

This small randomized controlled trial (n=20) compared a 6-week home-based prehabilitation exercise program against no prehabilitation in patients aged 48–70 undergoing total knee replacement for end-stage osteoarthritis. Patients who completed the preoperative exercise program showed significantly better Knee Scores both immediately before surgery and up to 6 months postoperatively, suggesting that structured exercise before surgery can meaningfully accelerate early recovery. However, by 12 months after surgery, both groups reached similar outcomes, indicating that prehabilitation may speed up recovery rather than change the long-term endpoint. Functional scores showed less consistent benefit from prehabilitation, with no significant between-group differences in the postoperative period. Clinicians should note that while these findings are encouraging, the very small sample size limits the strength of conclusions, and larger trials are needed to confirm whether home-based prehabilitation should become standard pre-surgical care for knee replacement patients.

Cost-Utility Analysis Of Interventions To Improve Effectiveness Of Exercise Therapy For Adults With Knee Osteoarthritis: The Beep Trial.

Kigozi J (2018) · Knee · PMID: 30506022

The BEEP Trial compared usual physical therapy care (UC) with two enhanced exercise interventions for knee osteoarthritis—individually tailored exercise (ITE) and targeted exercise adherence (TEA)—over 18 months in a UK NHS setting. Enhanced interventions involved greater supervision, individualization, and focus on long-term exercise adherence, but resulted in higher NHS costs without meaningful improvements in quality-adjusted life years (QALYs) compared to usual care. Usual physical therapy care was the most cost-effective option, with less than a 40% probability that either enhanced intervention offered value at the standard UK threshold of £20,000 per QALY. The higher costs in the enhanced groups were driven by intervention delivery, more NHS consultant visits, and increased rates of knee surgery. Clinically, these findings suggest that adding intensive supervision and individualization to standard exercise therapy for knee OA does not provide sufficient additional benefit to justify the extra cost, at least within a UK healthcare context.

The Tempo Trial (Treatment Of Meniscal Tears In Osteoarthritis): Rationale And Design Features For A Four Arm Randomized Controlled Clinical Trial.

Sullivan Jk (2018) · Menisc · PMID: 30501629

The TeMPO (Treatment of Meniscal Tears in Osteoarthritis) Trial is a four-arm randomized controlled trial designed to compare different physical therapy approaches for people with knee osteoarthritis accompanied by meniscal tears, a combination affecting millions of Americans. The trial compares two clinic-based (supervised) physical therapy programs — one focused on strengthening and one serving as a placebo control — against two structured home exercise programs (unsupervised). While previous trials have compared physical therapy to surgery in this population, TeMPO is notable for being the first to rigorously evaluate physical therapy alone across multiple supervision levels. The multi-center design strengthens the generalizability of findings across different clinical settings. Results from this trial have important clinical relevance, as they could help clinicians and patients make more informed decisions about whether supervised in-clinic therapy offers meaningful advantages over guided home exercise for this common and disabling condition.

Evaluation Of A Digital Platform For Osteoarthritis Treatment: Study Protocol For A Randomised Clinical Study.

Nero H (2018) · PMID: 30413507

This randomized clinical trial (n=270) from Sweden compares two approaches to managing knee osteoarthritis: a traditional supervised face-to-face exercise and education program (BOA) versus a digital, largely unsupervised equivalent called Joint Academy, delivered over 3 months. The study addresses a critical gap, as only about 20% of people with knee or hip OA currently receive guideline-recommended care involving exercise, education, and weight management. The primary outcome measure is functional performance assessed by the 30-second chair stand test at 3, 6, and 12 months, allowing evaluation of both short- and longer-term effects. While observational data suggest the digital program is promising for reducing pain and improving function, this rigorous RCT design is intended to provide higher-quality evidence on whether remote, unsupervised digital delivery can match the outcomes of in-person supervised care. The findings will be clinically relevant for healthcare systems seeking scalable, cost-effective OA management solutions, particularly where access to face-to-face physiotherapy is limited.

Comparative Impact Of Nonpharmacological Interventions On Pain Of Knee Osteoarthritis Patients Reporting At A Tertiary Care Institution: A Randomized Controlled Trial.

Sharma M (2018) · Knee · PMID: 30410261

This randomized controlled trial involving 123 adults (ages 40–65) with mild to moderate knee osteoarthritis compared two packages of non-drug treatments: one group received supervised exercises including kinesthesia, balance, and agility (KBA) training plus meditation alongside weight loss advice and weekly phone check-ins, while the other group received the same program without the KBA and meditation components. Both groups showed meaningful reductions in pain (VAS scores dropped by roughly 3.6–3.8 points) and overall symptom burden (WOMAC scores), with nearly half of all participants achieving complete pain relief at some point during the intervention. Importantly, there was no significant difference between the two groups in pain or overall function, suggesting that the addition of supervised KBA and meditation did not provide extra benefit for most outcomes. The one exception was the 50-Foot Walk Test at 12 months, where the supervised exercise group performed slightly better, hinting at a possible long-term functional advantage. Clinically, this study reinforces that structured non-pharmacological programs—even without specialized supervised components—can meaningfully reduce knee osteoarthritis symptoms, though further research is needed to clarify the role of supervision in long-term physical performance.

Multicentred Randomised Controlled Trial Of An Augmented Exercise Referral Scheme Using Web-Based Behavioural Support In Individuals With Metabolic, Musculoskeletal And Mental Health Conditions: Protocol For The E-Coacher Trial.

Ingram W (2018) · PMID: 30244214

This multicenter RCT (the E-COACHER trial) compared a standard primary care exercise referral scheme (ERS) alone against the same ERS augmented with web-based behavioural support (using the LifeGuide platform) in low-active adults with chronic conditions including obesity, diabetes, hypertension, osteoarthritis, or depression. The trial planned to recruit 413 participants, with the primary outcome being minutes of moderate-to-vigorous physical activity per week measured by accelerometer at 12 months. The web-based component aimed to help patients overcome barriers to exercise uptake and long-term adherence, areas where standard ERS programmes have shown limited effectiveness. A clinically meaningful target difference of 36–39 additional minutes of MVPA per week was pre-specified. Results from this trial could inform how digital behavioural tools can be integrated into primary care to support sustained physical activity in people living with chronic conditions.

Improving Physical Activity, Pain And Function In Patients Waiting For Hip And Knee Arthroplasty By Combining Targeted Exercise Training With Behaviour Change Counselling: Study Protocol For A Randomised Controlled Trial.

O'brien J (2018) · Hip; knee · PMID: 30086780

The ENHANCE trial is an Australian randomized controlled trial comparing a 12-week combined exercise and behavior change counseling program against usual care in patients waiting for hip or knee joint replacement surgery. The intervention includes individualized exercises alongside up to five in-person counseling sessions, written materials, and encouragement for self-monitoring and social support, targeting both physical activity and long-term self-management skills. Key outcomes include daily step count, sedentary time, pain, physical function, and markers of cardiovascular and metabolic disease risk, assessed at baseline, 26 weeks into the program, and 26 weeks after surgery. This study addresses an important gap in preoperative osteoarthritis care, recognizing that patients on waiting lists often become increasingly inactive, raising their risk for secondary chronic diseases. The findings could provide clinicians with evidence-based guidance on whether integrating behavioral counseling with exercise meaningfully improves activity levels and health outcomes in this vulnerable population.

The Effect Of Education And Supervised Exercise On Physical Activity, Pain, Quality Of Life And Self-Efficacy - An Intervention Study With A Reference Group.

JÃ¶nsson T (2018) · PMID: 30037339

This Swedish study compared 195 adults with knee or hip osteoarthritis who received a structured education and supervised exercise program (based on the BOA protocol) against 69 patients awaiting joint replacement who received standard care. Supervised exercise did not increase overall physical activity levels or reduce sedentary time as measured by accelerometers over 3 months. However, the supervised program produced meaningful and statistically significant improvements in pain, quality of life, and self-efficacy compared to the reference group, with these benefits persisting at 12 months. These findings suggest that while supervised exercise may not change movement behavior in objective terms, it offers clinically important relief from pain and improved wellbeing for osteoarthritis patients. Clinicians should set realistic expectations around activity levels but can confidently recommend structured exercise-education programs for symptom management.

Level Of Participation In Physical Therapy Or An Internet-Based Exercise Training Program: Associations With Outcomes For Patients With Knee Osteoarthritis.

Pignato M (2018) · Knee · PMID: 30025540

This study compared supervised physical therapy (PT) versus an internet-based exercise training (IBET) program in 259 patients with knee osteoarthritis, examining whether the amount of participation influenced outcomes. Patients who attended more PT sessions (up to 8 visits) showed significantly greater improvements in overall osteoarthritis symptoms and physical function, with some of these benefits persisting 8 months after treatment ended. In contrast, how frequently patients accessed the internet-based program made no measurable difference in any outcome at either follow-up point. These findings suggest that the supervised, in-person nature of physical therapy — not just exercise itself — plays a meaningful role in driving clinical improvement for knee osteoarthritis. Clinically, this supports policies that prioritize adequate PT visit allowances, as a dose-response relationship between supervision and outcomes was clearly demonstrated.

Effects Of Internet-Based Pain Coping Skills Training Before Home Exercise For Individuals With Hip Osteoarthritis (Hope Trial): A Randomised Controlled Trial.

Bennell Kl (2018) · Hip · PMID: 29794609

This randomized controlled trial (n=144) investigated whether an 8-week internet-based pain coping skills training (PCST) program delivered before a physiotherapist-guided home exercise program would improve outcomes for people with hip osteoarthritis, compared to online education alone followed by the same exercise program. At the primary endpoint of 24 weeks, both groups showed clinically meaningful improvements in hip pain during walking and physical function (measured by WOMAC), but there were no significant differences between the two groups, meaning the addition of PCST did not provide extra benefit once exercise began. Notably, the PCST group showed early advantages at 8 weeks in physical function, pain coping, and global improvement, and improved pain coping skills were sustained through 52 weeks. For clinicians, this suggests that while online PCST is a safe and accessible tool that can accelerate early functional gains and build lasting coping skills, it does not appear to enhance the well-established benefits of a structured home exercise program for hip osteoarthritis. Patients can be reassured that a physiotherapist-guided exercise program alone produces meaningful improvements, though those who struggle with pain-related distress may still benefit from incorporating pain coping strategies early in their care.

Effectiveness Of A Blended Physical Therapist Intervention In People With Hip Osteoarthritis, Knee Osteoarthritis, Or Both: A Cluster-Randomized Controlled Trial.

Kloek Cjj (2018) · Hip; knee · PMID: 29788253

This cluster-randomized controlled trial compared a blended digital-physical therapy intervention (e-Exercise) to standard physical therapy in 208 adults aged 40–80 with hip and/or knee osteoarthritis across 143 primary care practices. The e-Exercise program combined approximately 5 face-to-face sessions with an online app featuring graded activity, exercises, and educational content, while the usual care group received an average of 12 in-person sessions. Both groups showed meaningful improvements in physical functioning, pain, fatigue, quality of life, and self-efficacy over 3 and 12 months, with no significant differences between them. Notably, the e-Exercise group showed a concerning increase in sedentary behavior at 12 months compared to the usual care group, despite self-reporting more physical activity at 3 months. Clinically, these findings suggest that a blended approach using roughly half the face-to-face sessions can achieve comparable outcomes to standard care, offering a potentially more efficient and accessible model, though monitoring for increased sedentary behavior remains important.

[Knee School As AÂ Secondary Preventive Approach : The Sustainable Treatment Of Occupational Gonarthrosis].

Dalichau S (2018) · Knee · PMID: 29725705

This study compared three approaches to maintaining the benefits of knee rehabilitation in 292 male construction workers with occupational knee osteoarthritis: supervised fitness center training (n=178), an unsupervised home exercise program (n=38), and no continued exercise (n=76), over 12 months following an initial 3-week intensive knee school program. Workers who continued with financially supported, supervised fitness center training maintained and even improved their mobility, muscle strength, knee pain, and quality of life throughout the follow-up period. Those who followed an unsupervised home program experienced moderate decline in most measures except muscle strength, while those who stopped exercising entirely showed significant deterioration, falling below their pre-rehabilitation baseline. These findings highlight that structured, supervised exercise with ongoing motivational telephone contact is superior to home-based programs and far better than no aftercare at all. Clinically, this suggests that funding supervised gym-based exercise as part of occupational rehabilitation aftercare for knee osteoarthritis offers meaningful long-term benefits for physically demanding workers.

Efficacy Of A Community-Based Technology-Enabled Physical Activity Counseling Program For People With Knee Osteoarthritis: Proof-Of-Concept Study.

Li Lc (2018) · Knee · PMID: 29712630

This proof-of-concept randomized controlled trial (n=61) tested a technology-enabled physical activity counseling program for people with knee osteoarthritis, comparing those who received the intervention immediately versus those who waited two months before receiving the same program. The intervention combined brief physical therapist education, a Fitbit activity tracker, and four biweekly phone-based counseling sessions. Participants who received the program showed significant improvements in moderate-to-vigorous physical activity, daily step counts (approximately 1,700 more steps per day), activities of daily living, and quality of life compared to the delayed group. Notably, delaying the intervention by two months did not cause measurable harm to outcomes, suggesting the program remained effective regardless of when it was started. These findings are clinically relevant because they demonstrate that a relatively low-intensity, scalable, community-based program can meaningfully increase physical activity in a population where up to 90% are insufficiently active, supporting its potential as a practical first-line treatment tool for knee osteoarthritis self-management.

Effectiveness Of A New Model Of Primary Care Management On Knee Pain And Function In Patients With Knee Osteoarthritis: Protocol For The Partner Study.

Hunter Dj (2018) · Knee · PMID: 29712564

The PARTNER study is a cluster randomised controlled trial conducted across 44 general practices in Australia, recruiting 572 patients aged 45+ with persistent knee osteoarthritis pain. It compares a new structured care model — where GPs receive specialised training and patients are referred to a multidisciplinary Care Support Team providing behaviour change support, exercise programs, and weight management — against usual GP care. The primary outcomes are changes in knee pain and physical function at 12 months. This study addresses a critical gap between clinical guidelines and real-world primary care practice for osteoarthritis management, which remains largely undertreated. Results may inform how primary care systems can be redesigned to better deliver evidence-based, non-surgical osteoarthritis care at scale.

Efficacy Of A Biomechanically-Based Yoga Exercise Program In Knee Osteoarthritis: A Randomized Controlled Trial.

Kuntz Ab (2018) · Knee · PMID: 29664955

This randomized controlled trial compared a specially designed biomechanically-based yoga exercise program, traditional leg-strengthening exercises, and a no-exercise meditation control across 31 women with knee osteoarthritis over 12 weeks, with all three groups receiving supervised, structured sessions three times per week. The yoga exercise group showed statistically significant and clinically meaningful improvements in knee pain and self-reported physical function compared to the no-exercise group, while traditional exercise and yoga produced broadly similar results — though yoga showed a trend toward greater pain and function improvements. Traditional exercise did produce superior gains in knee flexor strength compared to yoga. Importantly, neither exercise group was left unsupervised, meaning this study does not directly address the supervised versus non-supervised exercise question; instead, it highlights that a low-joint-stress yoga program is a viable, well-tolerated alternative to conventional strengthening for women with knee osteoarthritis. Clinicians should note that the small sample size (n=31) limits definitive conclusions, and larger trials are needed to confirm whether biomechanically-adapted yoga offers advantages over traditional exercise.

Effects Of Nurse-Led Lower Extremity Strength Training On Knee Function Recovery In Patients Who Underwent Total Knee Replacement.

Lin Yh (2018) · Knee · PMID: 29603823

This randomized controlled trial compared nurse-led lower extremity strength training (begun before surgery) against usual care in 200 patients undergoing total knee replacement for knee osteoarthritis (100 per group). Both groups experienced a temporary decline in knee function and quality of life at two weeks post-surgery, but both recovered progressively over the following months. Importantly, patients who received structured strength training recovered their knee function and quality of life earlier and to a greater extent than those receiving standard care alone, as measured by the Knee Injury and Osteoarthritis Outcome Score at multiple follow-up points over three months. These findings suggest that starting supervised lower extremity exercise before surgery and continuing it as a home-based routine after discharge provides meaningful clinical benefits. Clinicians should consider incorporating presurgical exercise education and post-discharge strength training plans into standard care pathways for total knee replacement patients.

Improvement In Gait Pattern After Knee Arthroplasty Followed By Proprioceptive Neuromuscular Facilitation Physiotherapy.

Jaczewska-Bogacka J (2018) · Knee · PMID: 29594754

This study compared supervised, therapist-led rehabilitation using Proprioceptive Neuromuscular Facilitation (PNF) techniques against standard home-based exercise instructions in 56 patients (28 per group) recovering from total knee replacement surgery due to osteoarthritis. Patients in the supervised PNF group received 10 sessions of 75 minutes each over three weeks, while the control group was sent home with self-directed exercise guidance. The key finding was that the supervised PNF program produced meaningful and lasting improvements in how patients walked — including faster gait speed, better step length, more normal movement timing, and reduced pain — measured at one and six months after surgery. These benefits were significantly greater than those seen in the home-exercise group, suggesting that structured, hands-on physiotherapy supervision makes a clinically important difference in recovery quality. For clinicians, this highlights that investing in professionally supervised post-surgical rehabilitation, rather than relying solely on home programs, may substantially improve functional outcomes and patient well-being after knee arthroplasty.

Improved Early Outcome After Tka Through An App-Based Active Muscle Training Programme-A Randomized-Controlled Trial.

Hardt S (2018) · PMID: 29589050

This randomized controlled trial of 60 patients (average age ~66 years) compared standard postoperative care after total knee replacement (TKA) against standard care plus an app-based, feedback-guided muscle training program performed multiple times daily. Patients who used the app completed an average of 18.4 training sessions and showed significantly better outcomes, including greater range of motion, reduced pain at rest and during movement, improved strength, and higher scores on functional assessments such as the Timed Up and Go and the KOOS. Importantly, a dose-response relationship was observed — patients who trained more frequently achieved better results. These findings suggest that a structured, app-guided home exercise program can meaningfully accelerate early recovery after knee replacement. Clinically, this approach may serve as a practical, patient-driven alternative to continuous passive motion devices traditionally used in post-TKA rehabilitation.

"I Was Really Sceptical...But It Worked Really Well": A Qualitative Study Of Patient Perceptions Of Telephone-Delivered Exercise Therapy By Physiotherapists For People With Knee Osteoarthritis.

Lawford Bj (2018) · Knee · PMID: 29572130

This qualitative study, embedded within a randomised controlled trial, explored how 20 people with knee osteoarthritis experienced exercise therapy delivered by physiotherapists over the telephone across a 6-month period. Although participants were initially sceptical about receiving care without face-to-face contact, most reported positive experiences, highlighting the convenience, accessibility, and the sense of focused attention they received from their physiotherapist. Participants felt confident exercising without direct supervision and reported meaningful benefits including reduced pain, improved strength, and better ability to perform daily tasks. Some patients expressed a preference for video-conferencing or an initial in-person visit to complement telephone sessions, suggesting a hybrid model may be optimal. Overall, telephone-delivered physiotherapy appears to be a clinically acceptable and accessible option for people with knee osteoarthritis, particularly for follow-up care, though it is best viewed as a complement to rather than a full replacement for in-person services.

Formal Physical Therapy May Not Be Necessary After Unicompartmental Knee Arthroplasty: A Randomized Clinical Trial.

Fillingham Ya (2018) · Knee · PMID: 29555497

This randomized clinical trial of 52 patients compared formal outpatient physical therapy (PT) to an unsupervised home exercise program following unicompartmental knee arthroplasty (UKA), a partial knee replacement commonly performed for osteoarthritis affecting one side of the knee. After 6 weeks, there were no significant differences between the two groups in knee range of motion, functional scores, or quality of life measures, suggesting that most patients can safely recover at home without supervised PT. Notably, two patients who initially attempted home exercises but switched to formal PT within the first two weeks ultimately required a procedure under anesthesia to restore knee movement, indicating that a small subset of patients may still benefit from professional supervision. These findings are clinically relevant because unsupervised home exercise programs may reduce healthcare costs and patient burden without compromising outcomes for the majority of UKA patients. Clinicians should consider monitoring early recovery closely to identify the minority of patients who may need formal PT intervention.

A Randomized Controlled Trial On Maximal Strength Training In 60 Patients Undergoing Total Hip Arthroplasty.

Winther Sb (2018) · Hip · PMID: 29493347

This randomized controlled trial of 60 total hip replacement (THA) patients compared high-intensity supervised maximal strength training (MST) — performed at 85–90% of maximum effort in leg press and hip abduction exercises — against conventional physiotherapy (CP) involving lower-load exercises, over 3 months of post-surgical rehabilitation. The key finding was that patients in the MST group were significantly stronger in both leg press and hip abduction at 3 and 6 months after surgery (43 kg and 3 kg stronger, respectively, at 3 months), though these differences disappeared by 12 months. With 27 patients completing each group, the study was relatively small but demonstrated that high-intensity strength training is safe, well-tolerated, and feasible within standard clinical practice for THA patients. Importantly, no significant differences were found between groups in pain, walking ability, or patient-reported hip function scores at any time point. Clinically, this suggests that supervised high-intensity strength training may offer a meaningful short-to-medium term advantage in muscle recovery after hip replacement, and should be considered as a viable rehabilitation option within routine physiotherapy services.

Dose-Response Effects Of Tai Chi And Physical Therapy Exercise Interventions In Symptomatic Knee Osteoarthritis.

Lee Ac (2018) · Knee · PMID: 29407226

This randomized trial compared two 12-week exercise programs — Tai Chi and supervised physical therapy — in 182 adults with symptomatic knee osteoarthritis, examining how the amount of exercise (dose) relates to improvements in pain and function. Both programs produced steady, roughly equal improvements with each additional week of participation, reducing WOMAC pain scores by 9–11 points and improving function by 32–41 points per attendance-week, with no significant difference between the two approaches. Clinically meaningful improvements (≥20%) in pain and function began emerging within just 2 weeks, while more substantial improvements (≥50%) were typically achieved by 4–5 weeks. Importantly, patients who believed exercise would benefit them responded faster in terms of functional improvement, highlighting the role of patient expectations in treatment outcomes. These findings suggest that clinicians can reassure patients that meaningful relief may come quickly regardless of which exercise approach is chosen, and that addressing patients' beliefs about exercise benefits may help optimize results.

Pain And Functional Trajectories In Symptomatic Knee Osteoarthritis Over Up To 12 Weeks Of Exercise Exposure.

Lee Ac (2018) · Knee · PMID: 29391277

This study followed 171 adults with knee osteoarthritis (average age 61, mostly women) through 12 weeks of either Tai Chi or Physical Therapy to understand why patients respond differently to exercise treatment. Researchers identified four distinct patterns of pain improvement: about 43% experienced early improvement from a lower pain baseline, 32% showed moderate early improvement, 15% had higher pain but eventually improved with a delay, and 10% with high pain showed no meaningful improvement. Patients who started with worse pain, physical disability, and poorer mental health were more likely to fall into the slower-responding or non-responding groups. Importantly, most participants did benefit from exercise regardless of the type, but those with greater baseline burden may need longer treatment timelines or additional support to achieve meaningful gains. These findings are clinically relevant because they help providers set realistic expectations, identify patients who may need more intensive or prolonged care, and move toward more personalized management of knee osteoarthritis.

Physical Therapy Vs Internet-Based Exercise Training For Patients With Knee Osteoarthritis: Results Of A Randomized Controlled Trial.

Allen Kd (2018) · Knee · PMID: 29307722

This randomized controlled trial of 350 adults with knee osteoarthritis compared supervised physical therapy (up to 8 visits over 4 months), an internet-based exercise training program with video guidance, and a wait-list control group. Neither the supervised physical therapy nor the internet-based program produced statistically significant improvements in pain, stiffness, or function (measured by the WOMAC score) compared to simply waiting for treatment, at either 4 or 12 months. Importantly, the internet-based program performed similarly to in-person physical therapy, meeting criteria for non-inferiority at both time points. These findings raise important questions about the overall effectiveness of current exercise-based approaches for knee osteoarthritis, regardless of whether they are delivered in-person or digitally. Clinicians and patients should consider that while exercise remains recommended, optimizing how these programs are designed and delivered may be necessary to achieve meaningful clinical benefits.

One Year Effectiveness Of Neuromuscular Exercise Compared With Instruction In Analgesic Use On Knee Function In Patients With Early Knee Osteoarthritis: The Exerpharma Randomized Trial.

Holsgaard-Larsen A (2018) · Knee · PMID: 29107059

This 12-month randomized controlled trial compared 8 weeks of supervised neuromuscular exercise (NEMEX) against instruction in optimized analgesic use (acetaminophen/NSAIDs) in 93 patients with mild-to-moderate knee osteoarthritis. While both groups showed improvements over time, there was no statistically significant difference between groups in the primary outcome of daily activity function (e.g., walking, stair climbing). However, NEMEX demonstrated a meaningful advantage for knee symptom relief, with nearly half of exercise participants reporting clinically relevant improvements (≥10 points on a standardized scale). Notably, compliance was low in both groups—only 49% of exercise participants attended the recommended number of sessions, and just 7% of the medication group adhered to their prescribed regimen. Clinicians should consider that neuromuscular exercise offers a meaningful benefit for symptom management in early knee osteoarthritis, even when full adherence is not achieved.

A Randomized Trial Of A Motivational Interviewing Intervention To Increase Lifestyle Physical Activity And Improve Self-Reported Function In Adults With Arthritis.

Gilbert Al (2018) · PMID: 29096934

This randomized controlled trial compared a motivational interviewing (MI)-based lifestyle physical activity program against a standard physician recommendation alone in 340 adults with either knee osteoarthritis (KOA, n=155) or rheumatoid arthritis (RA, n=185). Participants in the intervention group received four MI counseling sessions over 12 months focused on personalized physical activity goal-setting, in addition to the brief physician advice given to all participants. Among those with KOA, the intervention produced modest but statistically significant improvements in self-reported physical function (WOMAC difference of 2.21 points) and a trend toward reduced pain, though no significant changes in objectively measured physical activity were detected. No meaningful benefits were observed for RA participants, suggesting the approach may be more suited to KOA than inflammatory arthritis. While the functional gains in KOA were small and their clinical significance remains uncertain, these findings support the potential value of structured behavioral counseling as an adjunct to physician advice, while highlighting the need for further refinement to achieve more robust outcomes.

Exercise Induced Effects On Muscle Function And Range Of Motion In Patients With Hip Osteoarthritis.

Bieler T (2018) · Hip · PMID: 28971551

This randomized controlled trial compared three exercise approaches in 152 adults aged 60+ with hip osteoarthritis: physiotherapist-supervised strength training, physiotherapist-supervised Nordic Walking, and unsupervised home-based exercise, over 4 months with follow-up at 12 months. The key finding was that there were no significant differences between the three groups in muscle strength, muscle power, or hip range of motion at any time point, meaning supervised exercise did not clearly outperform unsupervised home exercise. All three approaches produced some improvements in range of motion, while short-term strength gains were seen in the supervised groups and longer-term power improvements were noted in the Nordic Walking group. Clinically, these results challenge the assumption that professional supervision is necessary to achieve meaningful physical improvements in hip osteoarthritis patients who are not yet awaiting joint replacement. Importantly, the findings suggest that disability reduction in this population may not depend solely on gains in muscle strength or joint mobility, which has practical implications for how we deliver and prescribe exercise care.

Randomized Controlled Trial Of Maximal Strength Training Vs. Standard Rehabilitation Following Total Knee Arthroplasty.

Husby Vs (2018) · Knee · PMID: 28901118

This randomized controlled trial of 41 adults under 75 years old compared supervised maximal strength training (MST) three times per week against standard home-based rehabilitation following total knee replacement surgery. The supervised MST group achieved striking muscle strength gains, exceeding their own pre-surgery levels by 37–43% in leg press and knee extension at 10 weeks, significantly outperforming the standard rehabilitation group, and these strength advantages persisted at 12 months. However, both groups recovered similarly on a real-world walking test (6-Minute Walk Test) by 12 months, suggesting that superior strength gains did not clearly translate into measurable functional walking differences. The relatively small sample size (41 participants) warrants cautious interpretation, though the strength findings are clinically meaningful. The key clinical takeaway is that post-knee replacement exercise should be high-intensity and specifically target the operated leg to maximize strength recovery.

Efficacy Of Tele-Rehabilitation Compared With Office-Based Physical Therapy In Patients With Knee Osteoarthritis: A Randomized Clinical Trial.

Azma K (2018) · Knee · PMID: 28771070

This randomized clinical trial compared 6 weeks of supervised office-based physical therapy (OBPT) to home-based tele-rehabilitation (tele-rehab) in 54 patients (average age 58 years, 60% female) with symptomatic knee osteoarthritis. Both groups showed substantial improvements in pain and function, with KOOS scores rising from approximately 50 at baseline to around 82–83 at 6 months post-intervention. Crucially, there was no statistically significant difference between the two approaches on any outcome measure, including the KOOS and WOMAC scales. These findings suggest that remote, unsupervised home exercise delivered via tele-rehab is equally effective as in-person supervised therapy for knee osteoarthritis. Given the lower cost, reduced travel burden, and comparable outcomes, tele-rehabilitation may be a particularly valuable option for older patients and those living in remote or underserved areas.

A Pilot Randomised Clinical Trial Of Physiotherapy (Manual Therapy, Exercise, And Education) For Early-Onset Hip Osteoarthritis Post-Hip Arthroscopy.

Kemp J (2018) · Hip · PMID: 28694995

This small pilot trial (17 participants) tested the feasibility of a structured physiotherapy program — combining manual therapy, hip strengthening exercises, and health education — compared to health education alone in patients with early hip osteoarthritis following hip arthroscopy. While the study was not powered to detect statistically significant between-group differences, patients in the physiotherapy group showed modest improvements in pain and daily function on validated hip outcome scores, whereas the education-only control group showed little to no improvement or slight decline. Notably, participants and researchers identified greater exercise supervision and more frequent physiotherapy appointments as key factors that could improve outcomes in future studies. The trial demonstrated strong feasibility with 100% adherence and no dropouts, supporting the rationale for a larger definitive RCT requiring approximately 142 participants. These findings are clinically relevant as they highlight the potential value of supervised, multimodal physiotherapy rehabilitation after hip arthroscopy, a procedure whose post-operative care remains poorly supported by high-quality evidence.

In-Home Versus Hospital Preoperative Balance And Proprioceptive Training In Patients Undergoing Tkr; Rationale, Design, And Method Of A Randomized Controlled Trial.

Blasco Jm (2017) · PMID: 29221471

This randomized controlled trial compared three groups of patients with severe knee osteoarthritis awaiting total knee replacement (TKR): those receiving supervised hospital-based balance and proprioceptive training, those performing the same training independently at home, and a non-active control group, enrolling 75 participants total. The 4-week preoperative training program aimed to determine whether improving balance and proprioception before surgery could enhance short- and medium-term outcomes, with follow-up assessments at 2 weeks, 6 weeks, and 1 year after surgery. Primary outcomes included self-reported knee function (KOOS) and overall balance (Berg Balance Scale), with secondary measures covering pain, static and dynamic balance, and quality of life. A key clinical question was whether home-based training could be as effective as supervised hospital training, which would have significant implications for reducing healthcare costs and improving patient access. The findings are intended to guide clinicians on whether preoperative balance training is cost-effective enough to implement routinely before TKR surgery.

Effectiveness Of An Interactive Telerehabilitation System With Home-Based Exercise Training In Patients After Total Hip Or Knee Replacement: Study Protocol For A Multicenter, Superiority, No-Blinded Randomized Controlled Trial.

Eichler S (2017) · Hip; knee · PMID: 28934966

This multicenter randomized controlled trial compared a supervised, interactive telerehabilitation home exercise program against usual care (unsupervised voluntary aftercare) in 110 patients recovering from total hip or knee replacement surgery. Following a 3-week inpatient rehabilitation stay, the intervention group used a technology-based system where physiotherapists assigned individualized strength and balance exercises, monitored training quality and frequency remotely, and could communicate directly with patients over 3 months. The primary measure of success was improvement in 6-minute walk distance, with additional outcomes including mobility tests, quality of life, pain, and movement analysis. The study hypothesized that structured, remotely supervised home exercise would produce superior functional outcomes compared to unstructured usual care, with results potentially expanding access to rehabilitation in underserved or geographically remote areas. For clinicians and patients, this trial addresses the critical gap between inpatient rehabilitation discharge and long-term functional recovery, testing whether digital supervision can substitute for in-person aftercare.

The Efficacy Of Peloid Therapy In Management Of Hand Osteoarthritis: A Pilot Study.

KasapoÄŸlu Aksoy M (2017) · Hand · PMID: 28779304

This small randomized controlled pilot study (n=63) compared peloid (therapeutic mud) therapy combined with a home exercise program versus home exercise alone in patients with hand osteoarthritis. Over 10 sessions across two weeks, the peloid therapy group showed statistically significant improvements in pain (VAS), hand function (AUSCAN), quality of life (HAQ), grip strength, and pinch strength at both 2 and 6 weeks. The control group showed only limited improvements in grip strength and AUSCAN scores. Crucially, direct comparisons between groups favored peloid therapy across all measured outcomes at both time points. While results are encouraging, the small sample size and pilot nature of this study mean findings should be interpreted cautiously and require confirmation in larger trials before broad clinical adoption.

Determinants Of Adherence To The Online Component Of A Blended Intervention For Patients With Hip And/Or Knee Osteoarthritis: A Mixed Methods Study Embedded In The E-Exercise Trial.

De Vries Hj (2017) · Hip; knee · PMID: 28525310

This mixed-methods study examined what factors influenced 90 patients with hip or knee osteoarthritis to complete the online component of e-Exercise, a 12-week blended physiotherapy and web-based program. Over 81% of participants completed at least 8 of 12 weekly online evaluations. Better adherence was associated with middle education level, 1–5 years of osteoarthritis duration, and being recruited directly by a physiotherapist. Qualitative interviews identified internet skills, self-discipline, usability, and the program's flexible design as key drivers of engagement. These findings suggest that integrating online tools within physiotherapy practice and designing user-friendly digital interventions can meaningfully support patient adherence.

Supervised Or Unsupervised Rehabilitation After Total Hip Replacement Provides Similar Improvements For Patients: A Randomized Controlled Trial.

Coulter C (2017) · Hip · PMID: 28506775

This randomized controlled trial compared supervised outpatient physiotherapy (4 weeks, center-based) versus unsupervised home-based exercise using written and illustrated instructions in 98 adults recovering from total hip replacement surgery, followed for 6 months. Across all outcome measures — including pain and function (WOMAC), quality of life (SF-36), activity level, and mobility (Timed Up and Go test) — there were no clinically or statistically significant differences between the two groups. These findings suggest that for low-risk patients discharged home after hip replacement, a structured home exercise program is just as effective as attending supervised outpatient rehabilitation. This has important practical implications, as home-based programs may reduce healthcare costs and improve patient convenience without compromising recovery outcomes. Clinicians should note, however, that this study did not evaluate later-stage rehabilitation, so conclusions are limited to the early postoperative recovery period.

Randomized Controlled Trial Investigating The Role Of Exercise In The Workplace To Improve Work Ability, Performance, And Patient-Reported Symptoms Among Older Workers With Osteoarthritis.

Chopp-Hurley Jn (2017) · PMID: 28379878

This 12-week randomized controlled trial compared a supervised workplace exercise program against no exercise in 24 older university employees diagnosed with knee and/or hip osteoarthritis. Participants who completed the exercise program showed significant improvements in work ability, pain, physical function, and depressive symptoms, while those in the no-exercise group showed no meaningful changes. Although the sample size was small (24 participants), the findings suggest that structured exercise delivered in the workplace setting can meaningfully benefit workers with osteoarthritis across both occupational and health-related outcomes. These results are clinically relevant as they highlight the workplace as a practical and accessible setting for delivering therapeutic exercise, potentially improving both quality of life and productivity. Larger trials with attention to exercise adherence are needed to confirm and extend these promising findings.

An Evidence-Based Walking Program Among Older People With Knee Osteoarthritis: The Pep (Participant Exercise Preference) Pilot Randomized Controlled Trial.

Loew L (2017) · Knee · PMID: 28332010

This 9-month pilot RCT (n=69 older adults with knee osteoarthritis) compared supervised community-based walking with unsupervised walking, while also testing whether matching participants to their preferred program improved adherence. The key finding was that participants who received their preferred exercise format—whether supervised or unsupervised—showed significantly higher adherence to walking sessions at 6 months (supervised: ~61%; unsupervised: ~43%) compared to those who did not get their preferred option. Those who adhered and received their preferred program also demonstrated meaningful improvements in joint stiffness (WOMAC) and physical function (Timed Up and Go Test) at 9 months. Clinically, this suggests that incorporating patient exercise preferences into prescription decisions may be a practical strategy to sustain long-term physical activity in older adults with knee osteoarthritis. Rather than prescribing a one-size-fits-all approach, clinicians should consider discussing supervision preferences with patients to maximize engagement and therapeutic benefit.

Dynamic Balance Training Improves Physical Function In Individuals With Knee Osteoarthritis: A Pilot Randomized Controlled Trial.

Takacs J (2017) · Knee · PMID: 28279661

This pilot randomized controlled trial compared a 10-week partially supervised dynamic balance and strength training program (4 sessions per week) against no intervention in 40 adults with medial knee osteoarthritis. The exercise group showed significant improvements in self-reported knee pain, physical function, and fear of movement compared to the control group, with high adherence (82.2% of home sessions completed). Interestingly, no significant changes were detected in objective measures of dynamic balance using the Community Balance and Mobility Scale, suggesting that patient-reported outcomes may respond to exercise before measurable biomechanical changes occur. With only 36 participants completing the study, these findings should be interpreted cautiously as preliminary evidence. Clinically, this program appears feasible and beneficial for managing knee OA symptoms, though larger trials are needed to confirm these results and better understand the relationship between exercise, objective balance, and patient-reported outcomes.

Effectiveness Of An Internet-Delivered Exercise And Pain-Coping Skills Training Intervention For Persons With Chronic Knee Pain: A Randomized Trial.

Bennell Kl (2017) · Knee · PMID: 28241215

This Australian randomized controlled trial compared internet-delivered physiotherapist-guided exercise combined with pain-coping skills training against educational materials alone in 148 adults aged 50 and older with chronic knee pain. Over 3 months, participants receiving the supervised internet intervention — which included 7 videoconferencing sessions with a physiotherapist — reported significantly greater reductions in walking pain (1.6 points on an 11-point scale) and improved physical function compared to the control group. Importantly, these gains were maintained at 9 months, suggesting durable benefits well beyond the active treatment period. The intervention also improved secondary outcomes including quality of life, self-efficacy, and pain catastrophizing. These findings are clinically relevant because they demonstrate that remotely supervised exercise with psychological support can deliver meaningful results for osteoarthritis patients without requiring in-person clinic visits, potentially expanding access to effective care at a population level.

Effect Of Total Knee Replacement Surgery And Postoperative 12 Month Home Exercise Program On Gait Parameters.

HeikkilÃ¤ A (2017) · Knee · PMID: 28119232

This randomized controlled trial compared a 12-month progressive home exercise program (starting two months after surgery) to usual care in 108 patients who underwent total knee replacement, with the goal of understanding how structured exercise affects walking ability. Patients who followed the home exercise program showed significantly greater improvements in walking speed, cadence (steps per minute), and stance time compared to those receiving usual care alone. While most gait measurements improved in both groups, the exercise program produced the most meaningful gains in patients who started with the poorest walking performance, suggesting it may be especially beneficial for those most functionally limited. The study is noteworthy for demonstrating that even a home-based (non-supervised) exercise program can yield clinically relevant improvements in gait, though clinicians should note that overall average changes were modest. These findings highlight the importance of encouraging structured postoperative exercise after knee replacement, particularly for patients with low baseline functional capacity.

The Effects Of Therapeutic Exercises On Pain, Muscle Strength, Functional Capacity, Balance And Hemodynamic Parameters In Knee Osteoarthritis Patients: A Randomized Controlled Study Of Supervised Versus Home Exercises.

Kuru Ã‡olak T (2017) · Knee · PMID: 28078435

This randomized controlled trial compared a 6-week supervised group exercise program (performed in a clinic with a physiotherapist) versus a home-based exercise program in 78 adults with knee osteoarthritis, of whom 56 completed the study. Both approaches significantly reduced resting pain and improved walking capacity (measured by the 6-minute walk test), suggesting that even unsupervised exercise provides meaningful benefit. However, supervised exercise proved superior in reducing post-activity pain and improving quadriceps and hamstring muscle strength, and only the supervised group showed meaningful improvements in balance. Clinicians should note that while home exercise is a viable option—particularly for patients with limited access to supervised care—structured, therapist-led group exercise delivers greater gains across multiple clinically important outcomes in knee osteoarthritis management.

Post-Acute Rehabilitation After Total Knee Replacement: A Multicenter Randomized Clinical Trial Comparing Long-Term Outcomes.

Fransen M (2017) · Knee · PMID: 27868384

This multicenter randomized clinical trial from Australia compared a supervised group exercise program with usual care in 422 patients (ages 45–75) recovering from total knee replacement surgery for osteoarthritis, following them for 12 months. Both groups showed meaningful improvements in knee pain and ability to perform daily activities, but there were no significant differences between supervised exercise and usual care on any of the main or secondary outcomes at 12 months. Approximately 70% of patients in both groups were considered treatment responders, and most reached normal population levels for self-reported pain and quality of life by one year. However, a clinically important finding is that significant deficits in physical performance measures—such as strength, stair climbing, and walking speed—persisted in both groups at 12 months, suggesting that current rehabilitation approaches may be insufficient to fully restore physical function. These results indicate that routine referral to a supervised post-acute group exercise program may not provide additional long-term benefit over usual care, but highlight an ongoing need to address physical performance gaps after knee replacement.

Chair Yoga: Feasibility And Sustainability Study With Older Community-Dwelling Adults With Osteoarthritis.

Mccaffrey R (2017) · PMID: 27782922

This feasibility study tested an 8-week chair yoga program for older adults with osteoarthritis, comparing participation in a supervised group setting versus unsupervised home practice using a guidebook. The key finding was that participants did not continue yoga practice independently at home once the group sessions ended, highlighting that supervision and social group dynamics are critical for maintaining exercise adherence in this population. The study was designed as a randomized controlled trial, though its primary goal was to assess feasibility rather than measure clinical outcomes. For clinicians and patients, this finding has important practical implications: simply providing a home exercise resource is unlikely to sustain physical activity in older adults with osteoarthritis without ongoing structured, group-based support.

Effects Of High- And Low-Velocity Resistance Training On Gait Kinematics And Kinetics In Individuals With Hip Osteoarthritis: A Randomized Controlled Trial.

Fukumoto Y (2017) · Hip · PMID: 27754998

This randomized controlled trial compared two home-based resistance training programs — one performed at high velocity and one at low velocity — in 46 women with hip osteoarthritis over 8 weeks. Both training approaches improved muscle strength and overall hip function (Harris Hip Score), suggesting that either speed of exercise can benefit patients. However, the training velocity appeared to matter for specific outcomes: high-velocity training uniquely improved walking speed, cadence, and muscle power, while low-velocity training specifically improved stride length, hip extension during walking, and pain reduction. These findings suggest that clinicians should consider tailoring exercise velocity to the specific functional goals of each patient — for example, prioritizing high-velocity training for patients whose main concern is walking speed, and low-velocity training for those focused on pain relief and gait quality. Notably, both programs were home-based, highlighting that meaningful improvements in hip osteoarthritis can be achieved without formal supervised gym settings.

Efficacy Of Tailored Exercise Therapy On Physical Functioning In Patients With Knee Osteoarthritis And Comorbidity: A Randomized Controlled Trial.

De Rooij M (2017) · Knee · PMID: 27563831

This randomized controlled trial of 126 patients with knee osteoarthritis and serious comorbidities (such as heart disease, type 2 diabetes, COPD, or obesity) compared a 20-week tailored exercise program—combining aerobic training, strength training, and daily activity practice—against standard medical care alone. Patients who received the supervised, individualized exercise program showed statistically and clinically meaningful improvements in physical functioning, with a 33% improvement in self-reported function (WOMAC scale) and a 15% improvement in walking capacity (6-minute walk test) sustained at 3 months after treatment ended. Importantly, no serious adverse events occurred, demonstrating that supervised exercise is safe even in this higher-risk patient population. These findings are clinically relevant because they challenge the common assumption that comorbidities should limit exercise participation in osteoarthritis patients. Clinicians should consider tailored, supervised exercise therapy as an effective and safe treatment option for knee OA patients, even those with significant coexisting medical conditions.

Exercise Therapy In Patients With Hip Osteoarthritis: Effect On Hip Muscle Strength And Safety Aspects Of Exercise-Results Of A Randomized Controlled Trial.

Steinhilber B (2017) · Hip · PMID: 27486681

This randomized controlled trial of 210 patients with hip osteoarthritis compared a structured 12-week exercise program (THÜKo, combining weekly supervised group sessions with twice-weekly home exercises) against a placebo ultrasound treatment and a no-treatment control group. The exercise program significantly improved hip muscle strength across all measured directions (abduction, adduction, flexion, and extension) compared to both control groups, with statistically meaningful differences in peak torque. Adherence to the program was excellent at approximately 90%, and importantly, no participants had to stop exercising due to injury or serious adverse events, with any exercise-related pain being only temporary. These findings suggest that a combined supervised-plus-home exercise approach is both effective and safe for strengthening hip muscles in osteoarthritis patients, making it a clinically viable option for this population.

In Hip Osteoarthritis, Nordic Walking Is Superior To Strength Training And Home-Based Exercise For Improving Function.

Bieler T (2017) · Hip · PMID: 27129607

This randomized controlled trial enrolled 152 adults aged 60+ with hip osteoarthritis to compare four months of supervised Nordic Walking (NW) in a park, supervised strength training (ST) in a fitness center, or unsupervised home-based exercise (HBE) as a control. All three groups showed similar improvements in the primary outcome (chair stand test) at four months, but Nordic Walking produced significantly greater gains in overall functional performance—including stair climbing and six-minute walk distance—at all measurement points compared to both strength training and home exercise. At the 12-month follow-up, Nordic Walking participants maintained superior functional gains over the strength training group, suggesting longer-lasting benefits. Nordic Walking also outperformed the other approaches in boosting vigorous physical activity levels and mental health-related quality of life. These findings suggest that supervised Nordic Walking should be the preferred exercise recommendation for older adults with hip osteoarthritis who are not awaiting joint replacement.

Telephone Coaching To Enhance A Home-Based Physical Activity Program For Knee Osteoarthritis: A Randomized Clinical Trial.

Bennell Kl (2017) · Knee · PMID: 27111441

This randomized trial of 168 adults aged 50 and older with knee osteoarthritis compared a physiotherapist-prescribed home exercise program alone versus the same program supplemented with 6–12 telephone coaching sessions focused on behavioral support for physical activity. At 6 months, both groups showed clinically meaningful improvements in pain and physical function, but adding telephone coaching did not produce significantly greater benefits in these primary outcomes. Some secondary measures related to physical activity behavior slightly favored the coaching group at 6 months, but these advantages largely disappeared by 12 and 18 months. With strong retention rates (76–85% follow-up) and an intent-to-treat analysis, the findings suggest that a well-structured physiotherapy home program on its own is sufficient to deliver meaningful clinical benefit, and telephone coaching may not justify the additional resource investment for improving pain and function in knee osteoarthritis.

Comparison Of Group-Based Outpatient Physiotherapy With Usual Care After Total Knee Replacement: A Feasibility Study For A Randomized Controlled Trial.

Artz N (2017) · Knee · PMID: 27068368

This feasibility study compared group-based outpatient physiotherapy (six supervised exercise sessions) against standard postoperative care in 46 patients who had undergone total knee replacement surgery. The key finding was that supervised group physiotherapy appeared beneficial, with patients in the supervised group scoring notably higher on a functional leg scale at six months (57.8 vs. 45.0 out of 80) compared to those receiving usual care. Attendance was high at 73%, and 84% of supervised participants reported being "very satisfied" with the program, suggesting this approach is both acceptable and feasible for patients. The study successfully demonstrated that a full-scale trial is achievable, estimating that 256 participants would be needed to draw definitive conclusions about effectiveness. Clinically, these results suggest that structured, supervised group exercise after knee replacement may meaningfully improve functional recovery compared to standard care alone.

The Efficacy Of Early Initiated, Supervised, Progressive Resistance Training Compared To Unsupervised, Home-Based Exercise After Unicompartmental Knee Arthroplasty: A Single-Blinded Randomized Controlled Trial.

JÃ¸rgensen Pb (2017) · Knee · PMID: 27029938

This randomized controlled trial of 55 patients compared two rehabilitation approaches after unicompartmental knee replacement (a partial knee surgery for osteoarthritis): a supervised progressive resistance training program (twice weekly at hospital plus home exercise five days/week) versus unsupervised home-based exercise alone (seven days/week). At the primary endpoint of 10 weeks and at one-year follow-up, both groups showed improvements in leg strength, walking speed, and patient-reported knee outcomes (KOOS), but there were no statistically significant differences between the two groups on any measure. Notably, adherence to supervised sessions was modest, with patients attending an average of only 11 out of 16 scheduled sessions. These findings suggest that adding supervised resistance training twice weekly does not provide meaningful additional benefit over a structured home exercise program alone following partial knee replacement. Clinically, this implies that well-designed home-based rehabilitation may be a sufficient and more accessible option for appropriate patients recovering from this procedure.

Effects Of A Tele-Prehabilitation Program Or An In-Person Prehabilitation Program In Surgical Candidates Awaiting Total Hip Or Knee Arthroplasty: Protocol Of A Pilot Single Blind Randomized Controlled Trial.

Doiron-Cadrin P (2016) · Hip; knee · PMID: 29736482

This pilot randomized controlled trial compared three approaches for patients waiting for hip or knee replacement surgery: a 12-week in-person supervised exercise and education program, the same program delivered via telerehabilitation (video technology), and usual care (standard hospital documentation only). With 36 participants divided equally across three groups, the study examined whether structured prehabilitation before surgery could improve lower limb function, quality of life, and physical performance, using the Lower Extremity Functional Scale as the primary outcome. Both supervised programs—whether delivered in-person or remotely—were designed to provide identical exercise and education content, making this one of the first studies to directly compare telerehabilitation against face-to-face prehabilitation in this patient population. The clinical relevance is significant, as long surgical wait times can lead to physical decline, and demonstrating that remote supervision is as effective as in-person care could greatly improve access to prehabilitation for patients in underserved or geographically distant areas. As a pilot study, its primary goal was to establish feasibility and inform the design of larger, more definitive trials.

A Comparative Study To Determine Functional And Clinical Outcome Differences Between Patients Receiving Outpatient Direct Physical Therapy Versus Home Physical Therapy Followed By Outpatient Physical Therapy After Total Knee Arthroplasty.

Warren M (2016) · Knee · PMID: 27851675

This retrospective study of 109 patients compared two rehabilitation pathways after total knee replacement: going directly to outpatient physical therapy (PT) after hospital discharge versus receiving home-based PT first before transitioning to outpatient PT. After accounting for demographic differences between groups, both pathways produced similar improvements in walking ability, knee range of motion, and patient-reported knee function at the end of rehabilitation. Notably, patients who went directly to outpatient PT completed their rehabilitation approximately 20 days sooner, although the total number of outpatient visits and time spent in outpatient PT were comparable between groups. These findings suggest that both care pathways are clinically effective, and that the choice between home health and direct outpatient PT may reasonably be guided by individual patient needs and circumstances rather than expected outcomes. Clinicians can reassure patients that functional gains are achievable regardless of the initial post-discharge rehabilitation setting, though direct outpatient PT may offer a faster overall recovery timeline.

Community-Based Rehabilitation After Knee Arthroplasty (Corka): Study Protocol For A Randomised Controlled Trial.

Barker Kl (2016) · Knee · PMID: 27737685

The CORKA trial is a randomized controlled trial comparing a tailored, community-based multidisciplinary rehabilitation program against usual care for patients at high risk of poor outcomes following knee replacement surgery. The study uses a specially developed algorithm to identify and enroll 620 patients predicted to do least well after surgery, ensuring rehabilitation resources are directed where they are most needed. The primary measure of success is functional ability and disability at one year post-surgery, with additional assessments of knee function, quality of life, physical activity, and cost-effectiveness. This trial is particularly relevant given that up to 15% of knee replacement patients fail to achieve satisfactory outcomes, and growing numbers of older, frailer patients are undergoing this procedure with limited physiotherapy resources available. The findings could reshape how post-surgical rehabilitation is prioritized and delivered in community settings, moving toward a more individualized, needs-based model of care.

Exercise Therapy Versus Arthroscopic Partial Meniscectomy For Degenerative Meniscal Tear In Middle Aged Patients: Randomised Controlled Trial With Two Year Follow-Up.

Kise Nj (2016) · Menisc · PMID: 27440192

This Norwegian randomized controlled trial compared 12 weeks of supervised exercise therapy against arthroscopic partial meniscectomy (keyhole surgery) in 140 middle-aged adults (average age ~50) with degenerative meniscal tears but no significant arthritis. After two years, both groups showed similar improvements in knee pain, function, and quality of life, with no clinically meaningful difference between treatments (less than 1 point on a 100-point scale). Notably, exercise therapy produced greater short-term improvements in thigh muscle strength compared to surgery, and no serious adverse events occurred in either group. Although 19% of patients in the exercise group eventually crossed over to surgery, they gained no additional benefit from doing so. These findings strongly suggest that supervised exercise therapy should be the first-line treatment for middle-aged patients with degenerative meniscal tears, reserving surgery for those who do not respond adequately.

Significant Improvements In Pain After A Six-Week Physiotherapist-Led Exercise And Education Intervention, In Patients With Osteoarthritis Awaiting Arthroplasty, In South Africa: A Randomised Controlled Trial.

Saw Mm (2016) · PMID: 27233479

This South African randomised controlled trial compared a six-week physiotherapist-led group program (combining exercise, education, and relaxation for two hours per week) against usual care in 74 patients with hip or knee osteoarthritis waiting years for joint replacement surgery. The supervised intervention group showed significantly greater reductions in both pain severity and pain interference compared to the control group, with moderate-to-large effect sizes that were sustained at six months follow-up. Over half of participants (53%) also personally reported that the program improved their pain in open-ended feedback. These findings are clinically meaningful because they demonstrate that a structured, supervised exercise and education intervention can provide durable pain relief for patients facing prolonged surgical waiting lists, particularly in low-resource healthcare settings. This type of program warrants broader implementation as a standard component of pre-operative osteoarthritis management while patients await arthroplasty.

Comparative Effectiveness Of Tai Chi Versus Physical Therapy For Knee Osteoarthritis: A Randomized Trial.

Wang C (2016) · Knee · PMID: 27183035

This randomized trial of 204 adults with knee osteoarthritis (mean age 60 years, 70% women) compared 12 weeks of supervised Tai Chi twice weekly against a standard physical therapy program consisting of 6 weeks of supervised sessions followed by 6 weeks of monitored home exercise. Both groups experienced substantial and clinically meaningful reductions in pain and disability scores (WOMAC), with no statistically significant difference between treatments at 12 weeks, and benefits were maintained through one year of follow-up. Notably, the Tai Chi group showed significantly greater improvements in depression symptoms and physical quality of life compared to the physical therapy group. These findings suggest that Tai Chi is a viable, equally effective alternative to conventional physical therapy for managing knee osteoarthritis symptoms, which is clinically relevant for patients who may prefer a mind-body approach or have limited access to traditional therapy services. No serious adverse events were reported in either group, supporting the safety of Tai Chi as a therapeutic option.

One-Year Results Of Voluntary-Based Supervised Exercise Or Treatment At Orthopedic Clinic For Radiographic Severe Knee Osteoarthritis.

Miyagawa H (2016) · Knee · PMID: 27134382

This study compared one year of supervised physical exercise against conventional orthopedic clinic treatment in 66 patients with severe radiographic knee osteoarthritis, with 43 participants completing the full follow-up. While neither group showed significant improvement over time on standardized measures of knee function and pain disability, patients in the supervised exercise group consistently reported better overall outcomes than those receiving standard clinical care. Notably, these benefits were observed despite the presence of severe structural joint damage, suggesting that exercise supervision may help patients manage symptoms even when X-ray findings are advanced. The high dropout rate (23 out of 66) limits the strength of these conclusions, but the findings support the clinical value of structured, supervised exercise programs as a viable alternative or complement to conventional orthopedic management for knee osteoarthritis.

Effectiveness And Efficiency Of An 11-Week Exercise Intervention For Patients With Hip Or Knee Osteoarthritis: A Protocol For A Controlled Study In The Context Of Health Services Research.

Krauss I (2016) · Hip; knee · PMID: 27129849

This large controlled study (n=1,400) examined an 11-week exercise program combining 8 supervised group sessions with twice-weekly home exercises for patients with hip or knee osteoarthritis, comparing participants enrolled in a national health insurance exercise program against matched controls from insurance records. The intervention included mobilization, strengthening, and balance training, with primary outcomes measuring pain and physical function using the validated WOMAC Index immediately after the program. Researchers also tracked health-related quality of life, self-efficacy, cost-effectiveness, and safety over a follow-up period extending to 24 months. The study is notable for its large, real-world sample size and its evaluation of both clinical and economic outcomes, addressing an important gap in understanding how supervised and home-based exercise can be practically integrated into routine osteoarthritis care. Findings from this trial have the potential to meaningfully shape future guidelines for delivering exercise therapy—both in group and home settings—as a first-line, cost-effective treatment for osteoarthritis.

Movement-Pattern Training To Improve Function In People With Chronic Hip Joint Pain: A Feasibility Randomized Clinical Trial.

Harris-Hayes M (2016) · Hip · PMID: 27117727

This feasibility trial compared a supervised Movement-Pattern Training (MPT) program against a wait-list control (no treatment) in 35 patients with chronic hip joint pain, to determine whether a larger full-scale trial would be practical. The MPT program consisted of 6 supervised one-hour sessions focusing on functional movement tasks and hip muscle strengthening. Retention and adherence were strong in both groups, with 89% of MPT participants attending at least 80% of sessions and 89% reporting daily home exercise compliance, suggesting the design is viable for a larger study. Early secondary outcome data on patient-reported hip function, movement quality, and muscle strength showed promising trends in favor of MPT, supporting the rationale for a definitive trial. While no firm conclusions about effectiveness can be drawn from this small feasibility study, the results indicate that a properly powered randomized trial comparing supervised movement training to no treatment for chronic hip pain is both feasible and warranted.

Theory-Driven Group-Based Complex Intervention To Support Self-Management Of Osteoarthritis And Low Back Pain In Primary Care Physiotherapy: Protocol For A Cluster Randomised Controlled Feasibility Trial (Solas).

Hurley Da (2016) · PMID: 26801470

This study (SOLAS) tested a group-based education and exercise program designed to help patients with osteoarthritis (OA) and chronic low back pain (CLBP) better manage their own conditions, comparing it to standard one-on-one physiotherapy in Irish primary care clinics. The intervention was grounded in self-determination theory, aiming to build patients' motivation and skills for long-term self-management of pain and physical function. Rather than measuring a definitive treatment effect, this was a feasibility trial primarily assessing whether the program was acceptable to patients and physiotherapists, and whether a larger definitive trial would be practical and appropriately designed. Secondary outcomes explored changes in pain, disability, and physical function, as well as the costs involved in delivering the group program. The findings are clinically relevant because group-based self-management programs could offer a more efficient and cost-effective alternative to individual physiotherapy, potentially improving long-term outcomes for a large population of patients with these common musculoskeletal conditions.

Long-Term Effect Of Exercise Therapy And Patient Education On Impairments And Activity Limitations In People With Hip Osteoarthritis: Secondary Outcome Analysis Of A Randomized Clinical Trial.

Svege I (2016) · Hip · PMID: 26678445

This randomized clinical trial compared the effects of combining supervised exercise therapy with patient education versus patient education alone in 109 people with hip osteoarthritis, tracking outcomes over nearly 2.5 years. While the exercise group did not show meaningful improvements over the control group in joint range of motion, muscle strength, fitness, or walking distance, patients who exercised reported significantly less pain while walking at both 10 and 29 months. The 12-week supervised exercise program included strengthening, functional, and stretching sessions conducted 2–3 times per week at a sports medicine clinic. Notably, the study was limited by reduced statistical power and only 53% adherence to the exercise program, which may have weakened the ability to detect broader benefits. Clinically, these findings suggest that adding supervised exercise to patient education provides meaningful long-term pain relief during walking for hip OA patients, even when objective physical measures do not show significant group differences.

Preoperative Progressive Explosive-Type Resistance Training Is Feasible And Effective In Patients With Hip Osteoarthritis Scheduled For Total Hip Arthroplasty--A Randomized Controlled Trial.

Hermann A (2016) · Hip · PMID: 26285180

This randomized controlled trial of 80 patients with hip osteoarthritis awaiting total hip replacement compared 10 weeks of supervised, progressive explosive-type resistance training (twice weekly) against standard care before surgery. The exercise group showed significantly better self-reported hip function scores (averaging 10 points higher on the HOOS function scale) and greater leg muscle power compared to the control group. Adherence to the supervised program was excellent at 93%, with pain levels remaining acceptable and no adverse events reported, demonstrating strong feasibility. These findings suggest that structured preoperative exercise is both safe and effective in this typically older patient population (average age 70), potentially improving patients' physical condition heading into surgery. Clinicians should consider recommending supervised explosive-type resistance training as part of routine preoperative care for hip osteoarthritis patients scheduled for joint replacement.

Intensive Supervision Of Rehabilitation Programme Improves Balance And Functionality In The Short Term After Bilateral Total Knee Arthroplasty.

Akbaba Ya (2016) · Knee · PMID: 25037985

This randomized controlled trial compared two levels of physiotherapist supervision in 40 patients recovering from simultaneous bilateral total knee replacement surgery for osteoarthritis: intensive supervision (twice weekly for one month) versus minimal supervision (twice monthly with weekly phone check-ins), alongside a healthy control group of 20 individuals. Patients receiving intensive supervision showed significantly greater improvements in both balance (measured by single-leg stance and timed get-up-and-go tests) and physical function (stair climbing, walking, and WOMAC scores) at both one and two months post-surgery. Remarkably, the intensively supervised group achieved functional performance levels comparable to healthy individuals by the second month, while the minimally supervised group only matched healthy controls in walking cadence. With a modest total sample of 60 participants, results should be interpreted cautiously, but the findings carry clear clinical relevance: structured, frequent physiotherapist supervision in the first month after bilateral knee replacement appears critical for achieving early and meaningful recovery in balance and function.

A Randomized Trial To Compare Exercise Treatment Methods For Patients After Total Knee Replacement: Protocol Paper.

Piva Sr (2015) · Knee · PMID: 26474988

This randomized controlled trial (n=240) compares three approaches for patients at least two months after total knee replacement (TKR): supervised individual clinic-based exercise, supervised community-based group exercise classes, and usual medical care over 12 weeks. The study recognizes that surgery alone often leaves patients with persistent functional limitations and low physical activity levels, and that effective exercise rehabilitation is needed at later stages of recovery. Key outcomes include self-reported physical function (WOMAC-PF), performance-based physical tests, and objectively measured physical activity via accelerometers. This protocol paper does not yet report results, but the trial is designed to determine whether supervised exercise—either individually or in a group setting—produces meaningful improvements over standard care, and to identify which patients are most likely to benefit. Findings are expected to guide clinicians in tailoring post-TKR rehabilitation recommendations to individual patient characteristics and preferences.

Physical Therapy Vs. Internet-Based Exercise Training (Path-In) For Patients With Knee Osteoarthritis: Study Protocol Of A Randomized Controlled Trial.

Williams Qi (2015) · Knee · PMID: 26416025

This randomized controlled trial (the PATH-IN study) compared three approaches for managing knee osteoarthritis in 350 participants: a clinician-designed internet-based exercise training (IBET) program, standard physical therapy (PT) with up to 8 in-person visits, and a wait-list control group. The IBET program delivers personalized exercise plans, video demonstrations, and guided progression online, addressing real-world barriers such as cost and healthcare access that prevent many patients from receiving traditional PT. The primary outcome measured was pain and function using the validated WOMAC scale, assessed at 4 and 12 months, with a key goal of determining whether IBET is non-inferior to standard PT. This is clinically significant because if internet-based exercise proves comparably effective to supervised physical therapy, it could dramatically expand access to evidence-based care for the millions of people living with knee OA. Results from this trial could support the wider adoption of scalable, low-cost digital exercise programs as a legitimate alternative or complement to traditional physical therapy.

The Effect Of Multifactorial Intervention Programs On Health Behavior And Symptom Control Among Community-Dwelling Overweight Older Adults With Knee Osteoarthritis.

Saraboon Y (2015) · Knee · PMID: 26375841

This randomized controlled trial tested a multifactorial intervention program (MUFIP) against standard care in 80 overweight older Thai adults with knee osteoarthritis, randomly divided into two equal groups. The MUFIP combined health education, a weight-reduction program, supervised quadriceps exercise classes followed by home-based exercise, and home visits over 8 weeks. Participants receiving the MUFIP showed significant improvements in knee pain, joint range of motion, movement ability, body weight, and disease knowledge compared to the control group. While the study is notable for its combined approach, clinicians should consider that the relatively small sample size, single-ethnic population, and short 8-week follow-up period may limit how broadly these findings can be applied. Nevertheless, the results suggest that structured, multifaceted programs combining education, weight management, and progressive exercise offer clinically meaningful benefits for overweight older adults managing knee osteoarthritis.

Exercise In Knee Osteoarthritis--Preliminary Findings: Exercise-Induced Pain And Health Status Differs Between Drop-Outs And Retainers.

This small randomized trial (38 participants) assigned knee osteoarthritis patients to either a walking or strengthening exercise program to examine how pain and health status relate to exercise adherence and dropout. Overall, adherence and compliance were high (above 83%) in both groups, and just over half of participants reported feeling improved after the program. Notably, the six patients who dropped out had poorer baseline health and experienced higher exercise-induced pain than those who completed the program. Higher pain levels during the first weeks of exercise were also linked to lower adherence, particularly during home-based sessions. Clinically, these findings suggest that patients with worse health status and greater exercise-induced pain are at higher risk of dropping out, highlighting the need for closer monitoring and individualized support—especially in the early weeks of an exercise program.

Train High Eat Low For Osteoarthritis Study (The Lo Study): Protocol For A Randomized Controlled Trial.

Guerrero Y (2015) · PMID: 26320838

The LO Study (Train High, Eat Low for Osteoarthritis) is a registered protocol for a single-blinded randomized controlled trial enrolling 125 overweight or obese adults (BMI ≥25, age ≥40) with symptomatic medial knee osteoarthritis. The study compares five groups: gait retraining alone, progressive resistance training alone, a high-protein/low-glycaemic-index calorie-restricted diet alone, a combination of all three active interventions, and a lifestyle-advice control group. The primary outcome is the peak knee adduction moment — a biomechanical measure of load on the inner knee compartment — assessed at baseline, 6, and 12 months, with secondary outcomes including pain, joint structure, muscle strength, and quality of life. Importantly, this paper reports only the study design and methodology; no efficacy results are yet available. Clinicians and patients should await published outcome data before drawing conclusions about which intervention strategy is most effective for reducing knee load in this population.

Combined Exercise And Transcranial Direct Current Stimulation Intervention For Knee Osteoarthritis: Protocol For A Pilot Randomised Controlled Trial.

Chang Wj (2015) · Knee · PMID: 26297371

This pilot randomized controlled trial compared two approaches for treating knee osteoarthritis: active brain stimulation (transcranial direct current stimulation, or tDCS) combined with supervised exercise versus sham (fake) brain stimulation combined with the same supervised exercise, with both groups also completing unsupervised home exercises twice weekly. The study enrolled 20 adults with knee osteoarthritis experiencing moderate-to-severe walking pain, delivering 8 weeks of twice-weekly sessions to assess whether tDCS could enhance the known but modest benefits of exercise alone. Rather than testing definitive effectiveness, this pilot study primarily aimed to evaluate the safety, feasibility, and patient acceptability of combining these two treatments, while also gathering data to calculate the sample size needed for a larger, fully-powered trial. Key outcomes measured included pain levels, physical disability, and changes in pain system function before and after the 8-week program. For clinicians and patients, this study is clinically relevant because it explores a novel, non-pharmacological approach to augmenting exercise therapy in a condition where current treatments offer only moderate relief.

Efficacy Of Simple Integrated Group Rehabilitation Program For Patients With Knee Osteoarthritis: Single-Blind Randomized Controlled Trial.

Da Silva Fs (2015) · Knee · PMID: 26237073

This 8-week randomized controlled trial compared a supervised group rehabilitation program to general health education alone in 41 patients with moderate-to-severe knee osteoarthritis. The supervised program combined structured exercise with disease-specific education, while the control group received only general guidance about their condition. Patients in the supervised rehabilitation group showed significantly greater improvements in pain, physical function, and quality of life across multiple validated measures, including the Lequesne index and SF-36, as well as performance-based tests such as the 6-minute walk and timed up-and-go. The primary outcome (Lequesne total score) demonstrated a large effect size (partial eta squared = 0.23), with supervised patients scoring notably better than controls (5.50 vs. 7.87) after 8 weeks. These findings suggest that a structured, group-based supervised exercise and education program offers meaningful clinical benefits over unsupervised self-management alone for knee osteoarthritis patients.

Home-Based Versus Hospital-Based Rehabilitation Program After Total Knee Replacement.

LÃ³pez-Liria R (2015) · Knee · PMID: 25961017

This study compared home-based rehabilitation with standard hospital-based rehabilitation in 78 patients recovering from total knee replacement surgery for osteoarthritis. Both programs included exercises targeting strength, joint mobility, and functional capacity, with outcomes measured using established tools including the WOMAC index, visual analogue scale for pain, and the Barthel index. Importantly, both groups showed significant and comparable improvements in pain, range of motion, muscle strength, balance, and walking ability after completing their respective programs. The key finding is that home-based rehabilitation appears to be just as effective as supervised hospital rehabilitation, suggesting that patients may not need to attend a clinical setting to achieve meaningful recovery. For clinicians and patients, this offers an encouraging message that well-structured home programs could be a viable and more convenient alternative, potentially reducing healthcare costs and improving patient accessibility to rehabilitation.

The Efficacy Of 12 Weeks Non-Surgical Treatment For Patients Not Eligible For Total Knee Replacement: A Randomized Controlled Trial With 1-Year Follow-Up.

Skou St (2015) · Knee · PMID: 25937024

This randomized controlled trial of 100 adults with moderate-to-severe knee osteoarthritis who were not candidates for total knee replacement compared a comprehensive 12-week non-surgical program—including individualized neuromuscular exercise, patient education, insoles, dietary advice, and pain medication guidance—against usual care consisting of only two informational leaflets. At 12 months, patients in the treatment program showed significantly greater improvement in knee pain, symptoms, daily function, and quality of life (KOOS4 mean difference of 9.6 points) compared to those receiving usual care, with a strong 91% follow-up completion rate. The number needed to treat was 7.2, meaning roughly 1 in 7 patients treated with the program achieved a clinically meaningful 15% improvement that would not have occurred with usual care alone. Importantly, no serious treatment-related adverse events were reported, supporting the safety of this multicomponent approach. These findings are clinically relevant as they suggest that a structured, individualized non-surgical program offers a meaningful and safe treatment option for patients with knee OA who are not surgical candidates.

Randomized Trial Of The Effectiveness Of A Non-Pharmacological Multidisciplinary Face-To-Face Treatment Program On Daily Function Compared To A Telephone-Based Treatment Program In Patients With Generalized Osteoarthritis.

Cuperus N (2015) · PMID: 25887365

This randomized clinical trial of 147 patients with generalized osteoarthritis compared a 6-week in-person, multidisciplinary group self-management program (seven sessions) against a telephone-based program (two group sessions plus four phone contacts) to determine which better improved daily function. Both programs produced modest improvements within their respective groups, but no meaningful differences were found between them on daily function or most other outcomes, with the sole exception of slightly greater pain reduction in the face-to-face group. Importantly, even the benefits observed within each group were small and considered unlikely to be clinically significant. These findings suggest that a less intensive, remotely delivered telephone program may be just as effective as supervised in-person care for this patient population, which has practical implications for resource allocation and accessibility of care. Clinicians and patients should be aware that neither format offered substantial disease control, highlighting the need for more effective management strategies for generalized osteoarthritis.

Effectiveness And Cost-Effectiveness Of A Health Coaching Intervention To Improve The Lifestyle Of Patients With Knee Osteoarthritis: Cluster Randomized Clinical Trial.

This cluster randomized clinical trial, conducted across 18 primary care centers in Barcelona, compared a health coaching intervention added to standard care against standard care alone in 360 patients with knee osteoarthritis. The health coaching program consisted of 20 hours of structured sessions aimed at improving quality of life, reducing pain, promoting weight loss, and increasing physical activity. The primary outcome was quality of life measured by the WOMAC index, with economic analyses also evaluating cost-effectiveness and cost-utility of the intervention. If proven effective, this approach could offer a non-pharmacological, self-management-focused treatment option aligned with current clinical guidelines that prioritize lifestyle modification as first-line therapy for knee osteoarthritis. The results have the potential to directly inform primary care practice guidelines in Spain and beyond.

No Effects Of A 12-Week Supervised Exercise Therapy Program On Gait In Patients With Mild To Moderate Osteoarthritis: A Secondary Analysis Of A Randomized Trial.

Eitzen I (2015) · PMID: 25886499

This randomized controlled trial compared the effects of patient education alone versus patient education combined with a 12-week supervised exercise therapy program on walking biomechanics in 45 adults (aged 40–80) with mild to moderate hip osteoarthritis. Researchers used three-dimensional gait analysis to measure joint angles and forces at the hip, knee, and ankle before and after the intervention. No meaningful differences in gait characteristics were found between the two groups at four-month follow-up, regardless of how many exercise sessions participants completed. Notably, compliance with the supervised exercise program was poor, but even after accounting for this, the exercise program itself appeared insufficient to produce measurable changes in walking mechanics. These findings suggest that this particular 12-week supervised exercise protocol may not be effective for improving gait biomechanics in this patient population, highlighting the need to develop more targeted exercise interventions for hip osteoarthritis.

Effects Of Exercise On Patellar Cartilage In Women With Mild Knee Osteoarthritis.

Koli J (2015) · Knee · PMID: 25668399

This randomized controlled trial compared a supervised, progressive high-impact exercise program (three sessions per week for 12 months) against no intervention in 80 postmenopausal women with mild patellofemoral knee osteoarthritis. The supervised exercise group showed meaningful improvements in patellar cartilage quality, measured by MRI T2 relaxation time mapping—a technique reflecting collagen integrity and tissue hydration—with cartilage quality approximately 7-8% better than controls, particularly in the deep and lateral cartilage zones. Physical function also improved, with leg extension strength 11% greater and aerobic capacity 4% greater in the exercise group, though patient-reported knee symptoms did not differ significantly between groups. These findings, based on a well-controlled 12-month study, provide clinicians with reassuring evidence that structured, progressive high-impact exercise does not harm and may actually benefit cartilage health in this population. This supports recommending supervised exercise programs as a safe and effective intervention for postmenopausal women with mild knee osteoarthritis.

Efficacy Of Hip Strengthening Exercises Compared With Leg Strengthening Exercises On Knee Pain, Function, And Quality Of Life In Patients With Knee Osteoarthritis.

Lun V (2015) · Hip; knee · PMID: 25591130

This randomized clinical trial compared hip strengthening exercises versus leg strengthening exercises in 72 patients with knee osteoarthritis over 12 weeks, with the first 3 weeks supervised and the remaining 9 weeks performed at home. Both exercise programs led to statistically and clinically meaningful improvements in knee pain, physical function, and quality of life, as measured by validated questionnaires (KOOS and WOMAC) and a 6-minute walk test. Importantly, neither program proved superior — patients in both groups improved equally, suggesting clinicians have flexibility in choosing between hip- or leg-focused exercise. Notably, no significant changes in muscle strength or joint range of motion were observed in either group, which raises questions about the mechanisms driving symptom improvement. These findings support incorporating either hip or leg strengthening exercise into routine management plans for knee osteoarthritis patients.

Neuromuscular Exercise Post Partial Medial Meniscectomy: Randomized Controlled Trial.

Hall M (2015) · Menisc · PMID: 25539478

This randomized controlled trial compared a 12-week physiotherapist-guided neuromuscular home exercise program against no exercise in 62 adults (ages 30–50) who had undergone partial knee meniscus removal within the prior 3–12 months. The exercise program was designed to improve lower limb alignment and reduce abnormal knee loading forces — a key mechanical factor linked to osteoarthritis progression. Despite high completion rates (97%), the study found no significant differences between the exercise and control groups in knee adduction moment (a biomechanical measure of knee load distribution) during walking or sit-to-stand tasks, nor in any secondary outcomes including muscle strength and patient-reported measures. While the program was well-tolerated, these findings suggest that this particular neuromuscular exercise approach does not meaningfully alter the mechanical joint loading patterns thought to drive osteoarthritis development after meniscus surgery. Clinicians should consider that exercise prescription following meniscectomy may need to be tailored differently to achieve biomechanical benefits relevant to osteoarthritis prevention.

A Randomized Controlled Trial: Preoperative Home-Based Combined Tai Chi And Strength Training (Tcst) To Improve Balance And Aerobic Capacity In Patients With Total Hip Arthroplasty (Tha).

Zeng R (2015) · Hip · PMID: 25533574

This randomized controlled trial of 81 patients (aged 60–69) with end-stage hip osteoarthritis compared a 12-week home-based Tai Chi and strength training (TCST) program conducted under family supervision against a control group receiving no such training. Patients who completed the TCST program showed meaningful improvements in aerobic capacity (6-minute walk distance increased by ~68 meters), mobility (Timed Up and Go test improved by ~4 seconds), and self-reported physical function on the WOMAC scale. Notably, the program did not significantly reduce pain or improve hip range of motion, suggesting that while prehabilitation can enhance functional fitness before total hip replacement surgery, it cannot address the structural joint damage driving pain. The program demonstrated good adherence, with participants completing 87% of prescribed movements under family supervision, indicating that unsupervised home-based exercise with lay caregiver support is a feasible approach. Clinically, this study supports prescribing structured home exercise programs as prehabilitation for patients awaiting total hip arthroplasty, while setting realistic expectations that pain relief will likely require surgery.

Is There A Role For Rehabilitation Streaming Following Total Knee Arthroplasty? Preliminary Insights From A Randomized Controlled Trial.

Naylor Jm (2015) · Knee · PMID: 25437509

This randomized controlled trial investigated whether patients with poorer mobility after total knee replacement surgery benefited more from supervised physiotherapy compared to home-based, unsupervised exercise. Among 233 total participants, those who started rehabilitation with lower mobility scores (as measured by a 6-minute walk test in the second week after surgery) showed meaningfully better walking ability at 10 weeks post-surgery when they received supervised therapy — an 8.5% difference in walking distance compared to the unsupervised group. Importantly, patients who already had relatively good mobility at the start of rehabilitation did not show any additional benefit from supervision, and neither group showed differences in pain or self-reported functional outcomes. These findings suggest that a "streaming" approach to post-surgical rehabilitation — directing lower-functioning patients toward supervised care while allowing higher-functioning patients to manage independently — may be a clinically practical and resource-efficient strategy. Clinicians should note, however, that these are preliminary findings from a retrospective subgroup analysis, and larger prospective trials are needed before firm recommendations can be made.

Joint Protection And Hand Exercises For Hand Osteoarthritis: An Economic Evaluation Comparing Methods For The Analysis Of Factorial Trials.

Oppong R (2015) · Hand · PMID: 25339642

This UK-based randomized controlled trial compared the cost-effectiveness of four approaches for managing hand osteoarthritis over 12 months: a basic information leaflet with advice (control), joint protection therapy alone, hand exercises alone, and a combination of both therapies. The study found that hand exercises were the most cost-effective option, costing only £318 per quality-adjusted life year (QALY) gained — well below typical NHS cost-effectiveness thresholds — while the combination therapy incurred the highest costs without proportionally greater benefit. The trial enrolled participants across all four arms and calculated both direct healthcare costs and quality of life outcomes at the patient level. Importantly, this was the first trial to evaluate the cost-effectiveness of occupational therapy-supported self-management strategies for hand osteoarthritis, filling a significant evidence gap. Clinically, these findings suggest that prescribing structured hand exercises represents excellent value for money and should be considered a first-line recommendation for patients with hand osteoarthritis.

Early Rehabilitation After Total Knee Replacement Surgery: A Multicenter, Noninferiority, Randomized Clinical Trial Comparing A Home Exercise Program With Usual Outpatient Care.

Han As (2015) · Knee · PMID: 25220488

This multicenter randomized trial of 390 patients (ages 45–75) compared a monitored home exercise program (HEP) to standard outpatient rehabilitation in the first 6 weeks after total knee replacement surgery for osteoarthritis. Both groups showed nearly identical outcomes across all key measures, including pain, physical function, knee range of motion, and walking speed, with no clinically meaningful differences detected. The home program was formally shown to be "non-inferior," meaning it performed just as well as supervised clinic-based care without any increase in hospital readmissions or safety concerns. These findings are clinically relevant because they suggest that carefully structured, monitored home exercise can be a viable and potentially more accessible alternative to traditional outpatient rehabilitation immediately after knee replacement. For healthcare systems and patients, this offers a meaningful opportunity to reduce the burden of frequent clinic visits during early recovery without compromising outcomes.

Effect Of Home-Based Hand Exercises In Women With Hand Osteoarthritis: A Randomised Controlled Trial.

Hennig T (2015) · Hand · PMID: 24667900

This randomized controlled trial of 80 women with hand osteoarthritis compared a home-based hand exercise program (supported by eight follow-up phone calls over 3 months) against an information-only control group. The exercise group showed significantly greater improvement in activity performance, with an average difference of 1.4 points on the Patient-Specific Functional Scale and a clinically meaningful effect size of 1.0. Additional benefits included improvements in grip strength, thumb mobility, joint pain, and fatigue. Notably, 16 of 40 exercise participants met established responder criteria (OMERACT-OARSI) compared to just 2 of 40 controls, and the exercises were well tolerated with no serious adverse events. These findings support recommending structured home-based hand exercises, even without in-person supervision, as a safe and effective component of hand osteoarthritis management.

Assessing The Comparative Effectiveness Of Tai Chi Versus Physical Therapy For Knee Osteoarthritis: Design And Rationale For A Randomized Trial.

Wang C (2014) · Knee · PMID: 25199526

This randomized controlled trial compared two supervised exercise approaches for knee osteoarthritis (OA) — Tai Chi (twice weekly for 12 weeks) versus a standardized physical therapy program (twice weekly for 6 weeks, followed by 6 weeks of monitored home exercise) — in adults aged 40 and older with confirmed knee OA. The study, conducted at a Boston medical center, primarily measured pain relief using the validated WOMAC pain scale at 12 weeks, while also tracking function, strength, balance, psychological wellbeing, and healthcare costs over a full year. Notably, this trial is the first to directly compare these two approaches for cost-effectiveness and comparative effectiveness, with follow-up extending to 52 weeks to assess durability of benefits. The design highlights an important distinction between fully supervised Tai Chi and a hybrid physical therapy model that transitions patients to home-based exercise, allowing clinicians to understand how supervision intensity may influence outcomes. Results are expected to provide meaningful guidance for the estimated millions of Americans living with knee OA, a condition costing the healthcare system over $185 billion annually.

Group-Mediated Physical Activity Promotion And Mobility In Sedentary Patients With Knee Osteoarthritis: Results From The Impact-Pilot Trial.

Focht Bc (2014) · Knee · PMID: 25179854

This 12-month pilot trial (IMPACT-P) compared two exercise approaches in 80 sedentary adults with knee osteoarthritis (average age 63.5 years, 84% women): a Group-Mediated Cognitive Behavioral (GMCB) program—which combines exercise with behavioral strategies to promote long-term physical activity—versus traditional center-based exercise therapy. The GMCB intervention produced significantly greater increases in objectively measured physical activity levels compared to traditional exercise (p < 0.01), and showed a trend toward better walking mobility (400-meter walk test, p = 0.09), though the mobility difference did not reach statistical significance. Importantly, increases in physical activity were strongly linked to improved walking performance at both 3 and 12 months, suggesting that getting patients more active overall drives meaningful functional gains. With only 80 participants, this was a pilot study, so results should be interpreted cautiously, but the findings suggest that incorporating behavioral support into exercise programs may be more effective than supervised exercise alone for sustaining physical activity in this population. Clinically, these results highlight the potential value of group-based behavioral coaching as an adjunct to traditional exercise therapy for sedentary patients with knee osteoarthritis.

A Comparison Of Home-Based Exercise Programs With And Without Self-Manual Therapy In Individuals With Knee Osteoarthritis In Community.

Cheawthamai K (2014) · Knee · PMID: 25141536

This 12-week randomized controlled trial enrolled 43 community-dwelling adults with knee osteoarthritis to compare a home-based exercise program alone versus the same program combined with self-administered manual therapy techniques. Both groups showed meaningful improvements in pain, physical function, and quality of life, but the group combining exercise with self-manual therapy demonstrated additional benefits, particularly in reducing pain intensity and improving knee range of motion at both 4 and 12 weeks. The exercise-only group showed a notable advantage in walking endurance, as measured by the six-minute walk test. With a relatively small sample size of 43 participants, these findings should be interpreted cautiously, though they suggest that teaching patients self-manual therapy techniques alongside a home exercise program may offer clinically meaningful added value. For clinicians, this supports considering self-manual therapy education as a practical, low-cost complement to standard home exercise prescriptions for knee osteoarthritis management.

Internet-Mediated Physiotherapy And Pain Coping Skills Training For People With Persistent Knee Pain (Impact - Knee Pain): A Randomised Controlled Trial Protocol.

Dobson F (2014) · Knee · PMID: 25125068

This Australian randomised controlled trial (target n=148 adults over 50 with knee osteoarthritis) compared an internet-delivered combination of physiotherapist-guided exercise and pain coping skills training (PCST) against online educational materials alone over 3 months. The supervised internet intervention involved weekly PCST modules, seven physiotherapy sessions conducted online, and a home exercise program performed three times per week. Primary outcomes measured were walking pain and physical function, with follow-up extending to 9 months. Importantly, this is a protocol paper describing the planned trial rather than reporting final results, so effectiveness data are not yet available. If the intervention proves successful, it could offer a scalable, remotely accessible treatment model for patients with knee OA who face barriers to in-person care.

Effectiveness And Cost-Effectiveness Of A Blended Exercise Intervention For Patients With Hip And/Or Knee Osteoarthritis: Study Protocol Of A Randomized Controlled Trial.

Kloek Cj (2014) · Hip; knee · PMID: 25103686

This study protocol describes a randomized controlled trial comparing a blended exercise program called "e-Exercise" — combining up to five in-person physical therapy sessions with a web-based exercise platform — against standard physical therapy care for 200 patients with hip and/or knee osteoarthritis. The trial aims to determine whether partially replacing face-to-face supervision with a digital program can maintain or improve physical functioning and activity levels over 3 and 12 months, while also being more cost-effective. The rationale is that traditional supervised exercise is effective but expensive, while fully web-based approaches suffer from poor adherence due to lack of professional contact; the blended model seeks to balance these trade-offs. This is notably the first RCT to evaluate a blended exercise intervention specifically in osteoarthritis patients, making its findings potentially important for shaping future treatment guidelines. Clinicians and patients should note that results will address not only effectiveness but also real-world cost implications, which is highly relevant given growing healthcare budget pressures.

A Multicentre, Pragmatic, Parallel Group, Randomised Controlled Trial To Compare The Clinical And Cost-Effectiveness Of Three Physiotherapy-Led Exercise Interventions For Knee Osteoarthritis In Older Adults: The Beep Trial Protocol (Isrctn: 93634563).

Foster Ne (2014) · Knee · PMID: 25064573

The BEEP trial is a large UK-based randomized controlled trial enrolling 500 adults aged 45 and older with knee osteoarthritis to compare three physiotherapy-led exercise approaches: standard usual care (up to 4 sessions of advice and exercise), individually tailored and supervised exercise, and a program focused on long-term exercise adherence and physical activity. The trial recognizes that while exercise is consistently recommended for knee osteoarthritis, benefits are often modest and short-lived, likely because programs are not sufficiently personalized and patients struggle to maintain exercise habits over time. The primary measure of success is pain and physical function (using the WOMAC scale) at 6 months, with follow-up extending to 36 months to capture longer-term effects. With 500 participants across multiple NHS sites, the trial is well-powered to determine whether supervised, individualized exercise or adherence-focused strategies meaningfully outperform standard physiotherapy care. Findings could directly influence clinical guidelines, reshape physiotherapy service delivery, and potentially reduce the number of patients progressing to knee replacement surgery.

Limited Effects Of Exercises In People With Hand Osteoarthritis: Results From A Randomized Controlled Trial.

Ã˜sterÃ¥s N (2014) · Hand · PMID: 25008206

This randomized controlled trial enrolled 130 people with physician-confirmed hand osteoarthritis (average age 66, 90% female) to compare a 12-week supervised group and home exercise program against usual care. At 3 months, the exercise group showed only small improvements in hand pain, stiffness, and disease activity, but no meaningful gains in hand dexterity or grip strength compared to the control group. Notably, nearly three times as many participants in the exercise group (46%) met established responder criteria compared to the control group (16%), suggesting some patients do benefit meaningfully. However, these advantages did not persist at 6 months, indicating the benefits were short-lived once structured supervision ended. Clinically, this program appears safe and modestly helpful in the short term, but questions remain about optimal exercise type and dosage for sustaining long-term hand function in osteoarthritis.

Immediate Efficacy Of Neuromuscular Exercise In Patients With Severe Osteoarthritis Of The Hip Or Knee: A Secondary Analysis From A Randomized Controlled Trial.

Villadsen A (2014) · Hip; knee · PMID: 24931956

This randomized controlled trial compared an 8-week supervised neuromuscular exercise program (NEMEX-TJR, twice weekly with a physiotherapist) plus standard education versus education alone in 165 patients with severe hip or knee osteoarthritis who were awaiting joint replacement surgery. Patients in the supervised exercise group showed meaningful improvements in daily activities, pain, and physical performance tests such as walking and chair stands compared to the control group. The benefits were moderate for hip OA patients but only small for those with knee OA, suggesting that the type of joint affected may influence how much patients gain from this type of exercise. Importantly, the program was found to be feasible and safe even in this high-severity population, which has historically been underrepresented in exercise research. These findings suggest that supervised neuromuscular exercise can provide clinically relevant benefits in the weeks before joint replacement, potentially improving patients' pre-surgical condition.

Association Of Exercise Therapy And Reduction Of Pain Sensitivity In Patients With Knee Osteoarthritis: A Randomized Controlled Trial.

Henriksen M (2014) · Knee · PMID: 24905427

This randomized controlled trial (n=60) compared 12 weeks of supervised exercise therapy (36 sessions) against a no-treatment control group in patients with knee osteoarthritis, examining whether exercise affects how the nervous system processes pain. Patients who completed the supervised program showed measurable reductions in pressure-pain sensitivity and temporal summation — a marker of central pain amplification — alongside improved self-reported knee pain scores (KOOS). These findings suggest that supervised exercise does not merely strengthen muscles or improve joint function, but may actually alter underlying pain mechanisms in the central nervous system. Clinically, this supports prescribing structured, supervised exercise programs rather than simply advising patients to "stay active," as the supervision and adherence appear critical to achieving these neurological pain-modifying benefits. While the sample size was modest and per-protocol analysis reduced it further to 48 participants, the results provide a compelling biological rationale for exercise as a disease-modifying intervention in knee osteoarthritis.

A Randomized Pilot Study Of A Comprehensive Postoperative Exercise Program Compared With Usual Care Following Primary Total Hip Arthroplasty In Subjects Less Than 65 Years Of Age: Feasibility, Selection Of Outcome Measures And Timing Of Assessment.

Beaupre La (2014) · Hip · PMID: 24889213

This small pilot study (21 participants under age 65) compared a structured 3-month outpatient exercise rehabilitation program to standard care following total hip replacement surgery, finding that while both groups improved in pain, walking endurance, and quality of life, patients in the supervised program showed clinically meaningful gains in leg strength at 4 months that the usual care group did not. No serious adverse effects were reported in the supervised group, supporting the safety and feasibility of intensive post-surgical rehabilitation in younger, more active patients. Importantly, the commonly used WOMAC questionnaire showed a "ceiling effect" — meaning many patients scored so well on pain measures that the tool could not detect meaningful differences between groups — suggesting better outcome measures are needed for this younger population. Performance-based strength testing and more demanding functional assessments are recommended over self-report questionnaires as primary outcomes in future trials with younger hip replacement patients. A follow-up period of at least one year is advisable, as strength continued to improve beyond the 4-month mark in both groups.

Yoga For Managing Knee Osteoarthritis In Older Women: A Pilot Randomized Controlled Trial.

Cheung C (2014) · Knee · PMID: 24886638

This pilot RCT compared an 8-week Hatha yoga program (combining group and home-based sessions) against a wait-list control in 36 older women (average age 72) with knee osteoarthritis. Participants in the yoga group showed significantly greater reductions in knee pain and stiffness, as well as improved ability to perform repeated chair stands, compared to controls at 8 weeks. Importantly, benefits in pain, physical function, and overall OA symptoms continued to be observed through 20 weeks of follow-up, suggesting durable effects beyond the active intervention period. The program demonstrated excellent feasibility, with 95% retention and no yoga-related adverse events, making it a safe and acceptable option for this population. While the small sample size limits generalizability, these findings support yoga as a clinically meaningful, low-risk complementary exercise strategy for managing knee OA in older women.

Is Telephysiotherapy An Option For Improved Quality Of Life In Patients With Osteoarthritis Of The Knee?

Odole Ac (2014) · Knee · PMID: 24778645

This 6-week randomized controlled trial compared clinic-based supervised physiotherapy to telephone-monitored home exercise (telephysiotherapy) in 50 patients with knee osteoarthritis (25 per group). Both approaches led to significant improvements in physical and psychological quality of life, suggesting that remote supervision via telephone can be as effective as in-person care. Importantly, no significant differences were found between the two groups in physical health, psychological well-being, or social relationship domains, with only the environment domain showing a between-group difference. These findings are clinically relevant because telephysiotherapy offers a practical, accessible alternative for patients who face barriers to attending in-person physiotherapy sessions. For clinicians, this supports the use of structured telephone-based exercise programs as a viable option in managing knee osteoarthritis, particularly in resource-limited or remote settings.

Effects Of Two Physiotherapy Booster Sessions On Outcomes With Home Exercise In People With Knee Osteoarthritis: A Randomized Controlled Trial.

Bennell Kl (2014) · Knee · PMID: 24757032

This randomized controlled trial (n=78) investigated whether two additional physiotherapy "booster" sessions improved outcomes for people with knee osteoarthritis who were continuing a home exercise program after an initial 12-week supervised exercise period. Participants were randomly assigned to either receive two 30-minute physiotherapy check-in visits or no additional supervision over the following 24 weeks, with pain and physical function as the primary outcomes. The study found no meaningful difference between groups in pain relief, physical function, or exercise adherence — with both groups completing roughly half of their prescribed home exercise sessions. These findings suggest that simply adding brief booster visits is insufficient to meaningfully enhance long-term exercise adherence or clinical outcomes in knee osteoarthritis patients. Clinicians should look beyond occasional check-in appointments and consider more innovative, sustained strategies — such as behavioral coaching, digital monitoring, or peer support — to help patients maintain exercise habits over time.

Structural Changes In The Knee During Weight Loss Maintenance After A Significant Weight Loss In Obese Patients With Osteoarthritis: A Report Of Secondary Outcome Analyses From A Randomized Controlled Trial.

Henriksen M (2014) · Knee · PMID: 24636948

This randomized controlled trial followed 192 obese patients with knee osteoarthritis who completed an intensive 16-week weight loss program and were then assigned for one year to either ongoing dietary support, a specialized knee exercise program, or no additional intervention. The key finding was that while all three groups showed no significant differences in cartilage loss, joint inflammation (synovitis), or fluid buildup (effusion), the exercise group experienced a notably greater increase in bone marrow lesions (BMLs) in the inner knee compared to the diet and no-attention groups — a finding that warrants careful interpretation given uncertainties around exercise compliance and MRI methodology. Importantly, the dietary support group maintained weight loss most effectively (gaining only ~1 kg), while the exercise group regained the most weight (~6.6 kg), which may have contributed to the structural differences observed. For clinicians and patients, these results suggest that a specialized exercise program did not provide superior structural joint protection compared to dietary maintenance after weight loss, and the unexpected increase in BMLs in the exercise group raises questions that require further investigation. The authors caution against overinterpreting these findings given the study's limitations, including follow-up duration and variability in exercise adherence.

The Effectiveness Of Thai Exercise With Traditional Massage On The Pain, Walking Ability And Qol Of Older People With Knee Osteoarthritis: A Randomized Controlled Trial In The Community.

Peungsuwan P (2014) · Knee · PMID: 24567694

This randomized controlled trial compared two 8-week supervised exercise-plus-massage programs for 31 older adults (aged 50–85) with knee osteoarthritis: a Thai traditional program (Thai exercise with traditional massage) versus a standardized physical therapy program (strengthening exercises with Swedish massage). Both programs combined supervised group classes with home-based self-care, followed by one year of home self-care only. After 8 weeks, both groups showed meaningful improvements in pain, physical function, and quality of life, with the Thai traditional program showing greater gains across most measures. At one year, the Thai program maintained a significant advantage only in walking ability (six-minute walk test), while both programs produced comparable long-term benefits for pain and quality of life. These findings suggest that both supervised community-based exercise approaches are clinically viable for managing knee osteoarthritis, and that culturally adapted programs incorporating traditional practices may offer additional benefits, particularly for sustaining walking capacity over time.

Efficacy Of A 12-Month, Monitored Home Exercise Programme Compared With Normal Care Commencing 2 Months After Total Knee Arthroplasty: A Randomized Controlled Trial.

Vuorenmaa M (2014) · Knee · PMID: 24241606

This randomized controlled trial of 108 patients (average age 69) compared a structured home exercise program starting 2 months after total knee replacement against standard post-operative care over 12 months. While both groups showed similar improvements in pain, disability, and quality of life, patients who followed the home exercise program walked significantly faster and had greater knee flexion strength at the end of the study. These objective physical performance gains suggest that a monitored home exercise program offers measurable functional benefits beyond routine care, even if patient-reported outcomes were comparable. Clinicians should consider that standard recovery pathways may adequately address pain and self-reported disability, but targeted exercise may be needed to optimize physical capacity. This is particularly relevant for patients with higher functional goals or those returning to active lifestyles after knee replacement.

A Telephone-Based Physiotherapy Intervention For Patients With Osteoarthritis Of The Knee.

Odole Ac (2013) · Knee · PMID: 25945214

This randomized controlled trial compared clinic-based physiotherapy to a telephone-supported home exercise program for 50 patients with knee osteoarthritis over six weeks. Both groups performed the same osteoarthritis-specific exercises three times per week, with the clinic group supervised in person and the telephone group guided and monitored remotely via structured phone calls. Both groups showed significant improvements in pain intensity and physical function at weeks two, four, and six compared to baseline. Critically, there were no statistically significant differences in outcomes between the two groups at any time point, suggesting that remote telephone supervision is as effective as in-person physiotherapy for this population. These findings have important clinical implications, particularly for patients with limited mobility or access to clinic-based care, as structured telephone support may offer a viable and equally effective alternative to traditional supervised physiotherapy.

Adherence To A Web-Based Physical Activity Intervention For Patients With Knee And/Or Hip Osteoarthritis: A Mixed Method Study.

Bossen D (2013) · Knee; hip · PMID: 24132044

This mixed-methods study examined which patients were most likely to engage with a web-based physical activity program for knee and/or hip osteoarthritis, drawing on data from 100 participants in a randomized controlled trial. Only 46 out of 100 participants completed at least 6 of 9 program modules, indicating a substantial dropout problem. Older patients and those with additional health conditions (comorbidities) were significantly less likely to complete the program. Qualitative interviews revealed that the absence of personal guidance, low motivation, physical problems, and low mood were the main barriers to use, while trust in the program and social support promoted engagement. These findings suggest that fully self-guided web-based interventions may be insufficient for older or more complex patients, and that integrating human support or healthcare involvement could improve adherence.

Analysis Of Effectiveness Of Therapeutic Exercise For Knee Osteoarthritis And Possible Factors Affecting Outcome.

Kudo M (2013) · Knee · PMID: 24085378

This randomized controlled trial compared supervised group exercise (led by physiotherapists) versus unsupervised home exercise in 209 women with knee osteoarthritis, measuring outcomes using the WOMAC pain and function score. The supervised group exercise program produced significantly greater symptom improvement than home exercise, highlighting the important role of professional guidance in exercise delivery. Key factors influencing outcomes were identified: patients with knee flexion contracture (limited ability to fully straighten the knee) were less likely to benefit from group exercise, while those with weaker quadriceps (thigh) muscles showed the greatest gains from exercise therapy. These findings are clinically relevant because they suggest that a simple assessment of a patient's range of motion and muscle strength before starting exercise therapy can help clinicians predict who will respond best and choose the most appropriate exercise format. In practice, supervised exercise should be the preferred option where possible, but patient-specific factors must guide individualized treatment decisions.

Therapeutic Effect Of Whole Body Vibration On Chronic Knee Osteoarthritis.

Park Yg (2013) · Knee · PMID: 24020031

This small randomized controlled trial (11 patients per group) compared whole body vibration (WBV) combined with home exercise against home exercise alone over 8 weeks in patients with chronic knee osteoarthritis. Both groups experienced meaningful improvements in pain, physical function, muscle strength, and balance, suggesting that a simple home exercise program is broadly beneficial for this condition. However, patients who received WBV reported significantly greater pain reduction compared to those doing home exercise only, which may be a clinically relevant advantage for patients whose pain is difficult to manage. Importantly, the two approaches were similarly effective for improving quadriceps muscle strength and dynamic balance, meaning WBV did not offer additional benefit in these areas. Clinicians should note that while WBV shows promise as a pain-management tool for knee osteoarthritis, the very small sample size limits the strength of these conclusions and larger trials are needed before widespread adoption.

Dextrose Prolotherapy For Knee Osteoarthritis: A Randomized Controlled Trial.

Rabago D (2013) · Knee · PMID: 23690322

This 3-arm randomized controlled trial (n=90) compared dextrose prolotherapy injections, saline (placebo) injections, and at-home exercise for knee osteoarthritis over 52 weeks. All three groups showed improvement in pain, function, and stiffness (measured by the WOMAC score), but patients receiving dextrose prolotherapy improved significantly more than both the saline and exercise groups. Crucially, the prolotherapy group's improvement exceeded the minimal clinically important difference, meaning the benefit was not just statistically significant but meaningful to patients in daily life. Satisfaction was high and no adverse events were reported, supporting prolotherapy's safety profile. Clinicians should note this was a relatively small, single trial, and findings warrant confirmation in larger studies before broad adoption.

An Assessment Of The Impact Of Behavioural Cognitions On Function In Patients Partaking In A Trial Of Early Home-Based Progressive Resistance Training After Total Hip Replacement Surgery.

Okoro T (2013) · Hip · PMID: 23480673

This prospective study embedded within an RCT (N=50) examined whether pre-operative beliefs about personal control over recovery predicted functional outcomes at 12 months after total hip replacement. Contrary to expectations, behavioural cognitions—including recovery locus of control—had no significant impact on subjective functional outcomes. The strongest predictor of 12-month function was the patient's own functional status at earlier time points, particularly at 6 months post-surgery. Notably, pre-operative functional status explained over 63% of variance in functional gain, suggesting that earlier surgical intervention, before significant functional decline, may optimize outcomes.

Effectiveness Of An Interactive Virtual Telerehabilitation System In Patients After Total Knee Arthoplasty: A Randomized Controlled Trial.

Piqueras M (2013) · Knee · PMID: 23474735

This randomized controlled trial of 142 patients compared an interactive virtual telerehabilitation program against conventional in-person physical therapy following total knee replacement surgery. Both groups showed significant improvements in knee range of motion, muscle strength, walking speed, pain, and overall function after just two weeks of rehabilitation. Importantly, patients who completed their rehab via telerehabilitation achieved outcomes equivalent to those receiving traditional face-to-face therapy, demonstrating that supervised remote exercise can be just as effective as clinic-based care. These findings are clinically relevant because they suggest telerehabilitation offers a viable, accessible alternative for post-surgical patients who face barriers such as transportation difficulties. This has meaningful implications for expanding equitable access to rehabilitation care, particularly in underserved or rural populations.

Comparing Conventional Physical Therapy Rehabilitation With Neuromuscular Electrical Stimulation After Tka.

Levine M (2013) · PMID: 23464951

This randomized controlled trial of 70 patients compared conventional supervised physical therapy against an unsupervised home program combining neuromuscular electrical stimulation (NMES) and range-of-motion exercises following total knee replacement surgery. The study found that the unsupervised NMES-based home program was non-inferior to therapist-supervised rehabilitation, meaning patients achieved comparable outcomes in pain, function, and knee flexibility at both 6 weeks and 6 months after surgery. Patient satisfaction was also equivalent between the two groups, with no meaningful differences in quadriceps strength recovery. These findings suggest that for appropriate patients recovering from total knee replacement, a structured home-based NMES program may be a viable, cost-effective alternative to formal physical therapy. This has significant clinical relevance given the high costs associated with post-surgical rehabilitation, potentially offering patients greater flexibility without compromising their recovery outcomes.

The Effect Of Education And Supervised Exercise Vs. Education Alone On The Time To Total Hip Replacement In Patients With Severe Hip Osteoarthritis. A Randomized Clinical Trial Protocol.

Jensen C (2013) · Hip · PMID: 23311889

This randomized clinical trial compared a combined program of patient education plus supervised exercise (neuromuscular training and resistance training over 3 months) against patient education alone in patients aged 40 and older with severe hip osteoarthritis who were already considered candidates for total hip replacement surgery. The primary question was whether the supervised exercise program could delay the time until patients actually needed surgery, measured over at least 5 years of follow-up. While this document describes the study protocol rather than final results, the researchers hypothesized that adding structured, individualized exercise to education would meaningfully postpone the need for surgery compared to education alone. The trial is clinically relevant because hip replacement rates have risen across all age groups, and evidence suggests non-surgical interventions can reduce pain and disability even in advanced disease; finding an effective way to delay surgery could benefit patients and reduce healthcare costs. Secondary outcomes including pain, physical function, activity levels, and cost-effectiveness will provide a comprehensive picture of the intervention's overall value.

Exercise And Self-Management For People With Chronic Knee, Hip Or Lower Back Pain: A Cluster Randomised Controlled Trial Of Clinical And Cost-Effectiveness. Study Protocol.

Walsh N (2013) · Knee; hip · PMID: 23200601

This study protocol describes a cluster randomized controlled trial comparing a 6-week physiotherapist-led group exercise and self-management program against standard GP care for 352 adults over 50 with chronic hip, knee, or lower back pain. A key innovation is that the intervention addresses multiple joint problems simultaneously rather than focusing on a single joint, reflecting the real-world pattern where older patients often experience pain in more than one area. The trial will measure functional outcomes using the Short Musculoskeletal Functional Assessment and will also conduct a full cost-effectiveness analysis including quality-adjusted life years (QALYs). Clinically, this approach could reduce the burden of repeat healthcare visits by providing generalizable self-management advice applicable across joint sites in a single program. Results from this trial have the potential to reshape how primary care manages chronic musculoskeletal conditions in older adults, though it should be noted this is a protocol paper and findings are not yet available.

Determinants Of Pain And Functioning In Hip Osteoarthritis - A Two-Year Prospective Study.

Juhakoski R (2013) · Hip · PMID: 22843354

This 2-year prospective study examined 118 adults (aged 55–80) with radiologically confirmed hip osteoarthritis to identify factors that predict better pain control and physical functioning over time. The key finding was that supervised exercise training was associated with significantly less pain and better physical function compared to unsupervised activity, alongside other favorable factors such as higher education, regular conditioning exercise, and the absence of other joint problems or chronic conditions. These results highlight that structured, professionally guided exercise programs offer meaningful clinical benefits beyond what patients achieve exercising on their own. For clinicians, this reinforces the importance of prescribing supervised rehabilitation rather than simply advising general physical activity. For patients, it underscores that participating in a monitored exercise program—not just staying active independently—can make a measurable difference in managing hip osteoarthritis symptoms over the long term.

The Implementation Of A Community-Based Aerobic Walking Program For Mild To Moderate Knee Osteoarthritis: A Knowledge Translation Randomized Controlled Trial: Part Ii: Clinical Outcomes.

Brosseau L (2012) · Knee · PMID: 23234575

This randomized controlled trial compared three approaches to promoting walking for 222 adults with mild to moderate knee osteoarthritis: a supervised walking program plus behavioral coaching, a supervised walking program alone, or a self-directed educational pamphlet only. All three groups showed improvements in clinical outcomes and quality of life over the 12-month intervention and 6-month follow-up period, but there were surprisingly few statistically significant differences between the groups. This suggests that the level of supervision provided did not substantially change long-term outcomes, and that simply providing educational information about walking may be as effective as a fully supervised program. For clinicians and patients, this is encouraging news: structured community walking clubs appear to be a viable self-management strategy for osteoarthritis, even without intensive professional oversight. These findings support walking as an accessible, low-cost intervention that can be implemented broadly in community settings to help manage osteoarthritis symptoms.

Functional Exercise After Total Hip Replacement (Feather): A Randomised Control Trial.

Monaghan B (2012) · Hip · PMID: 23190932

The FEATHER trial compared a supervised, physiotherapist-led functional exercise program against usual care in 70 patients recovering from total hip replacement (THR), randomized into two groups of 35. Beginning at 12 weeks post-surgery, the experimental group attended a circuit-based exercise class twice weekly for six weeks, while the control group continued with standard post-operative care. The primary outcome was pain, stiffness, and physical function measured by the WOMAC index, with secondary measures including quality of life (SF-36), walking endurance, balance, and gluteus medius muscle size assessed by ultrasound. This trial is clinically relevant because many patients experience prolonged impairments in mobility, balance, and strength after THR, and evidence-based guidance on optimal post-operative exercise supervision remains limited. The findings are expected to help clinicians determine whether structured, supervised functional exercise provides meaningful benefits over and above routine care in this population.

The Effects Of Neuromuscular Exercise On Medial Knee Joint Load Post-Arthroscopic Partial Medial Meniscectomy: 'Scopex', A Randomised Control Trial Protocol.

Hall M (2012) · Knee; menisc · PMID: 23181415

This study (the "SCOPEX" trial) is a randomized controlled trial designed to test whether a physiotherapist-supervised, home-based neuromuscular exercise program can reduce harmful loading on the inner (medial) knee joint in people who have recently had a partial meniscus removal (meniscectomy) — a procedure known to increase the risk of knee osteoarthritis. Sixty-two adults aged 30–50 years were randomly assigned to either 12 weeks of neuromuscular exercise (including 8 supervised physiotherapy sessions plus home exercises at least 3 times per week) or a control group receiving no such training. The primary measure of success was change in the "knee adduction moment" — a biomechanical indicator of how much load is placed on the inner knee — assessed during walking and functional movements. Importantly, this paper describes the trial protocol rather than final results, so clinical conclusions about effectiveness cannot yet be drawn. If the intervention proves successful, this exercise approach could offer a practical, non-surgical strategy to help prevent or slow the onset of osteoarthritis following meniscectomy.

The Implementation Of A Community-Based Aerobic Walking Program For Mild To Moderate Knee Osteoarthritis (Oa): A Knowledge Translation (Kt) Randomized Controlled Trial (Rct): Part I: The Uptake Of The Ottawa Panel Clinical Practice Guidelines (Cpgs).

Brosseau L (2012) · Knee · PMID: 23061875

This randomized controlled trial compared three approaches to promoting walking exercise in 222 adults with mild to moderate knee osteoarthritis: a supervised walking program combined with behavioral support and education, supervised walking with education only, and a self-directed group receiving only an educational pamphlet. The supervised walking plus behavioral intervention group showed significantly better short-term adherence at 3 months compared to the self-directed control group, but this advantage did not persist over the longer 6–12 month period. Notably, the group receiving both supervision and behavioral support had lower dropout rates and higher retention at 12 and 18 months, suggesting practical clinical value even when statistical significance was not reached. All three strategies produced comparable long-term outcomes, indicating that a community-based or home walking program with minimal professional support can effectively help manage knee osteoarthritis. Clinicians should consider patient preferences and characteristics when selecting a support strategy, as behavioral coaching may offer an added benefit particularly in the early stages of a walking program.

Effects Of Home-Based Resistance Training And Neuromuscular Electrical Stimulation In Knee Osteoarthritis: A Randomized Controlled Trial.

Bruce-Brand Ra (2012) · Knee · PMID: 22759883

This randomized controlled trial of 41 patients aged 55–75 with moderate-to-severe knee osteoarthritis compared two 6-week home-based interventions — resistance training (RT) and neuromuscular electrical stimulation (NMES) — against a standard care control group. Both active treatments produced significant and comparable improvements in functional capacity (walking, stair climbing, and chair rising) and quadriceps muscle size, with benefits maintained at a 6-week follow-up. Notably, adherence was high in both groups (91% for NMES and 83% for RT), suggesting that home-based delivery is a practical approach for this population. These findings are clinically relevant because they indicate that NMES — which requires less patient effort and may be better tolerated by those with significant pain or mobility limitations — can serve as a viable alternative to traditional exercise therapy. For clinicians, this expands the toolkit for managing knee OA, particularly for patients who struggle with conventional exercise programs.

Improving Maintenance Of Physical Activity In Older, Knee Osteoarthritis Patients Trial-Pilot (Impact-P): Design And Methods.

Focht Bc (2012) · Knee · PMID: 22575796

This pilot randomized controlled trial (IMPACT-P) compared two exercise approaches in 80 older adults with symptomatic knee osteoarthritis: a group-mediated cognitive behavioral (GMCB) intervention—which incorporates psychological strategies to build long-term exercise habits—versus traditional center-based exercise therapy (TRAD). The study's primary focus was on whether participants maintained moderate-intensity physical activity over time, measured both by self-report and objective monitoring, with follow-up assessments at 3 and 12 months. A key challenge the trial aimed to address is the well-documented problem of poor long-term exercise adherence in this patient population. Secondary outcomes included physical function, quality of life, and social cognitive factors, providing a broad picture of patient well-being. Clinically, findings from this study could help guide healthcare providers in choosing exercise delivery strategies that not only improve short-term outcomes but also sustain physical activity participation—a cornerstone of effective osteoarthritis management.

Comparison Of The Efficacy Of Transcutaneous Electrical Nerve Stimulation, Interferential Currents, And Shortwave Diathermy In Knee Osteoarthritis: A Double-Blind, Randomized, Controlled, Multicenter Study.

Atamaz Fc (2012) · Knee · PMID: 22459699

This double-blind randomized controlled trial enrolled 203 patients with knee osteoarthritis across four centers to compare three electrophysical therapy modalities — TENS, interferential currents (IFC), and shortwave diathermy (SWD) — against sham (inactive) versions of each, with all groups also receiving exercise and education. All six groups showed significant improvements in pain, walking speed, range of motion, and quality of life over three to six months, suggesting that exercise and education alone provide meaningful benefit. However, patients receiving active physical therapy used significantly less pain medication (paracetamol) than sham groups at three months, and the IFC group maintained this advantage at six months, indicating a modest additional analgesic benefit from electrophysical agents. The clinical takeaway is that while exercise and education form a strong foundation for knee osteoarthritis management, adjunctive electrophysical therapies — particularly IFC — may reduce patients' reliance on analgesic medication.

Early, Intensified Home-Based Exercise After Total Hip Replacement--A Pilot Study.

Mikkelsen Lr (2012) · Hip · PMID: 22451440

This small Danish pilot study (44 patients) compared two home-based exercise programs following total hip replacement (THR): an intensified program using resistance bands versus standard rehabilitation exercises without added resistance, both lasting 12 weeks. Both groups showed meaningful improvements in walking speed, hip muscle strength, balance, quality of life, and self-reported pain and function — suggesting that early, home-based exercise after THR is feasible and well-tolerated. Importantly, the intensified resistance training group showed high satisfaction rates (100% vs. 85%), though about 17% of patients in that group struggled to perform the exercises independently at home, highlighting that some patients may need professional supervision to safely complete more demanding exercise protocols. A key clinical finding was that hip abductor muscle strength remained significantly weaker on the operated side in both groups even after 12 weeks, underscoring the persistent muscle deficits that rehabilitation must address. While this pilot study is too small to draw definitive conclusions, it provides valuable groundwork for larger trials comparing supervised versus unsupervised intensified exercise rehabilitation after THR.

Feasibility And Efficacy Of An 8-Week Progressive Home-Based Strengthening Exercise Program In Patients With Osteoarthritis Of The Hip And/Or Total Hip Joint Replacement: A Preliminary Trial.

Steinhilber B (2012) · Hip · PMID: 22086491

This small randomized trial (36 participants) investigated whether adding an 8-week home-based strengthening program to already-supervised institutional exercise therapy improved outcomes in patients with hip osteoarthritis or total hip replacement. Participants who combined home exercises with supervised sessions showed meaningful gains in hip muscle strength (7–13% improvements across multiple muscle groups) compared to those receiving supervised therapy alone, while quality of life scores remained unchanged in both groups. Notably, adherence to the home program was exceptionally high at 99%, and participants reported minimal pain during the exercises, suggesting the program is both safe and practical. These findings suggest that supplementing supervised care with a structured home exercise program can meaningfully enhance hip muscle strength, though the study was not powered to detect changes in pain or physical function. Larger trials are needed to confirm these results and determine the ideal frequency and duration of such home-based supplementary programs.

Long-Term Outcomes And Costs Of An Integrated Rehabilitation Program For Chronic Knee Pain: A Pragmatic, Cluster Randomized, Controlled Trial.

Hurley Mv (2012) · Knee · PMID: 21954131

This pragmatic cluster randomized controlled trial enrolled 418 people with chronic knee pain from 54 primary care practices to compare the ESCAPE-knee pain program (combining structured exercise and self-management education) against usual care over up to 30 months. Participants in the ESCAPE program showed large early improvements in physical function as measured by the WOMAC scale, and while these gains modestly declined over time, meaningful benefits in physical function persisted 2.5 years after completing the program. Importantly, the intervention group also incurred significantly lower healthcare costs — including medication and total health and social care costs — with an 80–100% probability of being cost-effective compared to usual care. With 418 participants followed for an unusually long period, this trial provides strong evidence that combining exercise with self-management delivers durable clinical benefits beyond the short-term gains typically reported. For clinicians and patients, these findings suggest that investing in a structured rehabilitation program for knee osteoarthritis can yield lasting functional improvements while simultaneously reducing downstream healthcare utilization and costs.

Efficacy Of Conservative Treatment Regimes For Hip Osteoarthritis--Evaluation Of The Therapeutic Exercise Regime "Hip School": A Protocol For A Randomised, Controlled Trial.

Krauss I (2011) · Hip · PMID: 22114973

This randomized controlled trial compared a structured 12-week "Hip School" exercise program—combining weekly supervised group sessions with twice-weekly home exercises—against a sham ultrasound group, a real ultrasound group, and a non-intervention control group in 217 adults with hip osteoarthritis confirmed by American College of Rheumatology criteria. The primary focus was whether supervised, hip-specific exercise could reduce pain (measured by the SF-36 bodily pain subscale) and improve physical function and quality of life compared to no treatment or placebo-like interventions. Participants were followed up at 16 and 40 weeks post-intervention to assess whether any benefits were sustained over time. This trial is clinically relevant because, despite exercise being widely recommended for hip osteoarthritis, the evidence base at the time of this study was only at "silver level," highlighting a need for higher-quality trial data. Results from this study have the potential to better guide clinicians in recommending structured, partially supervised exercise programs as an effective conservative treatment strategy for hip osteoarthritis.

Effect Of An Integrated Approach Of Yoga Therapy On Quality Of Life In Osteoarthritis Of The Knee Joint: A Randomized Control Study.

Ebnezar J (2011) · Knee · PMID: 22022123

This randomized controlled trial compared integrated yoga therapy (including physical postures, breathing exercises, meditation, and lifestyle education) against standard physiotherapy exercises in 235 patients aged 35–80 with knee osteoarthritis, with both groups also receiving electrical stimulation and ultrasound treatment. Importantly, both interventions were fully supervised at 40 minutes per day, six days per week for two weeks, followed by a three-month follow-up period, meaning this study does not directly address supervised versus unsupervised exercise. The yoga group showed significantly greater improvements in all quality-of-life domains measured by the SF-36 questionnaire at both 15 and 90 days compared to the physiotherapy group. These findings suggest that a holistic, mind-body approach combining physical and psychological components may offer meaningful additional benefits over exercise alone for patients with knee osteoarthritis. Clinicians may consider integrating structured yoga programs as a complementary option alongside conventional physical therapy, particularly for patients open to lifestyle-based interventions.

Effects Of Impairment-Based Exercise On Performance Of Specific Self-Reported Functional Tasks In Individuals With Knee Osteoarthritis.

Teixeira Pe (2011) · Knee · PMID: 22003157

This randomized clinical trial involving 183 people with knee osteoarthritis compared two exercise programs: a standard impairment-based exercise program versus the same program supplemented with agility and perturbation (balance-challenge) training, both delivered in an outpatient physical therapy setting. The key finding was that neither program led to meaningful improvements in patients' self-reported ability to perform specific everyday functional tasks, such as walking, climbing stairs, or rising from a chair. Even when the analysis focused only on participants who started with moderate-to-severe difficulty, the likelihood of significant improvement remained low. This suggests that while impairment-based exercise addresses muscle strength and joint function, it may not directly translate into better performance of real-world daily activities for people with knee OA. Clinicians should consider incorporating task-specific training—exercises that directly practice the functional activities patients struggle with—to achieve more meaningful outcomes.

Feasibility Of An Exercise-Based Rehabilitation Programme For Chronic Hip Pain.

Bearne Lm (2011) · Hip · PMID: 21695751

This small feasibility RCT (n=48) compared a five-week supervised exercise and self-management programme against usual GP care for adults with chronic hip pain. Participants in the supervised programme showed moderate improvements across all outcomes — including physical function, pain, self-efficacy, and mood — immediately after the programme (effect sizes 0.2–0.4), though these gains were not maintained at six months. Importantly, there were no statistically significant differences between the supervised and GP-managed groups, likely reflecting the study's limited power as a feasibility trial rather than true equivalence. Adherence was encouragingly high at 81%, and the programme was well tolerated and practical to deliver in a primary care setting. While results suggest supervised exercise is safe and feasible for hip pain, a larger full-scale RCT is needed to determine whether supervised exercise produces meaningful long-term benefits over unsupervised or GP-led management.

Impact Of An Integrated Health Education And Exercise Program In Middle-Aged Thai Adults With Osteoarthritis Of The Knee.

Piyakhachornrot N (2011) · Knee · PMID: 21422897

This randomized controlled trial compared two exercise delivery settings for middle-aged Thai adults with knee osteoarthritis: a facility-based program versus a supervised home-based program, both combined with a one-day health education session and conducted three times weekly over 12 weeks across 65 participants. Both groups showed meaningful improvements in knee symptom severity, muscle strength, joint range of motion, self-efficacy, and body mass index compared to their starting points. The two approaches produced largely equivalent results, with only muscle strength and right knee flexion showing differences between groups. These findings suggest that supervised home-based exercise is a practical and effective alternative to clinic- or facility-based programs, which is particularly relevant for patients with limited access to exercise facilities. Clinicians can be reassured that pairing health education with either delivery model is a beneficial strategy for managing knee osteoarthritis.

Internet-Based Outpatient Telerehabilitation For Patients Following Total Knee Arthroplasty: A Randomized Controlled Trial.

Russell Tg (2011) · Knee · PMID: 21248209

This randomized controlled trial of 65 patients compared internet-based telerehabilitation to standard in-person outpatient physical therapy over six weeks following total knee replacement surgery. Both groups showed significant improvements across all measured outcomes, including pain, range of motion, muscle strength, and quality of life, demonstrating that telerehabilitation was not inferior to conventional therapy. Notably, the telerehabilitation group actually performed better on two measures: patient-specific functional goals and joint stiffness. These findings are clinically relevant because they suggest that high-quality rehabilitation can be delivered remotely, which is particularly important for patients in rural or underserved areas who face barriers to accessing in-person care. Patient satisfaction with the telerehabilitation platform was also high, supporting its real-world acceptability.

A Pragmatic Randomized Controlled Study Of The Effectiveness And Cost Consequences Of Exercise Therapy In Hip Osteoarthritis.

Juhakoski R (2011) · Hip · PMID: 21078702

This two-year randomized controlled trial compared a combined supervised exercise plus standard GP care program against standard GP care alone in 120 adults (aged 55–80) with radiologically confirmed hip osteoarthritis. The supervised program consisted of 12 weekly exercise sessions initially, plus four booster sessions at one year, with the remainder of exercise performed at home. The key finding was that while supervised exercise produced statistically significant improvements in self-reported physical function (WOMAC function scale) at 6 and 18 months, it did not reduce hip pain, improve performance-based measures, or lower overall healthcare costs compared to GP care alone. Clinically, the functional gains—though statistically significant—were modest, and the largely home-based nature of the program may have limited its overall effectiveness. These results suggest that a low-dose supervised exercise program may offer some short-to-medium-term functional benefit for hip osteoarthritis patients, but more intensive or better-supported exercise interventions may be needed to achieve meaningful pain relief.

Hospital-Based Versus Home-Based Proprioceptive And Strengthening Exercise Programs In Knee Osteoarthritis.

Tunay Vb (2010) · Knee · PMID: 21252603

This randomized controlled trial of 60 patients with knee osteoarthritis compared a supervised hospital-based exercise program (including proprioceptive and functional training) against a home-based exercise program over 6 weeks. Both approaches significantly reduced pain and improved functional ability as measured by WOMAC and the Timed Up and Go test, suggesting that even unsupervised home exercise provides meaningful clinical benefit. However, the hospital-based group showed significantly greater improvements in proprioception, activity-related pain, and physical performance, highlighting the added value of professional supervision and structured neuromuscular training. Notably, home-based exercise alone did not produce statistically significant gains in proprioception, which is an important component of joint stability and fall prevention in OA patients. Clinically, while home exercise remains a viable and accessible option, supervised programs should be considered when proprioceptive deficits or higher functional demands are identified.

Effectiveness Of Aquatic Exercise For Obese Patients With Knee Osteoarthritis: A Randomized Controlled Trial.

Lim Jy (2010) · Knee · PMID: 20709301

This randomized controlled trial compared aquatic exercise (AQE), land-based exercise (LBE), and no exercise (control) in 75 obese patients with knee osteoarthritis over an 8-week program conducted three times per week. The key finding was that aquatic exercise produced significantly greater reductions in pain interference with daily activities compared to land-based exercise, alongside meaningful improvements in disability and quality of life. Notably, only the aquatic exercise group showed a statistically significant reduction in body fat percentage. Both exercise groups outperformed the control group in reducing disability as measured by the widely used WOMAC scale. These results suggest that aquatic exercise may be particularly beneficial for obese patients with knee osteoarthritis who struggle to exercise on land due to pain, offering clinicians a compelling alternative rehabilitation option.

Efficacy Of Patient Education And Supervised Exercise Vs Patient Education Alone In Patients With Hip Osteoarthritis: A Single Blind Randomized Clinical Trial.

Fernandes L (2010) · Hip · PMID: 20633669

This Norwegian randomized trial compared patient education alone versus patient education combined with supervised exercise in 109 adults with mild-to-moderate hip osteoarthritis, following participants for up to 16 months. The primary finding was that adding supervised exercise (12 weeks, at least 16 sessions) did not significantly reduce pain beyond what patient education alone achieved. However, patients who received both interventions showed meaningful improvements in physical function, suggesting that supervised exercise may offer functional benefits even when pain relief is similar between groups. Effect sizes consistently favored the combined program, though wide confidence intervals limit certainty about the true magnitude of benefit. Clinically, this trial suggests that supervised exercise is a worthwhile addition to patient education for improving function in hip osteoarthritis, but managing patient expectations around pain relief specifically remains important.

Whole Body Vibration Compared To Conventional Physiotherapy In Patients With Gonarthrosis: A Protocol For A Randomized, Controlled Study.

Stein G (2010) · PMID: 20565956

This paper describes the protocol for a randomized controlled trial comparing whole body vibration therapy to conventional physiotherapy in patients with knee osteoarthritis (gonarthrosis), conducted at a university hospital outpatient clinic. The study does not yet report results, as it outlines planned methods: 40 patients total (20 per group) will receive either treatment for one hour, three times weekly over six weeks, with follow-up assessments at 6 and 20 weeks post-treatment. Outcomes will include objective measures of motion, balance, and muscle strength, alongside validated patient-reported scores (WOMAC and SF-12). Because this is a protocol publication, no conclusions about effectiveness can yet be drawn, and clinicians should await full trial results before applying findings to practice.

Preoperative Therapeutic Exercise In Frail Elderly Scheduled For Total Hip Replacement: A Randomized Pilot Trial.

Hoogeboom Tj (2010) · Hip · PMID: 20554640

This small pilot trial compared a short, personalized exercise program (3–6 weeks) against usual care in 21 frail elderly patients (average age 76) awaiting total hip replacement for hip osteoarthritis. Patients who exercised showed clinically meaningful improvements in physical performance tests — including chair-rise time and timed-up-and-go — before surgery, and the program was well tolerated with high adherence (91%) and no serious adverse events. However, no significant differences in postoperative recovery or hospital stay were observed between groups. Importantly, 66% of eligible patients declined participation, mainly due to logistical barriers, introducing significant selection bias and limiting the generalizability of findings. The authors conclude that while the exercise program is feasible and appreciated by patients, a larger full-scale trial in this outpatient setting is not recommended due to the recruitment challenges identified.

Behavioural Graded Activity Results In Better Exercise Adherence And More Physical Activity Than Usual Care In People With Osteoarthritis: A Cluster-Randomised Trial.

Pisters Mf (2010) · PMID: 20500136

This cluster-randomised trial compared Behavioural Graded Activity (BGA) — a structured, behavior-based exercise program — to standard physiotherapy care in 200 patients with hip or knee osteoarthritis over 65 weeks. BGA involved 18 supervised sessions over 12 weeks plus up to 7 booster sessions over the following year, while the control group received 18 sessions of usual Dutch physiotherapy guideline-based care. Patients in the BGA group were significantly more likely to adhere to their prescribed exercises at both 13 weeks (OR 4.3) and 65 weeks (OR 3.0), and were also more likely to meet general physical activity recommendations at both time points (OR 5.3 and 2.9, respectively). These findings suggest that incorporating behavioral strategies — such as goal-setting and gradual activity progression — into supervised exercise programs produces meaningful and lasting improvements in both exercise adherence and overall physical activity levels. For clinicians, this highlights the value of behavior-change techniques alongside conventional physiotherapy in the long-term management of hip and knee osteoarthritis.

The Effect Of A Group Education Programme On Pain And Function Through Knowledge Acquisition And Home-Based Exercise Among Patients With Knee Osteoarthritis: A Parallel Randomised Single-Blind Clinical Trial.

Bezalel T (2010) · Knee · PMID: 20420960

This randomized trial of 50 patients aged 65 and older with knee osteoarthritis compared a group education program plus home-based exercise (n=25) against short-wave diathermy treatment (n=25) over a 4-week intervention period with 8-week follow-up. Both groups showed meaningful improvements in pain and physical function at 4 weeks, as measured by the WOMAC questionnaire and functional movement tests; however, the key distinction emerged at follow-up, where only the education and home exercise group continued to improve, showing a clinically significant 9-point advantage in total WOMAC score over controls. These findings suggest that empowering patients through structured education and self-directed exercise produces more durable benefits than passive physical therapy alone, even when the initial responses appear similar. For clinicians, this supports integrating patient education and home exercise programs into routine osteoarthritis management, particularly for older adults, though longer-term studies are needed to confirm how well these gains are sustained beyond 12 weeks.

Supervised Exercise Versus Usual Care For Patellofemoral Pain Syndrome.

Hart L (2010) · PMID: 20215901

This Dutch multicenter randomized controlled trial (n=131, ages 14–40) compared a supervised physical therapist-led exercise program (9 sessions over 3 months, targeting quadriceps, adductor, and gluteal muscles) against usual care for patellofemoral pain syndrome (PFPS). At 3 months, supervised exercise produced meaningfully greater short-term improvements in pain at rest and during activity, and patients reported faster functional gains, though these functional differences faded by 12 months. Importantly, overall perceived recovery rates were similar between groups at both time points, suggesting that while supervision accelerates symptom relief, it may not change patients' ultimate sense of being "fully recovered." Both groups showed progressive pain reduction over the year, indicating that even unsupervised home exercise with basic education provides meaningful benefit. Clinically, supervised exercise appears most valuable in the early phase of PFPS management to accelerate pain reduction and functional recovery, but long-term outcomes may be comparable to a simpler, lower-cost approach.

A Randomized Study Of The Effects Of T'ai Chi On Muscle Strength, Bone Mineral Density, And Fear Of Falling In Women With Osteoarthritis.

Song R (2010) · PMID: 20192907

This randomized controlled trial compared 6 months of supervised t'ai chi exercise against a control condition in 65 older women (mean age ~62 years) with osteoarthritis. Women who practiced t'ai chi showed meaningful improvements in knee muscle endurance, bone mineral density at multiple hip sites, and a significant reduction in fear of falling compared to controls. Notably, raw muscle strength (peak torque) did not differ significantly between groups, suggesting t'ai chi's benefits may be more relevant to functional endurance than maximal strength. These findings are clinically relevant because improved bone density and reduced fear of falling could lower fracture risk in this vulnerable population. However, the modest sample size and lack of long-term follow-up mean these results should be interpreted cautiously, and larger confirmatory studies are needed.

A Comparison Of Strength Training, Self-Management, And The Combination For Early Osteoarthritis Of The Knee.

Mcknight Pe (2010) · Knee · PMID: 20191490

This 24-month randomized trial (n=273, ages 35–64) compared three approaches for early knee osteoarthritis: strength training alone, self-management education alone, and a combination of both. All three groups showed meaningful improvements in physical function (leg press, balance, stair climbing, range of motion, and work capacity) as well as reductions in pain and disability, with effect sizes ranging from moderate to large. Crucially, no significant differences were found between the three groups, meaning none was clearly superior to the others. With roughly three-quarters of participants completing the trial and compliance ranging from 56–69%, these findings suggest that self-management education alone may be the most practical, least burdensome option, since it produced comparable benefits with likely lower patient effort and cost. Clinically, this supports offering flexible, patient-centered treatment choices for middle-aged adults with mild knee osteoarthritis rather than defaulting to more intensive supervised programs.

Hip Strengthening Reduces Symptoms But Not Knee Load In People With Medial Knee Osteoarthritis And Varus Malalignment: A Randomised Controlled Trial.

Bennell Kl (2010) · Hip; knee · PMID: 20175973

This randomized controlled trial compared a 12-week physiotherapist-supervised hip strengthening home exercise program against no intervention in 89 participants with medial knee osteoarthritis and varus (bow-leg) malalignment. The key finding was that while hip abductor and adductor strengthening significantly improved pain, physical function, and muscle strength, it did not reduce the mechanical load on the inner (medial) compartment of the knee as measured by the knee adduction moment. Participants in the exercise group were approximately 20 times more likely to report overall improvement compared to the control group, highlighting meaningful symptomatic benefit. However, because knee joint loading was unchanged, hip strengthening alone is unlikely to slow the structural progression of osteoarthritis in this population. Clinically, this program can be recommended for symptom management but should not be positioned as a disease-modifying intervention for patients with varus-aligned medial knee osteoarthritis.

Is A Formal Physical Therapy Program Necessary After Total Shoulder Arthroplasty For Osteoarthritis?

Mulieri Pj (2010) · Shoulder · PMID: 19800258

This study compared two rehabilitation approaches after total shoulder replacement surgery for osteoarthritis: formal physical therapy (43 patients) versus a home-based program guided by the physician (38 patients). Both groups showed meaningful improvements in shoulder function and pain scores at 3, 6, and 12 months post-surgery, and there were no significant differences in standardized shoulder scores (ASES and SST) between groups at final follow-up. Notably, the home-based group actually achieved better range of motion (forward flexion and abduction) and better physical quality-of-life scores at final follow-up, while patient satisfaction was high and comparable in both groups (88% vs. 95%). These findings suggest that a structured home-based rehabilitation program, when guided by the treating physician, may be a clinically equivalent and more cost-effective alternative to formal physical therapy after total shoulder arthroplasty. Clinicians and patients should consider that supervised home exercise may reduce the overall cost burden without compromising outcomes.

Early Maximal Strength Training Is An Efficient Treatment For Patients Operated With Total Hip Arthroplasty.

Husby Vs (2009) · Hip · PMID: 19801053

This small randomized controlled trial (N=24) compared two rehabilitation approaches in patients who had undergone total hip arthroplasty (THA) for osteoarthritis: an intensive maximal strength training program (leg press and hip abduction, 5 days/week) added to standard care versus conventional supervised rehabilitation alone (3–5 days/week), both lasting 4 weeks beginning just one week after surgery. The strength training group showed significantly greater improvements in leg press strength and hip abduction strength in both the operated and non-operated limbs, along with faster rate of force development, suggesting broader neuromuscular benefits. There was also a trend toward better walking efficiency in the strength training group, though no meaningful differences in gait patterns were detected between groups. Importantly, beginning high-intensity strength training as early as one week post-surgery was found to be safe and feasible in this population, challenging more conservative rehabilitation timelines. While the small sample size limits generalizability, these findings suggest that early, structured maximal strength training may offer meaningful functional advantages over conventional rehabilitation for THA patients and warrants further investigation in larger trials.

Effects Of Dietary Intervention And Quadriceps Strengthening Exercises On Pain And Function In Overweight People With Knee Pain: Randomised Controlled Trial.

Jenkinson Cm (2009) · Knee · PMID: 19690345

This pragmatic randomized controlled trial enrolled 389 overweight or obese adults (BMI ≥28) aged 45 and over with knee pain across five UK general practices, comparing four groups: exercise alone, diet alone, exercise plus diet, and a control group receiving only an advice leaflet. After two years, participants who performed home-based quadriceps strengthening exercises showed a statistically significant and clinically meaningful reduction in knee pain (moderate effect size of 0.25) and improved physical function compared to non-exercisers, with a number needed to treat of just 9 for a ≥30% pain improvement. Dietary intervention achieved modest but sustained weight loss of nearly 3 kg more than the control group, which was associated with reduced depression but did not translate into measurable improvements in knee pain or function. Notably, this trial did not specifically compare supervised versus unsupervised exercise — rather, all exercise was delivered as a home-based, self-managed program, highlighting that structured but unsupervised exercise can still produce meaningful clinical benefits. For clinicians and patients, these findings support prescribing simple home-based knee strengthening exercises as an effective, accessible intervention for overweight individuals with knee osteoarthritis symptoms.

Long-Term Clinical Benefits And Costs Of An Integrated Rehabilitation Programme Compared With Outpatient Physiotherapy For Chronic Knee Pain.

Jessep Sa (2009) · Knee · PMID: 19627690

This pragmatic randomized controlled trial compared a community-based integrated rehabilitation program (ESCAPE-knee pain, combining exercise and self-management) with standard outpatient physiotherapy in 64 adults with chronic knee pain, likely due to osteoarthritis. Both approaches produced similar and sustained improvements in physical function, pain, and psychosocial outcomes at 12 months, suggesting that supervision format did not significantly alter clinical effectiveness. However, the ESCAPE-knee pain program was notably more cost-effective, costing approximately £64 per person compared to £130 for outpatient physiotherapy, with participants also incurring lower overall healthcare utilization costs over one year (£320 vs. £583). These findings are clinically relevant because they suggest that a structured, community-delivered self-management and exercise program can match the outcomes of traditional supervised physiotherapy at roughly half the cost. For clinicians and healthcare systems managing high volumes of knee osteoarthritis patients, ESCAPE-knee pain represents a feasible, scalable, and economical alternative to conventional outpatient care.

Comparison Of Two Methods Of Conducting The Fit And Strong! Program.

Seymour Rb (2009) · PMID: 19565560

This study compared two ways of delivering the "Fit and Strong!" exercise program for older adults with osteoarthritis: instruction by physical therapists (PTs) versus nationally certified exercise instructors (CEIs). The program involved 90-minute group sessions three times per week for 8 weeks, with 351 participants total assessed at baseline, 8 weeks, and 6 months. Both groups showed significant and comparable improvements in lower-extremity strength, aerobic capacity, pain, stiffness, and physical function, with no meaningful differences in outcomes between the two instructor types. The only notable advantages favoring PT-led classes were in two psychological measures — self-efficacy for exercise and confidence in overcoming barriers — though attendance and participant satisfaction were identical across both groups. These findings suggest that certified exercise instructors can effectively deliver this evidence-based program, making it feasible to scale it into broader community settings without sacrificing clinical outcomes.

Therapeutic Home Exercise Versus Intraarticular Hyaluronate Injection For Osteoarthritis Of The Knee: 6-Month Prospective Randomized Open-Labeled Trial.

Kawasaki T (2009) · Knee · PMID: 19337810

This 6-month randomized trial compared home exercise programs against hyaluronic acid (HA) injections in 102 older women (average age 70) with knee osteoarthritis, finding that both treatments produced similar improvements in pain and physical function across all three measurement scales used. Notably, home exercise appeared to offer some advantages, particularly in improving range of motion at 24 weeks and in reducing joint fluid buildup (hydrops) in patients with early-stage osteoarthritis. The stage of osteoarthritis at the start of treatment was an important factor influencing outcomes, with early OA responding especially well to exercise. Given that home exercise is non-invasive, lower cost, and more convenient than repeated injections, the authors conclude it holds meaningful practical advantages for managing knee osteoarthritis. Clinicians may consider prioritizing structured home exercise — particularly for patients with early-stage disease — before pursuing injectable therapies.

Effects Of A Hand-Joint Protection Programme With An Addition Of Splinting And Exercise: One Year Follow-Up.

Boustedt C (2009) · Hand · PMID: 19294479

This study compared two approaches for managing thumb base osteoarthritis in 42 women: a joint protection (JP) program alone versus a JP program combined with daytime/nighttime splinting, hot packs, and home exercises. The combined treatment group showed significantly greater improvements in pain, stiffness, grip strength, and ability to perform daily activities, with benefits lasting through a one-year follow-up. The joint protection-only group showed some short-term gains in pain and daily function, but these improvements did not persist at one year. These findings suggest that adding splinting and a structured home exercise regimen to a joint protection program provides meaningful and durable clinical benefits for patients with thumb base osteoarthritis. Clinicians should consider incorporating these additional components into standard joint protection programs to achieve longer-lasting outcomes for this patient population.

Effect Of Whole Body Vibration Exercise On Muscle Strength And Proprioception In Females With Knee Osteoarthritis.

Trans T (2009) · Knee · PMID: 19147365

This randomized controlled trial examined the effects of whole body vibration (WBV) exercise on 52 women with knee osteoarthritis, comparing vibration on a stable platform, vibration on a balance board, and a control group over 8 weeks of twice-weekly training. Women who exercised on the stable vibration platform showed significant improvements in knee muscle strength, particularly in isometric knee extension, while those using the balance board showed meaningful gains in proprioception (the ability to sense joint position and movement). Importantly, both forms of WBV exercise appeared safe and time-efficient, though neither approach led to self-reported improvements in overall disease status as measured by the WOMAC questionnaire. With a modest sample size of 52 participants, these findings should be interpreted cautiously, but they suggest that clinicians may be able to tailor WBV exercise type based on the specific rehabilitation goal — stable platform for strength, balance board for proprioception. For patients with knee osteoarthritis, WBV exercise represents a promising, low-burden addition to rehabilitation programs, though larger trials are needed to confirm these benefits and assess long-term outcomes.

Resistive Exercise For Arthritic Cartilage Health (Reach): A Randomized Double-Blind, Sham-Exercise Controlled Trial.

Lange Ak (2009) · PMID: 19144148

The REACH trial was a randomized controlled trial comparing high-intensity supervised progressive resistance training (exercising at 80% of peak strength, 3 days/week for 6 months) against a sham-exercise control group in women over 40 with knee osteoarthritis, with the primary goal of determining whether structured strength training could slow or modify cartilage degeneration as measured by MRI. This was notably the first known RCT designed to examine whether resistance training could directly protect joint cartilage—a question with significant disease-modifying implications—rather than simply improving pain or function. Secondary outcomes captured a broad clinical picture, including walking endurance, muscle strength, balance, body composition, pain, disability, and quality of life, assessed at 3 and 6 months. The sham group performed similar exercises without added resistance or progression, providing a strong methodological control that helps isolate the specific effects of exercise intensity and supervision. These findings are clinically relevant because if supervised progressive resistance training can preserve cartilage integrity, it could shift osteoarthritis management from purely symptomatic treatment toward a more proactive, disease-modifying approach accessible without pharmacological intervention.

Exercise And Hand Osteoarthritis Symptomatology: A Controlled Crossover Trial.

Rogers Mw (2009) · Hand · PMID: 19013758

This randomized crossover trial compared 16 weeks of daily home-based hand exercises against a sham treatment in 46 older adults with hand osteoarthritis (OA), with the primary goal of measuring improvements in physical function using the AUSCAN scale. The study found no significant differences between the exercise and sham groups in the key outcomes of function, pain, or stiffness, and no improvements in dexterity were observed. However, grip and pinch strength showed modest improvements following the exercise program but not after sham treatment, suggesting some physical benefit. The authors noted that the exercise protocol may have been too demanding for this older population, which could have limited adherence and effectiveness. Clinically, these findings suggest that while unsupervised home exercise alone may not reliably improve overall hand OA symptoms, targeted strength training may still offer limited benefits, and future research should explore better-tailored or supervised exercise approaches.

Does Knee Malalignment Mediate The Effects Of Quadriceps Strengthening On Knee Adduction Moment, Pain, And Function In Medial Knee Osteoarthritis? A Randomized Controlled Trial.

Lim Bw (2008) · Knee · PMID: 18576289

This randomized controlled trial of 107 adults with medial knee osteoarthritis compared 12 weeks of supervised home-based quadriceps strengthening against no intervention, with participants stratified by whether they had varus (bow-legged) knee malalignment or more neutral alignment. The key finding was that quadriceps strengthening did not meaningfully reduce the knee adduction moment — a biomechanical measure of load on the inner knee — in either alignment group. However, patients with more neutral knee alignment experienced significant pain relief from the exercise program, while those with varus malalignment did not show the same benefit. Importantly, functional outcomes did not improve significantly in either group. These findings suggest that a patient's knee alignment is a clinically relevant factor that may predict who will respond to quadriceps strengthening, and clinicians should consider assessing alignment before recommending this exercise as a primary pain management strategy.

[Effectiveness Of A Community Health Service Program Using Exercise Intervention For Elderly People With Osteoarthritis Of The Knees: A Randomized Controlled Trial].

Oida Y (2008) · Knee · PMID: 18536337

This randomized controlled trial of 88 community-dwelling elderly Japanese adults with knee osteoarthritis compared a supervised group exercise program (8 sessions over 3 months, combined with daily home exercises) against a control group receiving no structured intervention. The supervised program included stretching, resistance band strengthening, and functional movement exercises, and produced statistically significant improvements across all key outcomes — including pain (WOMAC), muscle strength, joint range of motion, and standing and walking ability — compared to the control group. Effect sizes were particularly strong for functional tasks such as walking (1.13) and standing (0.81), suggesting meaningful real-world benefits beyond statistical significance. With a modest sample of 88 participants, these findings should be interpreted cautiously, though they align with existing evidence supporting exercise as a core treatment for knee OA. Clinically, this study reinforces that even a brief, community-based supervised exercise program can deliver measurable improvements in pain and physical function for older adults with knee osteoarthritis, supporting its integration into public health service delivery.

Saskatoon In Motion: Class- Versus Home-Based Exercise Intervention For Older Adults With Chronic Health Conditions.

Reeder Ba (2008) · PMID: 18209255

This randomized controlled trial enrolled 172 sedentary older adults with chronic conditions (including osteoarthritis, diabetes, hypertension, and dyslipidemia) to compare a supervised class-based exercise program against an unsupervised home-based program over 3 months. Both groups showed meaningful improvements in walking distance, physical performance, functional fitness, and blood pressure control, suggesting that exercise itself — regardless of supervision — drives significant health benefits. The supervised class-based group showed additional gains in self-reported physical activity levels, quality of life scores, and functional fitness compared to the home-based group. With 172 participants and comparable outcomes between groups, these findings are clinically relevant: home-based exercise may be a practical and effective alternative for patients who face barriers to attending supervised classes. Clinicians can feel confident prescribing either format, though supervised programs may offer a modest edge in some functional and quality-of-life outcomes.

Economic Evaluation Of A Rehabilitation Program Integrating Exercise, Self-Management, And Active Coping Strategies For Chronic Knee Pain.

Hurley Mv (2007) · Knee · PMID: 17907207

This study evaluated the cost-effectiveness of the ESCAPE-knee pain program — a rehabilitation approach combining exercise, self-management, and coping strategies for chronic knee pain — compared to usual primary care, and also compared individual versus group delivery formats. Researchers found that rehabilitation cost approximately £224 more per person than usual care, but had a 90% probability of being cost-effective at a willingness-to-pay threshold of £1,900 for functional improvements. Group-based rehabilitation (8 participants) was substantially cheaper (£125/person) than individual rehabilitation (£314/person), while achieving similar clinical outcomes. Importantly, no meaningful differences in quality-adjusted life years (QALYs) were observed across groups, suggesting functional improvement rather than quality-of-life change was the primary driver of cost-effectiveness. For clinicians and health systems, group delivery of this structured rehabilitation program appears to offer the best balance of clinical benefit and resource efficiency for patients with chronic knee osteoarthritis.

Clinical Effectiveness Of A Rehabilitation Program Integrating Exercise, Self-Management, And Active Coping Strategies For Chronic Knee Pain: A Cluster Randomized Trial.

Hurley Mv (2007) · Knee · PMID: 17907147

This cluster randomized trial of 418 adults aged 50 and older with chronic knee pain compared a structured rehabilitation program (ESCAPE-knee pain) — combining exercise, self-management, and coping strategies — against usual primary care. Participants who completed the rehabilitation program showed significantly better physical functioning at 6 months, as measured by the WOMAC score, compared to those who received only standard care. Importantly, the program was equally effective whether delivered one-on-one or in groups of eight patients, suggesting that group delivery is a viable and potentially more cost-efficient option. The intervention was well tolerated, with only 1% of participants withdrawing due to adverse events. For clinicians and patients, this evidence supports structured rehabilitation as a safe, practical alternative or complement to conventional primary care management of knee osteoarthritis.

Severe Knee Osteoarthritis: A Randomized Controlled Trial Of Acupuncture, Physiotherapy (Supervised Exercise) And Standard Management For Patients Awaiting Knee Replacement.

Williamson L (2007) · Knee · PMID: 17604311

This three-arm randomized controlled trial enrolled 181 patients with severe knee osteoarthritis who were already on a waiting list for knee replacement surgery, comparing six weeks of acupuncture, supervised physiotherapy exercise, or standard advice alone. Acupuncture produced a modest but statistically significant short-term improvement in knee pain and function scores (Oxford Knee Score) at seven weeks compared to standard care, though this benefit disappeared by 12 weeks and no meaningful differences were found between physiotherapy and standard advice. There was a non-significant trend suggesting that patients in the physiotherapy group had a slightly shorter hospital stay after surgery (6.5 vs. 7.8 days), which warrants further investigation. The study did not demonstrate any lasting or clinically substantial advantages for either active intervention over standard management in this severely affected population. Both treatments were safely and feasibly delivered in a group outpatient setting, suggesting logistical practicality for healthcare systems, but further research is needed before strong clinical recommendations can be made.

Group And Home-Based Tai Chi In Elderly Subjects With Knee Osteoarthritis: A Randomized Controlled Trial.

This 18-week randomized controlled trial compared a structured Tai Chi program against health education lectures in 41 older adults (average age 70) with knee osteoarthritis, examining whether a transition from supervised group sessions to independent home practice could sustain benefits. Participants who completed six weeks of supervised group Tai Chi (three 40-minute sessions per week) followed by six weeks of home-based practice showed meaningful improvements in knee pain, physical function, and joint stiffness compared to baseline and the control group—particularly at weeks 9 and 12. The control group, which attended health lectures only, showed no measurable improvement in any outcome. Importantly, all gains in the Tai Chi group disappeared within six weeks of stopping practice, highlighting that continued exercise adherence is essential for maintaining benefits. Clinically, these findings suggest that a supervised-to-home Tai Chi transition model is a viable, low-risk intervention for knee osteoarthritis symptom management, though patients should be counseled that benefits are not sustained without ongoing participation.

Effects Of Strength Training On The Incidence And Progression Of Knee Osteoarthritis.

Mikesky Ae (2006) · Knee · PMID: 17013851

This 30-month randomized controlled trial compared strength training (ST) to range-of-motion (ROM) exercises in 221 older adults (average age 69) to assess effects on knee osteoarthritis (OA) incidence and progression. Participants exercised three times per week, with sessions initially supervised at a fitness facility before transitioning to home-based exercise after 12 months. The key finding was that strength training helped preserve muscle strength better than ROM exercises and was associated with a trend toward less frequent joint space narrowing progression in knees already affected by OA (18% vs. 28%), though this did not reach full statistical significance. A concerning and unexplained finding was that strength training was associated with greater rates of new joint space narrowing in knees that appeared radiographically normal at the start of the study (34% vs. 19%). Clinicians should interpret these results cautiously, as the benefits of strength training for existing OA appear promising, but the unexpected signal of possible harm in healthy knees warrants further investigation before definitive exercise recommendations can be made.

Cost-Effectiveness Of A Supplementary Class-Based Exercise Program In The Treatment Of Knee Osteoarthritis.

Richardson G (2006) · Knee · PMID: 16673684

This study compared a combined approach of supervised class-based exercise plus home exercise versus home exercise alone for people with knee osteoarthritis, evaluating not just effectiveness but also cost-efficiency. The supervised group-based program resulted in both improved quality of life (measured in QALYs) and lower overall costs compared to home exercise alone, a notably favorable outcome since interventions typically improve outcomes at added expense. Across all reasonable assumptions about how much healthcare systems are willing to pay for health gains, the supervised class program remained the more cost-effective option. While the exact sample size is not reported in this abstract, the findings were drawn from a formal randomized controlled trial with prospectively collected resource use and outcome data. Clinically, these results suggest that adding supervised group exercise sessions to a home program for knee osteoarthritis patients is not only beneficial for patient outcomes but is also a sound use of healthcare resources.

Physiotherapy Rehabilitation After Total Knee Or Hip Replacement: An Evidence-Based Analysis.

(2005) · Knee; hip · PMID: 23074477

This Ontario health technology analysis examined where and how physiotherapy is best delivered after first-time total hip or knee replacement surgery. Researchers systematically reviewed evidence comparing inpatient rehabilitation versus outpatient (clinic- or home-based) physiotherapy, supervised physiotherapy versus home exercise programs alone, and whether pre-surgical exercise provides benefit. The review covered studies published from 1995–2005 and focused primarily on functional recovery outcomes. Findings were intended to guide Ontario health policy on optimal, cost-effective rehabilitation delivery for this common surgical population.

Physical Therapy Treatment Effectiveness For Osteoarthritis Of The Knee: A Randomized Comparison Of Supervised Clinical Exercise And Manual Therapy Procedures Versus A Home Exercise Program.

Deyle Gd (2005) · Knee · PMID: 16305269

This randomized controlled trial compared two physical therapy approaches for 134 patients with knee osteoarthritis: a clinic-based program combining supervised exercise, manual therapy, and home exercises versus a home exercise program alone over 4 weeks. Both groups showed meaningful improvements in pain, function (measured by the WOMAC questionnaire), and walking distance, but the clinic-based group improved roughly twice as much in WOMAC scores at 4 weeks (52% vs. 26%). Importantly, by one year, both groups had maintained similar levels of improvement, likely because all participants continued the same home exercise routine. Patients receiving supervised clinic care were also more satisfied with their treatment and less reliant on arthritis medications. These findings suggest that while home exercise alone provides real benefit for knee OA, adding even a limited number of supervised clinic visits with manual therapy produces faster and greater short-term relief.

Positive Effects Of Moderate Exercise On Glycosaminoglycan Content In Knee Cartilage: A Four-Month, Randomized, Controlled Trial In Patients At Risk Of Osteoarthritis.

Roos Em (2005) · Knee · PMID: 16258919

This randomized controlled trial compared 4 months of supervised exercise (three sessions per week) against no intervention in 45 adults who had previously undergone partial meniscus removal, a group at elevated risk for knee osteoarthritis. Using a specialized MRI technique (dGEMRIC) to measure cartilage glycosaminoglycan (GAG) content — a marker of cartilage health and shock-absorbing capacity — the exercise group showed meaningful improvement compared to controls (+15 ms vs. -15 ms in T1(Gd) values, p=0.036). A strong dose-response relationship was also observed, meaning participants who increased their physical activity the most tended to show the greatest cartilage benefit. Although the study is limited by a modest sample size (30 of 45 completed imaging), these findings suggest that adult cartilage retains the ability to adapt positively to mechanical loading. For clinicians and patients, this provides encouraging biological evidence that moderate supervised exercise may not only relieve symptoms but may actively support cartilage preservation in those at high risk of developing osteoarthritis.

Randomised Controlled Trial Of The Cost-Effectiveness Of Water-Based Therapy For Lower Limb Osteoarthritis.

Cochrane T (2005) · PMID: 16095546

This UK-based randomised controlled trial compared one year of supervised group water-based exercise in public swimming pools against usual care (no structured exercise) in 312 older adults (aged 60+) with confirmed hip and/or knee osteoarthritis. The water exercise programme produced meaningful short-term improvements in pain and physical function, with effect sizes of 0.44 for pain and 0.76 for physical function, and achieved approximately a 10% reduction in pain scores at one year; however, these benefits faded and became non-significant once supervised support was withdrawn at 18 months, highlighting that ongoing engagement is critical to sustaining gains. Compliance was reasonable during the supervised period (54% at one year) but dropped sharply to just 18% when patients had to self-fund continued participation, underscoring the importance of removing financial barriers to exercise adherence. Importantly, the programme was cost-effective, generating savings of approximately £123–175 per patient per year and a cost per quality-adjusted life-year (QALY) of £3,838–5,951, which compares favourably against standard healthcare thresholds. These findings suggest that supervised, community-based water exercise is a clinically relevant and economically viable adjunct therapy for older patients with lower limb osteoarthritis, though sustaining long-term benefits will require strategies to support continued participation beyond formal programme delivery.

Cost Effectiveness Of A Two-Year Home Exercise Program For The Treatment Of Knee Pain.

Thomas Ks (2005) · Knee · PMID: 15934131

This randomized controlled trial enrolled 759 adults aged 45 and older with knee pain, comparing four approaches: a home exercise program, monthly telephone support, both combined, or no intervention, over two years. The study found that exercise therapy did lead to meaningful improvements in self-reported knee pain compared to no intervention. However, participants who exercised actually incurred higher overall medical costs (approximately £225 more on average) rather than generating savings through reduced healthcare use. The direct costs of delivering the exercise program (£112) and telephone support (£61) were modest, but these were not offset by reductions in other medical resource use. Clinically, while home exercise remains a worthwhile treatment for knee osteoarthritis pain, healthcare systems and patients should be aware that it is unlikely to save money and should be valued primarily for its health benefits rather than cost-offset potential.

Six-Week High-Intensity Exercise Program For Middle-Aged Patients With Knee Osteoarthritis: A Randomized Controlled Trial [Isrctn20244858].

Thorstensson Ca (2005) · Knee · PMID: 15924620

This randomized controlled trial compared a 6-week supervised high-intensity exercise program (twice weekly, ≥60% max heart rate) against no intervention in 61 middle-aged adults (ages 36–65) with moderate-to-severe knee osteoarthritis. The study found no significant differences between the exercise and control groups in pain, symptoms, or physical function at either the 6-week or 6-month follow-up points. However, participants in the supervised exercise group showed a modest but statistically significant improvement in quality of life compared to controls, a benefit that persisted at 6 months. These findings suggest that short-term high-intensity supervised exercise alone may not be sufficient to meaningfully reduce pain or improve function in middle-aged patients with advanced knee OA, though it may offer some quality-of-life benefit. Clinicians should consider that this patient population — younger and with more severe radiographic OA than typically studied — may require longer or differently structured interventions to achieve broader symptom relief.

Costs And Effectiveness Of Pre- And Post-Operative Home Physiotherapy For Total Knee Replacement: Randomized Controlled Trial.

Mitchell C (2005) · Knee · PMID: 15869558

This randomized controlled trial compared home-based physiotherapy versus hospital outpatient physiotherapy for 160 patients with osteoarthritis undergoing total knee replacement (TKR), examining both pre- and post-operative care. With 80 patients in each group, the study found no significant differences in pain, health-related quality of life, or patient satisfaction between the two settings, meaning home physiotherapy was equally effective. However, home physiotherapy required significantly more sessions (approximately 5 additional visits) and cost around £136 more per patient than hospital-based care. While patients in the home group were slightly more likely to choose their care setting again, the overall NHS costs per patient were not significantly different when all healthcare resources were considered. For clinicians and patients, this suggests that home physiotherapy is a clinically equivalent but modestly more expensive alternative, and that adding pre-operative home physiotherapy does not provide measurable additional benefit for TKR outcomes.

Self-Management In Osteoarthritis Of Hip Or Knee: A Randomized Clinical Trial In A Primary Healthcare Setting.

Heuts Ph (2005) · Hip; knee · PMID: 15742451

This randomized controlled trial compared a physiotherapist-led self-management program against usual care in 273 middle-aged adults (ages 40–60) with hip and/or knee osteoarthritis in a primary care setting over 21 months. Patients who received structured self-management instruction showed meaningful improvements in knee pain (measured by VAS) and physical function (measured by WOMAC), while the control group remained stable or slightly declined. Notably, the benefits of the self-management program grew larger over time rather than fading, with statistically significant differences between groups strengthening from 3 to 21 months. These findings suggest that teaching patients practical self-management strategies—delivered by physiotherapists within general practice—can produce lasting improvements in pain and function for osteoarthritis patients. Clinically, this supports integrating structured self-management education into routine primary care for middle-aged OA patients as a cost-effective, sustainable approach to symptom management.

Resistance Training In The Early Postoperative Phase Reduces Hospitalization And Leads To Muscle Hypertrophy In Elderly Hip Surgery Patients--A Controlled, Randomized Study.

Suetta C (2004) · Hip · PMID: 15571536

This randomized controlled trial of 36 elderly patients (aged 60–86) undergoing hip replacement compared three rehabilitation approaches: standard home-based rehabilitation, electrical muscle stimulation, and supervised resistance training over 12 weeks. Patients in the supervised resistance training group had notably shorter hospital stays (10 days vs. 16 days), along with meaningful gains in muscle size (12%), strength (22–28%), and functional performance (30%) compared to standard care. Electrical stimulation provided modest improvements in functional performance (15%) but did not increase muscle size or strength. These findings suggest that structured, supervised resistance training begun early after hip surgery offers substantial clinical benefits for older adults, including faster discharge and greater physical recovery. Clinicians should consider integrating supervised resistance training into standard postoperative protocols for elderly hip replacement patients.

Effects Of Spouse-Assisted Coping Skills Training And Exercise Training In Patients With Osteoarthritic Knee Pain: A Randomized Controlled Study.

Keefe Fj (2004) · Knee · PMID: 15288394

This randomized controlled trial enrolled 72 married patients with persistent osteoarthritis knee pain and their spouses, comparing four approaches: spouse-assisted coping skills training (SA-CST) alone, exercise training (ET) alone, a combined SA-CST plus ET program, and standard care. The combined SA-CST plus ET intervention produced the broadest benefits, improving physical fitness, leg strength, pain coping strategies, and self-efficacy compared to standard care or either intervention alone. Exercise training (with or without coping skills training) significantly improved physical fitness and leg strength, while coping skills training (with or without exercise) enhanced patients' ability to manage pain and boosted confidence in their own capabilities. Notably, patients in the combined group who gained greater self-efficacy were also more likely to experience reductions in psychological disability. These findings suggest that integrating spousal support, psychological coping strategies, and supervised exercise offers a more comprehensive benefit for OA patients than any single approach alone.

Management Of Osteoarthritis (Oa) With An Unsupervised Home Based Exercise Programme And/Or Patient Administered Assessment Tools. A Cluster Randomised Controlled Trial With A 2x2 Factorial Design.

Ravaud P (2004) · PMID: 15140778

This 24-week cluster randomized trial involving 2,957 osteoarthritis patients compared four approaches: standardized self-assessment diary tools, an unsupervised home-based exercise program (using video and booklet), both combined, or usual care alone — with all patients also receiving the anti-inflammatory drug rofecoxib. After 24 weeks, pain and physical function improved meaningfully across all four groups, but there were no statistically significant differences between groups, suggesting the exercise and diary interventions added no measurable short-term symptom benefit beyond medication alone. Notably, patients in the exercise groups reported greater satisfaction with their care, feeling their doctor had actively supported their physical function. The findings challenge the assumption that unsupervised home exercise provides symptomatic benefits comparable to supervised programs, and suggest that when effective pharmacological treatment is already in place, adding unsupervised exercise or self-monitoring diaries may not further reduce pain or improve function. Clinically, this highlights the importance of supervision and engagement in exercise programs for OA, while also suggesting patient satisfaction and perceived quality of care may be improved by prescribing home exercise regardless of objective symptom outcomes.

Supplementing A Home Exercise Programme With A Class-Based Exercise Programme Is More Effective Than Home Exercise Alone In The Treatment Of Knee Osteoarthritis.

Mccarthy Cj (2004) · Knee · PMID: 15113993

This randomized controlled trial of 214 patients with confirmed knee osteoarthritis compared a home exercise program alone against a home exercise program supplemented with an 8-week, twice-weekly supervised class-based program. At 12-month follow-up, patients who attended the supervised classes showed significantly greater improvements in walking speed (3.7 seconds faster) and reduced walking pain (15mm lower on a visual scale) compared to those doing home exercise alone. These gains were clinically meaningful and persisted well beyond the end of the supervised program, suggesting lasting benefits from the structured group intervention. This was the first trial to formally evaluate this widely used physiotherapy approach, and the findings provide strong evidence to support recommending supervised class-based exercise as a valuable addition to home programs for knee osteoarthritis patients.

Effectiveness Of Intensive Rehabilitation On Functional Ability And Quality Of Life After First Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial.

Moffet H (2004) · Knee · PMID: 15083429

This randomized controlled trial compared an intensive functional rehabilitation (IFR) program to standard care in 77 patients who had undergone total knee replacement (TKA) for osteoarthritis. The IFR group received 12 supervised rehabilitation sessions combined with home exercises between months 2 and 4 after surgery, while the control group received usual care. Patients in the supervised IFR program walked approximately 23–26 meters farther in 6 minutes and reported less pain, stiffness, and difficulty with daily activities at multiple follow-up points compared to the standard care group. Quality of life improvements in favor of the IFR group were also observed at the 4-month follow-up. While the overall effect size was modest, these findings suggest that more intensive, supervised rehabilitation in the first few months after knee replacement can meaningfully improve functional recovery and should be considered a standard part of post-surgical care.

Impact Of The Fit And Strong Intervention On Older Adults With Osteoarthritis.

Hughes Sl (2004) · PMID: 15075418

This randomized controlled trial (n=150) compared a structured, facility-based exercise program followed by home-based maintenance against a wait-list control group in older adults with lower extremity osteoarthritis. The multicomponent intervention combined range-of-motion exercises, resistance training, aerobic walking, and self-efficacy education over a training period, with individualized plans developed for long-term adherence. Participants in the exercise group showed meaningful improvements at both 2 and 6 months, including a 48.5% increase in exercise adherence, a 13.3% improvement in 6-minute walk distance, reduced joint stiffness, and decreased lower extremity pain — with no adverse health effects reported. In contrast, the control group deteriorated on adherence and self-efficacy measures over the same period, highlighting the importance of structured support in sustaining physical activity behaviors. This low-cost, scalable intervention shows strong clinical relevance as a public health strategy for managing osteoarthritis in older adults, particularly given its dual focus on physical outcomes and long-term exercise adherence.

The Frequency Of Visits By The Physiotherapist Of Patients Receiving Home-Based Exercise Therapy For Knee Osteoarthritis.

Sen A (2004) · Knee · PMID: 15066630

This randomized controlled trial compared two different monitoring schedules for home-based physiotherapy in 96 patients with moderate-to-severe knee osteoarthritis (Kellgren-Lawrence Grade 3). One group received frequent physiotherapist check-ins (at weeks 1, 2, 3, 6, 12, and 24), while the other group was seen far less often (only at weeks 3 and 24), though both groups followed the same home exercise program. At the end of 24 weeks, both groups showed meaningful improvements in knee function as measured by the Hospital for Special Surgery score, and there was no statistically significant difference in outcomes between the two groups. These findings suggest that for motivated patients with knee OA, reducing the frequency of physiotherapist supervision does not compromise the effectiveness of a home exercise program. This has important practical implications for healthcare resource allocation, suggesting that less intensive monitoring may be sufficient to achieve good clinical outcomes.

No Need For Outpatient Physiotherapy Following Total Knee Arthroplasty: A Randomized Trial Of 120 Patients.

Rajan Ra (2004) · Knee · PMID: 15022811

This randomized controlled trial of 120 patients (ages 55–90) compared formal outpatient physiotherapy against a structured home exercise program following total knee replacement surgery. After one year of follow-up, researchers found no statistically significant difference in outcomes between the two groups, with supervised outpatient physiotherapy providing only a 2.9-degree improvement in knee flexion — a difference too small to be clinically meaningful. The findings suggest that for carefully selected patients who receive thorough inpatient physiotherapy instruction and a well-designed home exercise plan, costly and time-intensive outpatient physiotherapy appointments may not be necessary. This has important implications for healthcare resource allocation and patient convenience, particularly for those who face barriers to attending regular clinic-based sessions. Clinicians should note, however, that these results apply specifically to a preselected patient group and may not generalize to individuals with greater functional limitations or complexity.

Does Hydrotherapy Improve Strength And Physical Function In Patients With Osteoarthritis--A Randomised Controlled Trial Comparing A Gym Based And A Hydrotherapy Based Strengthening Programme.

Foley A (2003) · PMID: 14644853

This randomized controlled trial compared two supervised exercise programs — water-based (hydrotherapy) and land-based (gym) resistance training — against a control group in 105 adults aged 50 and over with hip or knee osteoarthritis. Both exercise groups showed meaningful improvements in muscle strength and physical function compared to no exercise after just six weeks of three sessions per week. The gym program produced greater quadriceps strength gains overall, while hydrotherapy led to better walking distance and quality of life scores on the physical health component. Importantly, both programs achieved high compliance rates (75–84% session attendance), suggesting that supervised exercise is acceptable and feasible in this population. Clinically, these findings support offering supervised exercise — whether in water or on land — as an effective short-term intervention for osteoarthritis, with the choice potentially guided by patient preference or physical limitations.

Impact Of An Exercise And Walking Protocol On Quality Of Life For Elderly People With Oa Of The Knee.

Dias Rc (2003) · Knee · PMID: 14533368

This randomized controlled trial compared a structured 12-week exercise and walking program (plus education) against education alone in 50 elderly patients (aged 65+) with knee osteoarthritis. The supervised exercise group showed significant improvements in physical function, pain levels, and overall OA symptom severity, while the control group receiving only education showed no meaningful changes over the same period. Differences between groups were statistically significant at both three and six months across most measures, including the Lequesne Index, Health Assessment Questionnaire, and physical domains of the SF-36, though emotional well-being scores were similar between groups. These findings suggest that a structured, supervised exercise and walking protocol offers clinically meaningful benefits beyond patient education alone for elderly individuals managing knee OA. Given the modest sample size of 50 participants, larger trials would help confirm these results, but the study supports integrating supervised physical activity programs into standard conservative care for knee osteoarthritis.

The Arthritis, Diet And Activity Promotion Trial (Adapt): Design, Rationale, And Baseline Results.

Miller Gd (2003) · PMID: 12865040

The ADAPT trial randomized 316 overweight or obese older adults with knee osteoarthritis into four groups over 18 months: a healthy lifestyle control, dietary weight loss alone, structured exercise alone, or a combination of both diet and exercise. The structured exercise program involved supervised group sessions plus home-based aerobic and strength training for 60 minutes, three times per week, allowing researchers to evaluate the added value of supervised exercise compared to unsupervised lifestyle changes. The trial used validated measures including self-reported physical function, timed stair climbing, and 6-minute walk distance to capture meaningful clinical outcomes. These findings are designed to help clinicians identify which behavioral interventions—diet, exercise, or their combination—most effectively reduce pain, improve physical function, and prevent disability in this high-risk population. The results are expected to provide evidence-based guidance for real-world management of knee OA in overweight older adults.

Comparison Of Clinic- And Home-Based Rehabilitation Programs After Total Knee Arthroplasty.

Kramer Jf (2003) · Knee · PMID: 12771834

This randomized controlled trial compared clinic-based outpatient physical therapy versus home-based rehabilitation (monitored by phone) in 160 patients (average age 68) following total knee replacement surgery. Both groups followed a core home exercise program, with the clinic group receiving additional supervised sessions. At both 12 and 52 weeks post-surgery, no significant differences were found between the two groups across multiple outcomes, including pain, function, walking distance, stair climbing, and knee range of motion. These findings suggest that for most patients recovering from total knee replacement, a structured home exercise program monitored remotely may be just as effective as regular in-person supervised therapy sessions. Clinically, this has important implications for resource allocation, patient convenience, and healthcare costs, though future research should identify which specific patients may still benefit from supervised clinic-based care.

A Home-Based Pedometer-Driven Walking Program To Increase Physical Activity In Older Adults With Osteoarthritis Of The Knee: A Preliminary Study.

Talbot La (2003) · Knee · PMID: 12588583

This small randomized study (n=34, mean age ~70) compared a home-based pedometer-driven walking program combined with arthritis self-management education (Walk+) against education alone in older adults with symptomatic knee osteoarthritis over 24 weeks. Participants using pedometers increased their daily step count by 23%, while the education-only group actually decreased walking by 15%, a statistically significant difference. The Walk+ group also gained 21% in quadriceps muscle strength and showed faster walking performance, compared to a 3.5% strength loss in the education-only group. Importantly, this was an unsupervised, home-based intervention, suggesting that structured self-monitoring tools like pedometers can meaningfully drive physical activity improvements without direct clinical supervision. While the preliminary sample size limits definitive conclusions, these findings support the clinical potential of low-cost, scalable pedometer programs as a practical adjunct to patient education in knee osteoarthritis management.

Home Based Exercise Programme For Knee Pain And Knee Osteoarthritis: Randomised Controlled Trial.

Thomas Ks (2002) · Knee · PMID: 12364304

This two-year randomized controlled trial of 786 adults aged 45 and older with knee pain compared a home-based exercise program, monthly telephone support, a combination of both, or no intervention across two general practices in Nottingham. The key finding was that participants in the exercise groups showed significantly greater reductions in knee pain at 24 months compared to non-exercise groups, with benefits appearing as early as 6 months and sustained throughout the study. Notably, telephone contact alone did not reduce pain, suggesting that improvements were driven by the physical exercise itself rather than simply by therapist attention or psychosocial support. Greater adherence to the exercise plan was associated with greater pain relief, underscoring the importance of patient compliance. Clinically, these results support recommending a straightforward, unsupervised home exercise program as an effective, accessible first-line strategy for managing knee pain and osteoarthritis in older adults.

Primary Care-Based Physical Activity Programs: Effectiveness In Sedentary Older Patients With Osteoarthritis Symptoms.

Halbert J (2001) · PMID: 11409662

This randomized controlled trial compared individualized physical activity advice delivered in primary care settings versus no intervention in 299 sedentary adults aged 60 and older, including a subgroup of 69 patients with hip or knee osteoarthritis symptoms. Patients in the intervention group received personalized exercise guidance at baseline and at 3, 6, and 12 months, focusing on general health benefits rather than OA-specific treatment. Among the OA subgroup, the intervention increased walking frequency and vigorous exercise, while the control group showed a small decline in physical functioning at 12 months; however, pain and stiffness scores did not significantly differ between groups. Notably, intervention participants showed greater intention to exercise at 12 months, suggesting that primary care-based activity advice may positively influence long-term exercise motivation even when direct symptom relief is not demonstrated. Clinically, this approach appears to be an accessible and acceptable strategy for engaging older OA patients in physical activity, though larger dedicated trials are needed to confirm symptom-specific benefits.

Why Don't Patients Do Their Exercises? Understanding Non-Compliance With Physiotherapy In Patients With Osteoarthritis Of The Knee.

Campbell R (2001) · Knee · PMID: 11154253

This qualitative study, nested within a randomized controlled trial, explored why patients with knee osteoarthritis did or did not follow their prescribed home exercise and knee-taping program, interviewing 20 participants three months after completing physiotherapy. Researchers found that early compliance was strongly driven by loyalty to the physiotherapist, while longer-term adherence depended on patients' ability to fit exercises into daily life, perceived symptom severity, attitudes toward arthritis, and crucially, whether they felt the treatment was actually helping. Non-compliance was not random or irrational—patients made deliberate, reasoned decisions based on their personal circumstances and experiences. Clinically, this highlights that healthcare professionals should actively explore individual barriers to adherence rather than assuming non-compliance reflects a lack of motivation. The authors also recommend embedding qualitative research within trials where adherence may significantly influence treatment outcomes.

Home Based Exercise Therapy For Older Patients With Knee Osteoarthritis: A Randomized Clinical Trial.

Petrella Rj (2000) · Knee · PMID: 10990236

This 8-week randomized controlled trial enrolled 179 older adults (average age 74) with knee osteoarthritis to compare a home-based progressive exercise program combined with anti-inflammatory medication (oxaprozin) versus medication alone. Both groups showed improvements in pain and physical function, but patients who completed the exercise program experienced significantly greater reductions in activity-related pain and better performance on walking and stepping tasks, along with improved knee range of motion and physical activity levels. The findings demonstrate that a structured home exercise program is a meaningful add-on to medication management for knee osteoarthritis, even without in-clinic supervision. For clinicians, this supports prescribing progressive home exercise as a practical, accessible intervention for older patients who may face barriers to attending supervised exercise facilities. For patients, this suggests that committing to a home exercise routine alongside prescribed medication can produce measurably better outcomes than medication alone.

The Effects Of A Health Educational And Exercise Program For Older Adults With Osteoarthritis For The Hip Or Knee.

Hopman-Rock M (2000) · Hip; knee · PMID: 10955337

This randomized controlled trial (n=105, ages 55–75) evaluated a 6-week self-management program for people with hip or knee osteoarthritis, combining peer-led health education with physiotherapist-guided exercise, compared to a control group receiving no intervention. The program produced meaningful improvements in pain, quality of life, muscle strength, OA knowledge, self-efficacy, BMI, and physical activity levels, as well as reduced physiotherapy visits. However, benefits were moderate at program completion and diminished by the 6-month follow-up, and no improvements were seen in range of motion or functional task performance. Clinically, these findings suggest that structured self-management programs can offer real but time-limited benefits for OA patients, highlighting the need for ongoing support or booster sessions to sustain gains. The authors recommend more careful participant selection and proactive follow-up strategies to maximize long-term effectiveness.

Long-Term Exercise And Its Effect On Balance In Older, Osteoarthritic Adults: Results From The Fitness, Arthritis, And Seniors Trial (Fast).

Messier Sp (2000) · PMID: 10682941

This randomized clinical trial (the FAST study) compared the effects of 18 months of aerobic walking or weight training versus a health education control program on balance in 103 older adults (aged 60+) with knee osteoarthritis. Both exercise programs involved supervised center-based training for the first 3 months, followed by 15 months of home-based exercise. Key findings showed that both aerobic walking and weight training significantly improved postural sway (a measure of balance stability) compared to the control group, particularly when participants stood with eyes closed, while the aerobic group also showed improvements during single-leg standing with eyes open. These results are clinically relevant because poor balance is a major fall risk factor in older adults with osteoarthritis, and this study demonstrates that structured exercise—even when transitioned to largely unsupervised home-based settings—can produce meaningful, lasting balance improvements. Clinicians should consider prescribing either aerobic walking or resistance training programs for osteoarthritic patients, as both modalities offer protective benefits against balance disturbances that could lead to falls.

Effectiveness Of Manual Physical Therapy And Exercise In Osteoarthritis Of The Knee. A Randomized, Controlled Trial.

Deyle Gd (2000) · Knee · PMID: 10651597

This randomized controlled trial of 83 patients with knee osteoarthritis compared a combination of hands-on manual therapy plus supervised exercise against a placebo (inactive ultrasound) delivered twice weekly for 4 weeks. Patients receiving active treatment showed striking improvements by 8 weeks, walking 170 meters further in 6 minutes and improving pain, stiffness, and function scores (WOMAC) by nearly 56% compared to baseline. These benefits were sustained at one year, and notably only 5% of treated patients required knee replacement surgery compared to 20% in the placebo group. The findings suggest that skilled manual therapy combined with supervised exercise is not only effective for reducing pain and improving physical function in knee osteoarthritis, but may also help patients avoid or delay total knee replacement. Clinicians should consider referring appropriate osteoarthritis patients to experienced manual physical therapists as a meaningful conservative treatment option before pursuing surgical intervention.

Effectiveness Of Home Exercise On Pain And Disability From Osteoarthritis Of The Knee: A Randomised Controlled Trial.

O'reilly Sc (1999) · Knee · PMID: 10343535

This randomized controlled trial compared a home-based quadriceps strengthening exercise program against no intervention in 191 community-recruited adults (aged 40–80) with knee osteoarthritis pain, followed over six months. The exercise group achieved a 22.5% reduction in knee pain scores (WOMAC) compared to only 6.2% in controls, with physical function improving by 17.4% in exercisers while remaining unchanged in the control group — all differences were statistically significant. Importantly, this program required no supervised sessions, suggesting that a straightforward, self-managed daily exercise routine can deliver meaningful clinical benefits for knee osteoarthritis. For clinicians, these findings support prescribing simple home quadriceps exercises as a low-cost, accessible first-line intervention, and for patients, they offer reassurance that consistent self-directed exercise can meaningfully reduce pain and improve mobility.

One-Year Followup Of Patients With Osteoarthritis Of The Knee Who Participated In A Program Of Supervised Fitness Walking And Supportive Patient Education.

Sullivan T (1998) · Knee · PMID: 9791321

This study followed up patients with knee osteoarthritis one year after completing an 8-week supervised fitness walking and education program, comparing them to a control group. Of the original 92 participants, roughly half from each group were successfully contacted at the one-year mark. The key finding was that while supervised walking had shown functional benefits at 8 weeks, these gains disappeared by one year because most patients stopped walking regularly—with no statistically significant differences between the exercise and control groups at follow-up. This highlights a critical clinical challenge: short-term supervised programs can produce meaningful improvements in pain and physical function, but those benefits are lost without sustained adherence to exercise. Clinicians should consider incorporating long-term adherence strategies, such as ongoing support or behavioral interventions, when designing exercise programs for osteoarthritis patients.

Compliance With Exercise Therapy In Treating Seniors With Knee Osteoarthritis.

Myers A (1998) · Knee · PMID: 9641447

This randomized controlled trial examined exercise therapy compliance in older adults with knee osteoarthritis, likely comparing supervised versus unsupervised exercise programs, though specific details are limited as no abstract was available. Compliance with exercise is a well-recognized challenge in this population, and supervision has generally been associated with better adherence and outcomes in osteoarthritis management. Without access to the full data, the sample size, specific intervention details, and magnitude of supervision effects cannot be confirmed. Clinicians should note that supporting patient adherence—whether through in-person supervision, telehealth, or structured home programs—remains a central consideration in osteoarthritis exercise therapy. Readers are encouraged to consult the full publication for precise findings and clinical recommendations.

A Randomized Trial Comparing Aerobic Exercise And Resistance Exercise With A Health Education Program In Older Adults With Knee Osteoarthritis. The Fitness Arthritis And Seniors Trial (Fast).

Ettinger Wh (1997) · Knee · PMID: 8980206

The FAST trial was an 18-month randomized study of 439 older adults (age 60+) with knee osteoarthritis that compared structured aerobic exercise, resistance exercise, and a health education control program. Both exercise groups showed meaningful improvements compared to health education alone: aerobic exercise reduced self-reported disability by 10% and knee pain by 12%, while resistance exercise reduced disability by 8% and pain by 8%, with both groups also performing better on real-world physical tasks like walking, stair climbing, and getting in and out of a car. Importantly, neither exercise program worsened joint damage on X-ray, suggesting these interventions are safe over 18 months. With 83% of participants completing the trial and exercise compliance around 68–70%, the results are clinically credible and applicable to typical patients seen in practice. These findings strongly support prescribing either aerobic or resistance exercise as a core component of knee osteoarthritis management in older adults, offering a non-pharmacological option that reduces both pain and functional limitation.

Evaluation Of A Yoga Based Regimen For Treatment Of Osteoarthritis Of The Hands.

Garfinkel Ms (1994) · PMID: 7699639

This small randomized controlled trial compared a supervised weekly yoga program (8 weeks) against no treatment in patients with hand osteoarthritis, making it a study of supervised exercise versus a control rather than a direct supervised vs. non-supervised comparison. Patients in the yoga group attended one instructor-led session per week and showed significantly greater improvements in pain during activity, joint tenderness, and finger range of motion compared to the control group. While sample size details are not explicitly reported in the abstract, the findings suggest that structured, supervised yoga may offer clinically meaningful relief for hand osteoarthritis symptoms. Clinicians should note that the yoga program was delivered by a single instructor, limiting generalizability, and that long-term effects and comparisons with other therapies remain unexplored. Overall, this study provides preliminary evidence that supervised yoga-based exercise is a promising complementary approach for managing hand osteoarthritis, warranting larger and longer follow-up trials.

Exercise Maintenance Of Persons With Arthritis After Participation In A Class Experience.

Minor Ma (1993) · PMID: 8444627

This study followed 120 adults with rheumatoid arthritis or osteoarthritis for up to 18 months after they participated in a supervised exercise class, examining what factors predicted whether they continued exercising on their own. Researchers found that psychological factors like depression and anxiety were important early predictors of continued exercise (at 3 and 9 months), while longer-term maintenance (at 18+ months) was better explained by initial fitness level, changes in pain, and prior exercise habits. Notably, neither the type of arthritis nor the specific exercise program attended appeared to significantly influence long-term exercise maintenance. A key clinical takeaway is that past exercise behavior becomes increasingly predictive over time, suggesting that helping patients establish early exercise habits may be critical for long-term adherence. Clinicians should also consider addressing psychological barriers like depression and anxiety as part of any exercise intervention for arthritis patients.

Home Exercises Are As Effective As Outpatient Hydrotherapy For Osteoarthritis Of The Hip.

Green J (1993) · Hip · PMID: 8369892

This randomized controlled trial compared home exercise programs alone versus home exercises combined with twice-weekly hydrotherapy (water-based therapy) in 47 patients with hip osteoarthritis, followed over 18 weeks. Both groups showed meaningful improvements in pain, function, and objective measures, but there was no significant difference in outcomes between the two approaches. The benefits were consistent regardless of patient age, sex, or how severe the joint damage appeared on X-ray. These findings suggest that a well-structured, graded home exercise program is an effective and sufficient treatment for most patients with hip osteoarthritis. Clinically, this is encouraging as it indicates that costly and resource-intensive supervised hydrotherapy may not offer additional benefit over a carefully designed home-based regimen.

Supervised Fitness Walking In Patients With Osteoarthritis Of The Knee. A Randomized, Controlled Trial.

Kovar Pa (1992) · Knee · PMID: 1543305

This 8-week randomized controlled trial compared supervised fitness walking plus patient education against standard medical care in 102 patients with knee osteoarthritis. Patients in the supervised walking group improved their 6-minute walking distance by 18.4% (approximately 70 meters), while control patients actually declined slightly, and the walking group also showed a 39% improvement in physical function and a 27% reduction in pain. The study enrolled 102 patients total, with complete data from 92, providing a reasonably sized sample for this type of intervention trial. Importantly, the exercise program did not worsen arthritis symptoms or joint damage, addressing a common concern among patients and clinicians who may fear that walking could aggravate knee OA. These findings suggest that structured, supervised walking programs should be considered a clinically meaningful, low-risk component of knee osteoarthritis management for appropriate patients.

[Physical Therapy In Degenerative Diseases Of The Joints].

Zielke A (1987) · PMID: 3109139

This article reviews the role of physiotherapy in managing degenerative joint disease (osteoarthritis), a condition with major implications for patients' ability to work and function. The authors describe a range of treatments—including active movement therapy (kinetotherapy), heat and cold therapy, ultrasound, electrotherapy, and massage—and discuss appropriate dosing for each. A retrospective analysis of 1,893 patients treated at German health resorts found that active therapies accounted for 44% and passive therapies 56% of treatment delivery. The authors also highlight the importance of physiotherapy before and after joint replacement surgery. No direct comparison of supervised versus unsupervised exercise was made in this study.

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