title: The effects of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity. Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis. A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis. Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life. A randomized study of the effects of t'ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis. Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis. Massage therapy for osteoarthritis of the knee: a randomized controlled trial. The effects of different elevations of laterally wedged insoles with subtalar strapping on medial compartment osteoarthritis of the knee. Unstable shoe construction and reduction of pain in osteoarthritis patients. Economic Evaluation of Aquatic Exercise for Persons With Osteoarthritis Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858] TENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee. A pilot study on using acupuncture and transcutaneous electrical nerve stimulation (TENS) to treat knee osteoarthritis (OA) Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a prospective randomized controlled study. A treatment applying a biomechanical device to the feet of patients with knee osteoarthritis results in reduced pain and improved function: a prospective controlled study Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear? Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trial The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. An optimal duration of daily wear for an insole with subtalar strapping in patients with varus deformity osteoarthritis of the knee. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial Effect of a walking program on gait characteristics in patients with osteoarthritis. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities osteoarthritis index questionnaire and global assessments in patients with osteoarthritis. Physiotherapy in knee osteoarthrosis: effect on pain and walking. Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis. Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Baduanjin alleviates the symptoms of knee osteoarthritis. Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. Home based exercise therapy for older patients with knee osteoarthritis: a randomized clinical trial. Comparing Hot Pack, Short-Wave Diathermy, Ultrasound, and TENS on Isokinetic Strength, Pain, and Functional Status of Women with Osteoarthritic Knees: A Single-Blind, Randomized, Controlled Trial Tai Chi Qigong for the quality of life of patients with knee osteoarthritis: a pilot, randomized, waiting list controlled trial Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. Progressive Resistance Training Improves Overall Physical Activity Levels in Patients With Early Osteoarthritis of the Knee: A Randomized Controlled Trial Investigation of Clinical Effects of High- and Low-Resistance Training for Patients With Knee Osteoarthritis: A Randomized Controlled Trial 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). Does Transcutaneous Electrical Nerve Stimulation Improve the Physical Performance of People With Knee Osteoarthritis? A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. Optimal stimulation frequency of transcutaneous electrical nerve stimulation on people with knee osteoarthritis. 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. Immediate effects of transcutaneous electrical nerve stimulation and focal knee joint cooling on quadriceps activation. Influence of concomitant heeled footwear when wearing a lateral wedged insole for medial compartment osteoarthritis of the knee. US Valuation of the EQ-5D Health States: Development and Testing of the D1 Valuation Model Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. The effects of sensorimotor training on knee proprioception and function for patients with knee osteoarthritis: a preliminary report No additional benefit of shortwave diathermy over exercise program for knee osteoarthritis in peri-/post-menopausal women: an equivalence trial. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain? One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education. OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Effects of a cross-training exercise program in persons with osteoarthritis of the knee a randomized controlled trial. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Efficacy of 2 non-weight-bearing interventions, proprioception training versus strength training, for patients with knee osteoarthritis: a randomized clinical trial. Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study Effect of low-intensity pulsed ultrasound on the cartilage repair in people with mild to moderate knee osteoarthritis: a double-blinded, randomized, placebo-controlled pilot study. The treatment of osteoarthritis of the knee with pulsed electrical stimulation. Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study. A double-blind trial of clinical effects of therapeutic ultrasound in knee osteoarthritis. Effects of strength training on the incidence and progression of knee osteoarthritis. Pulsed Shortwave Treatment in Women With Knee Osteoarthritis: A Multicenter, Randomized, Placebo-Controlled Clinical Trial The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. Prehabilitation Before Total Knee Arthroplasty Increases Strength and Function in Older Adults With Severe Osteoarthritis Validity and Responsiveness of the Knee Society Clinical Rating System in Comparisonwith the SF-36 and WOMAC The effect of neuromuscular electrical stimulation on arthritis knee pain in older adults with osteoarthritis of the knee. Effect of pulsed short-wave diathermy on pain and function of subjects with osteoarthritis of the knee: a placebo-controlled double-blind clinical trial Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. An evaluation of pulsed shortwave on knee osteoarthritis using radioleucoscintigraphy: a randomised, double blind, controlled trial. The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: a randomized, placebo-controlled trial Pilot study of the effects of a heat-retaining knee sleeve on joint pain, stiffness, and function in patients with knee osteoarthritis. A 1-year follow-up of an experimental study of a self-management arthritis programme with an added exercise component of clients with osteoarthritis of the knee Short-Term Effectiveness of Ultrasound Therapy in Knee Osteoarthritis A six-month followup of a randomized trial comparing the efficacy of a lateral-wedge insole with subtalar strapping and an in-shoe lateral-wedge insole in patients with varus deformity osteoarthritis of the knee. Physical exercise and comorbidity. Results from the Fitness and Arthritis in Seniors Trial (FAST) Preliminary results of integrated therapy for patients with knee osteoarthritis. Taping the patella medially: a new treatment for osteoarthritis of the knee joint? Hydrotherapy Versus Conventional Land-Based Exercise for the Management of Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial Effect of Home Exercise of Quadriceps on Knee Osteoarthritis Compared with Nonsteroidal Antiinflammatory Drugs: A Randomized Controlled Trial The lateral wedged insole with subtalar strapping significantly reduces dynamic knee load in the medial compartment gait analysis on patients with medial knee osteoarthritis. Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Treatment of osteoarthritis of the knee with transcutaneous electrical nerve stimulation Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis. Effects of a quantitative progressive rehabilitation program applied unilaterally to the osteoarthritic knee. A home-based protocol of electrical muscle stimulation for quadriceps muscle strength in older adults with osteoarthritis of the knee. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Would the addition of TENS to exercise training produce better physical performance outcomes in people with knee osteoarthritis than either intervention alone? Evaluating the benefits of patterned stimulation in the treatment of osteoarthritis of the knee: a multi-center, randomized, single-blind, controlled study with an independent masked evaluator. Effects of noninvasive interactive neurostimulation on symptoms of osteoarthritis of the knee: a randomized, sham-controlled pilot study. Minimal clinically important rehabilitation effects in patients with osteoarthritis of the lower extremities. Static and dynamic biomechanics of foot orthoses in people with medial compartment knee osteoarthritis. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Effect of a novel insole on the subtalar joint of patients with medial compartment osteoarthritis of the knee. Effects of activity modification on the patients with osteoarthritis of the knee. Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. Effects of disinhibitory transcutaneous electrical nerve stimulation and therapeutic exercise on sagittal plane peak knee kinematics and kinetics in people with knee osteoarthritis during gait: a randomized controlled trial
abstract: OBJECTIVE To evaluate the effect of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity . METHODS A total of 126 patients with bilateral knee osteoarthritis and obesity were classified into 3 groups by their stages of osteoarthritis . Each group was divided into subgroups a , b , and c. The subjects in subgroup a received weight reduction treatment , those in subgroup b received weight reduction and electrotherapy modalities , and those in subgroup c received electrotherapy modalities to relieve pain . RESULTS Pain reduction , weight reduction , ambulation speed , and changes of Lequesne 's index were greater in patients in subgroups a and b than in subgroup c after treatment . Although the last pain scores in subgroup b were less than those in subgroup a , as measured by a visual analog scale ( VAS ) , there was no significant difference between their functional status . Significant pain relief ( VAS < 2 ) and an acceptable functional status ( Lequesne 's index < 7 ) were indicated when weight reduction was more than 15 % and 12 % , respectively , of the initial body weight of the individual . CONCLUSION Weight reduction was found to be a practical adjuvant treatment in the rehabilitation of patients with knee osteoarthritis We recruited 132 subjects with bilateral knee osteoarthritis ( Altman Grade II ) to compare the effects of different stretching techniques on the outcomes of isokinetic muscle strengthening exercises . Patients were r and omly divided into four groups ( I-IV ) . The patients in Group I received isokinetic muscular strengthening exercises , Group II received bilateral knee static stretching and isokinetic exercises , Group III received proprioceptive neuromuscular facilitation ( PNF ) stretching and isokinetic exercises , and Group IV acted as controls . Outcomes were measured by changes in Lequesne 's index , range of knee motion , visual analog pain scale , and peak muscle torques during knee flexion and extension . Patients in all the treated groups experienced significant reductions in knee pain and disability , and increased peak muscle torques after treatment and at follow-up . However , only patients in Groups II and III had significant improvements in range of motion and muscle strength gain during 60 degrees/second angular velocity peak torques . Group III demonstrated the greatest increase in muscle strength gain during 180 degrees/second angular velocity peak torques . In conclusion , stretching therapy could increase the effectiveness of isokinetic exercise in terms of functional improvement in patients with knee osteoarthritis . PNF techniques were more effective than static stretching OBJECTIVE To compare the efficacy of aquatic exercise and a l and -based exercise programme vs control in patients with knee osteoarthritis .  METHODS Primary outcome was change in pain , and in addition Knee Injury and Osteoarthritis Outcome Score question naire ( KOOS ) . St and ing balance and strength was also measured after and at 3-month follow-up . Seventy-nine patients ( 62 women ) , with a mean age of 68 years ( age range 40 - 89 years ) were r and omized to aquatic exercise ( n = 27 ) , l and -based exercise ( n = 25 ) or control ( n = 27 ) . RESULTS No effect was observed immediately after exercise cessation ( 8 weeks ) . At 3-month follow-up a reduction in pain was observed only in the l and -based exercise group compared with control ( -8.1 mm , ( 95 % confidence interval -15.4 to -0.4 ; p = 0.039 ) , but no differences between groups were observed for KOOS ; and no improvement following aquatic exercise . Eleven patients reported adverse events ( i.e. discomfort ) in l and -based exercise , while only 3 reported adverse events in the aquatic exercise . CONCLUSION Only l and -based exercise showed some improvement in pain and muscle strength compared with the control group , while no clinical benefits were detectable after aquatic exercise compared with the control group . However , aquatic exercise has significantly less adverse effects compared with a l and -based programme This study examined the effects of dietary weight loss and exercise on the health-related quality of life ( HRQL ) of overweight and obese , older adults with knee osteoarthritis . A total of 316 older men and women with documented evidence of knee osteoarthritis were r and omly assigned to 1 of 4 18-month interventions : dietary weight loss , exercise , dietary weight loss and exercise , or healthy lifestyle control . Measures included the SF-36 Health Survey and satisfaction with body function and appearance . Results revealed that the combined diet and exercise intervention had the most consistent , positive effect on HRQL compared with the control group ; however , findings were restricted to measures of physical health or psychological outcomes that are related to the physical self PURPOSE Individuals with osteoarthritis can experience difficulty walking and poor strength , possibly leading to falls and fractures . Exercise has been found to increase strength and bone mineral density . The purpose of this study was to determine the effects of 6 months of t'ai chi on knee muscle strength , bone mineral density , and fear of falling in older women with osteoarthritis . METHODS Eighty-two ( 82 ) women with osteoarthritis , recruited from outpatient clinics and community health centers , were r and omly assigned to either a t'ai chi group and took part in a t'ai chi program , or a control group . Of these , 30 subjects ( mean age = 63 years ) in the t'ai chi group and 35 ( mean age = 61 years ) in the control group completed post-test measures at 6 months . RESULTS After the 6-month study period , subjects in the t'ai chi program had significantly greater knee extensor endurance ( pre- to post-test mean increase = 36.4 W/kg , versus 1.1 W/kg for the controls ) , and significantly greater bone mineral density in the neck of the proximal femur ( mean change = 0.09 , versus -0.10 for the controls ) , Ward 's triangle ( mean change = 0.04 , versus -0.04 for the controls ) , and trochanter ( mean change = 0.07 , versus -0.05 for the controls ) than the controls . However , knee extensor and flexor strength did not differ significantly between the groups . The fear of falling during daily activities reduced significantly more in the t'ai chi group ( mean change = -2.40 , versus 0.66 for the controls ) . CONCLUSIONS T'ai chi increased knee extensor muscle endurance and bone mineral density in older women with osteoarthritis , and decreased their fear of falling during daily activities . Further study with long-term follow-up is needed to substantiate the role of t'ai chi exercise in the prevention of fall and its related fracture OBJECTIVE To determine whether high exercise adherence improved physical function among older adults with knee osteoarthritis ( OA ) who were overweight or obese . METHODS Associations between  exercise adherence , changes in 6-minute walking distance in meters , and self-reported disability ( Western Ontario and McMaster Universities Osteoarthritis Index function subscale ) after 6 and 18 months were examined among an Arthritis , Diet , and Activity Promotion Trial sub sample ( n = 134 ) using multiple linear regression models . RESULTS Higher exercise adherence was associated with greater improvements in 6-minute walking distance after 6 and 18 months and in disability after 6 months . Pain and body mass index ( BMI ) contributed , to some extent , to explaining the link between exercise adherence  and changes in physical performance and self-reported disability . CONCLUSION Higher exercise adherence is associated with improved physical function in overweight and obese older adults with knee OA . This indicates that promoting adherence is clinical ly relevant when prescribing exercise regimens that also focus on decreasing pain and BMI BACKGROUND Massage therapy is an attractive treatment option for osteoarthritis ( OA ) , but its efficacy is uncertain . We conducted a r and omized , controlled trial of massage therapy for OA of the knee . METHODS Sixty-eight adults with radiographically confirmed OA of the knee were assigned either to treatment ( twice-weekly sessions of st and ard Swedish massage in weeks 1 - 4 and once-weekly sessions in weeks 5 - 8 ) or to control ( delayed intervention ) . Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain and functional scores and the visual analog scale of pain assessment . The sample provided 80 % statistical power to detect a 20-point difference between groups in the change from baseline on the WOMAC and visual analog scale , with a 2-tailed alpha of .05 . RESULTS The group receiving massage therapy demonstrated significant improvements in the mean ( SD ) WOMAC global scores ( -17.44 [ 23.61 ] mm ; P < .001 ) , pain ( -18.36 [ 23.28 ] ; P < .001 ) , stiffness ( -16.63 [ 28.82 ] mm ; P < .001 ) , and physical function domains ( -17.27 [ 24.36 ] mm ; P < .001 ) and in the visual analog scale of pain assessment ( -19.38 [ 28.16 ] mm ; P < .001 ) , range of motion in degrees ( 3.57 [ 13.61 ] ; P = .03 ) , and time to walk 50 ft ( 15 m ) in seconds ( -1.77 [ 2.73 ] ; P < .01 ) . Findings were unchanged in multivariable models controlling for demographic factors . CONCLUSIONS Massage therapy seems to be efficacious in the treatment of OA of the knee . Further study of cost effectiveness and duration of treatment effect is clearly warranted . OBJECTIVE To assess the radiographic and symptomatic effects of treating patients with medial compartment osteoarthritis ( OA ) of the knee with laterally wedged insoles with subtalar strapping of varying elevations . DESIGN Prospect i ve quasi-experimental evaluation . SETTING Outpatient clinic in Japan . PARTICIPANTS Sixty-two women out patients with knee OA who were r and omized into 3 groups according to their birth date s and wedge elevation . INTERVENTIONS Participants wore laterally wedged insoles with subtalar strapping with elevations of 8 , 12 , or 16 mm for 2 weeks . MAIN OUTCOME MEASURES St and ing radiographs were used to analyze the femorotibial angle for each subject , both with and without their respective unilateral insoles . The remission scores of the Lequesne index of severity for knee OA were compared among the 3 groups at the conclusion . Participants were asked to report adverse effects on use of the insoles . RESULTS The 16-mm group ( n=21 ) showed a significantly greater valgus correction of the femorotibial angle than the 8-mm group ( n=20 ) ( P=.013 ) . The remission score was significantly improved in the 12-mm group ( n=21 ) compared with the 16-mm group ( P=.029 ) . Adverse effects were more common in the 16-mm group ( 9/21 , 42.8 % ) than in the 12-mm ( 3/21 , 14.3 % ) or 8-mm ( 2/20 , 10 % ) groups . CONCLUSIONS The degree of change in femorotibial angle with the insole with subtalar strapping was affected by the tilt of the lateral wedge . For constant routine use , the 8- or 12-mm elevation wedged insoles with subtalar strapping may be more comfortable and effective than the 16-mm elevation wedge PURPOSE The purpose s of this study were to assess a ) the effectiveness of Masai Barefoot Technology ( MBT ) shoe in reducing  knee pain in persons with knee osteoarthritis ( OA ) and ( b ) changes in balance , ankle and knee ROM , and ankle strength compared with a high-end walking shoe for 12 wk . METHODS The research design was a r and omized controlled trial ( 123 subjects , knee OA ) . Subjects were r and omized to a MBT ( N = 57 ) or a control shoe ( N = 66 ) . A Western Ontario and McMaster Universities ( WOMAC ) OA index , BMI , balance , active ROM , and ankle torque were quantified at week 0 , 3 , 6 , 9 , and 12 . Two- sample t-tests were done for between-group comparisons . RESULTS There was no significant difference between groups in total pain score . A significant reduction over the 12-wk period was found for both shoe conditions ( -42/500 or 25.6 % MBT , -46.2 or 27.1 % control ) . There was no significant group difference in pain during walking ( t = -1.09 , P = 0.28 ) . Pain during walking was significantly reduced by 5.2/100 mm in the MBT and 9.7/100 mm in the control group . Total pain showed a significant reduction for the MBT -27.4/500 ( -16.6 % ) and the control group -28.9/500 ( -17.0 % ) between baseline and week 3 . Between week 3 and 6 , there was a significant reduction for the MBT group only ( -27.2/500 or -20.0 % ) . There was a significant increase in the static balance between baseline and 12 wk in the MBT group only , although the difference between groups was not significant . DISCUSSION The results indicate that special shoe interventions can reduce pain in subjects with moderate knee OA Objectives .To estimate cost and outcomes of the Arthritis Foundation aquatic exercise classes from the societal perspective . Design .R and omized trial of 20-week aquatic classes .  Cost per quality -adjusted life year ( QALY ) gained was estimated using trial data . Sample size was based on 80 % power to reject the null hypothesis that the cost/QALY gained would not exceed $ 50,000 . Subjects and Methods . Recruited 249 adults from Washington State aged 55 to 75 with a doctor-confirmed diagnosis of osteoarthritis to participate in aquatic classes .  The Quality of Well-Being Scale ( QWB ) and Current Health Desirability Rating ( CHDR ) were used for economic evaluation , supplemented by the arthritis-specific Health Assessment Question naire ( HAQ ) , Center for Epidemiologic Studies -Depression Scale ( CES-D ) , and Perceived Quality of Life Scale ( PQOL ) collected at baseline and postclass . Outcome results applied to life expectancy tables were used to estimate QALYs . Use of health care facilities was assessed from diaries/ question naires and Medicare reimbursement rates used to estimate costs . Nonparametric bootstrap sampling of costs/QALY ratios established the 95 % CI around the estimates . Results .Aquatic exercisers reported equal ( QWB ) or better ( CHDR , HAQ , PQOL ) health-related quality of life compared with controls . Outcomes improved with regular class attendance . Costs/QALY gained discounted at 3 % were $ 205,186 using the QWB and $ 32,643 using the CHRD . Conclusion .Aquatic exercise exceeded $ 50,000 per QALY gained using the community-weighted outcome but fell below this arbitrary budget constraint when using the participant-weighted measure . Confidence intervals around these ratios suggested wide variability of cost effectiveness of aquatic exercise OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone Background Studies on exercise in knee osteoarthritis ( OA ) have focused on elderly subjects . Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis . The aim was to test the effects of a short-term , high-intensity exercise program on self-reported pain , function and quality of life . Methods Patients aged 36–65 , with OA grade III ( Kellgren & Lawrence ) were recruited . They had been referred for radiographic examination due to knee pain and had no history of major knee injury . They were r and omized to a twice weekly supervised one hour exercise intervention for six weeks , or to a non-intervention control group . Exercise was performed at ≥ 60 % of maximum heart rate ( HR max ) . The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score ( KOOS ) . Follow-up occurred at 6 weeks and 6 months . Results Sixty-one subjects ( mean age 56 ( SD 6 ) , 51 % women , mean BMI 29.5 ( SD 4.8 ) ) were r and omly assigned to intervention ( n = 30 ) or control group ( n = 31 ) . No significant differences in the KOOS subscales assessing pain , other symptoms , or function in daily life or in sport and recreation were seen at any time point between exercisers and controls . In the exercise group , an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group ( mean change 4.0 vs. -0.7 , p = 0.05 ) . The difference between groups was still persistent at 6 months ( p = 0.02 ) . Conclusion A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA . Some effect was seen on quality of life in the exercise group compared to the control group The purpose of this study was to compare the effectiveness of transcutaneous nerve stimulation ( TENS ) , electroacupuncture ( EA ) , and ice massage with placebo treatment for the treatment of pain . Subjects ( n = 100 ) diagnosed with osteoarthritis ( OA ) of the knee were treated with these modalities . The parameters for evaluating the effectiveness of treatment include pain at rest , stiffness , 50 foot walking time , quadriceps muscle strength , and knee flexion degree . The results showed ( a ) that all three methods could be effective in decreasing not only pain but also the objective parameters in a short period of time ; and ( b ) that the treatment results in TENS , EA and ice massage were superior to placebo Background The present study tests whether a combined treatment of acupuncture and transcutaneous electrical nerve stimulation ( TENS ) is more effective than acupuncture or TENS alone for treating knee osteoarthritis ( OA ) . Methods Thirty-two patients with knee OA were r and omly allocated to four groups . The acupuncture group ( ACP ) received only acupuncture treatment at selected acupoints for knee pain ; the TENS group ( TENS ) received only TENS treatment at pain areas ; the acupuncture and TENS group ( A&T ) received both acupuncture and TENS treatments ; the control group ( CT ) received topical poultice ( only when necessary ) . Each group received specific weekly treatment five times during the study . Outcome measures were pain intensity in a visual analogue scale ( VAS ) and knee function in terms of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Results The ACP , TENS and A&T groups reported lower VAS and WOMAC scores than the control group . Significant reduction in pain intensity ( P = 0.039 ) and significant improvement in knee function ( P = 0.008 ) were shown in the A&T group . Conclusion Combined acupuncture and TENS treatment was effective in pain relief and knee function improvement for the sample d patients suffering from knee OA OBJECTIVE To compare the clinical effects of laterally wedged insoles and neutrally wedged insoles ( used as control ) in patients with medial femoro-tibial knee osteoarthritis ( OA ) . DESIGN 6-month prospect i ve r and omized controlled study . PATIENTS out patients with painful medial femoro-tibial knee OA . OUTCOME MEASURES patient 's overall assessment of disease activity ( 5 grade scale ) , WOMAC index subscales and concomitant treatments . STATISTICAL ANALYSIS Performed as an intention-to-treat analysis . Main criterion : improvement in the patient 's assessment of activity ( defined as a reduction of 1 grade or more at month 6 compared to baseline , and no intraarticular injection or lavage during the study ) . Secondary criteria for assessment : ( a ) improvement in the patient 's assessment of activity at months 1 and 3 compared to baseline , ( b ) improvement in the WOMAC subscales at months 1 , 3 and 6 , compared to baseline ( defined as an improvement of at least 30 % , and no intraarticular injection or lavage during the study ) and ( c ) concomitant therapies ( analgesics and NSAIDs ) . RESULTS The baseline characteristics of the 156 recruited patients ( 41 males , 115 females , mean age 64.8 years ) were not different in the two treatment groups . At months 1 , 3 and 6 the percentages of patients with improvement in assessment of disease activity , in WOMAC pain , joint stiffness , and physical functioning subscales were similar in the two groups . The number of days with NSAIDs intake during the previous 3 months was decreased at month 6 compared with baseline in the group furnished with laterally wedged insoles ( 14.1 days+/-28 vs 9.9 days+/-27 , P=0.04 , Wilcoxon paired test ) , while it remained unchanged in the other group ( 15.5 days+/-24 vs 15+/-28 , P=0.56 ) . Compliance and tolerance were satisfactory . Compliance was different between the two groups at month 6 , with a greater frequency of patients who wore insoles permanently in the laterally wedged insole group than in the other group ( 87.8 % vs 74.3%;P=0.032 ) . CONCLUSION This study failed to demonstrate a relevant short-term symptomatic effect of laterally-wedged insoles in medial femoro-tibial OA . However , the decrease in NSAIDs consumption together with better compliance in the treated group are in favor of a beneficial effect of laterally-wedged insoles in medial femoro-tibial OA Background This study examined the effect of treatment with a novel biomechanical device on the level of pain and function in patients with knee OA . Methods Patients with bilateral knee OA were enrolled to active and control groups . Patients were evaluated at baseline , at 4 weeks and at the 8-week endpoint . A novel biomechanical device was individually calibrated to patients from the active group . Patients from the control group received an identical foot-worn platform without the biomechanical elements . Primary outcomes were the WOMAC Index and ALF assessment s. Results There were no baseline differences between the groups . At 8 weeks , the active group showed a mean improvement of 64.8 % on the WOMAC pain scale , a mean improvement of 62.7 % on the WOMAC function scale , and a mean improvement of 31.4 % on the ALF scale . The control group demonstrated no improvement in the above parameters . Significant differences were found between the active and control groups in all the parameters of assessment . Conclusions The biomechanical device and treatment methodology is effective in significantly reducing pain and improving function in knee OA patients .The study is registered at clinical trials.gov , identifier NCT00457132 , http://www . clinical Objective This study aim ed to determine whether the effect of laterally wedged insoles on the adduction moment in knee osteoarthritis ( OA ) declined after one month of wear , and whether higher reported use of insoles was associated with a reduced effect on the adduction moment at one month . Methods Twenty people with medial compartment OA underwent gait analysis in their own shoes wearing i ) no insoles and ; ii ) insoles wedged laterally 5 ° in r and om order .  Testing occurred at baseline and after one month of use of the insoles . Participants recorded daily use of insoles in a log-book . Outcomes were the first and second peak external knee adduction moment and the adduction angular impulse , compared across conditions and time with repeated measures general linear models . Correlations were obtained between total insole use and change in gait parameters with used insoles at one month , and change scores were compared between high and low users of insoles using general linear models . Results There was a significant main effect for condition , whereby insoles significantly reduced the adduction moment ( all p < 0.001 ) . However there was no significant main effect for time , nor was an interaction effect evident . No significant associations were observed between total insole use and change in gait parameters with used insoles at one month , nor was there a difference in effectiveness of insoles between high and low users of the insoles at this time . Conclusion Effects of laterally wedged insoles on the adduction moment do not appear to decline after one month of continuous use , suggesting that significant wedge degradation does not occur over the short-term Objective : This investigation assessed preferences for , and effects of , 5 days of twice daily superficial heat , cold , or contrast therapy applied with a commercially available system permitting the circulation of water through a wrap-around garment , use of an electric heating pad , or rest for patients with level II – IV osteoarthritis ( OA ) of the knee . Methods : We employed a within subject , r and omized order design to study 34 patients receiving each treatment in 1-week blocks . A knee injury and osteoarthritis outcome score ( KOOS ) question naire and visual analog pain scale was completed at baseline , and twice each week . Treatment preferences were assessed in the last week of the study . Results : Treatment with the device set to warm was preferred by 48 % of subjects . Near equal preferences were observed for cold ( 24 % ) and contrast ( 24 % ) . Pain reduction and improvements in KOOS subscale measures were demonstrated for each treatment but responses were ( P < 0.05 ) greater with preferred treatments . Most patients preferred treatment with the water circulating garment system over a heating pad . Conclusions : We recommend that when superficial heat or cold is considered in the management of knee OA that patients experiment to identify the intervention that offers them the greatest relief and that contrast is a treatment option Objectives To evaluate the effectiveness of two primary care strategies for delivering evidence based care to people aged 55 or over with knee pain :  enhanced pharmacy review and community physiotherapy . Design Pragmatic multicentre r and omised clinical trial . Setting 15 general practice s in North Staffordshire . Participants 325 adults aged 55 years or over ( mean 68 years ) consulting with knee pain ; 297 ( 91 % ) reached six month follow-up . Interventions Enhanced pharmacy review ( pharmacological management in accordance with an algorithm ) ; community physiotherapy ( advice about activity and pacing and an individualised exercise programme ) ; control ( advice leaflet reinforced by telephone call ) . Main outcome measure Change in Western Ontario and McMaster Universities osteoarthritis index ( WOMAC ) at 3 , 6 , and 12 months . Results Mean baseline WOMAC pain score was 9.1 ( SD 3.7 ) , and mean baseline function score was 29.9 ( SD 12.8 ) . At three months , the mean reductions in pain scores were 0.41 ( SD 2.8 ) for control , 1.59 ( 3.2 ) for pharmacy , and 1.56 ( 3.4 ) for physiotherapy ; reductions in function scores were 0.80 ( 8.5 ) , 2.61 ( 9.8 ) , and 4.79 ( 10.8 ) . Compared with control , mean differences in change scores for physiotherapy were 1.15 ( 95 % confidence interval 0.2 to 2.1 ) for pain and 3.99 ( 1.2 to 6.8 ) for function ; those for pharmacy were 1.18 ( 0.3 to 2.1 ) for pain and 1.80 ( −0.8 to 4.5 ) for function . These differences were not sustained to six or 12 months . Significantly fewer participants in the physiotherapy group reported consulting their general practitioner for knee pain in the follow-up period , and use of non-steroidal anti-inflammatory drugs was lower in the physiotherapy and pharmacy groups than in the control group . Conclusions Evidence based care for older adults with knee pain , delivered by primary care physiotherapists and pharmacists , result ed in short term improvements in health outcomes , reduced use of non-steroidal anti-inflammatory drugs , and high patient satisfaction . Physiotherapy seemed to produce a shift in consultation behaviour away from the traditional general practitioner led model of care . Trial registration UK National Research Register N0286046917 ; Current Controlled Trials IS RCT N55376150 OBJECTIVE To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis ( OA ) of the knee . METHODS Forty-six community dwelling patients , aged 55 years or older with knee pain and radiographic evidence of knee OA , were r and omized to a 4 month home based progressive strength training program or a nutrition education program ( attention control ) .  Thirty-eight patients completed the trial with an adherence of 84 % to the intervention and 65 % to the attention control . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index pain and physical function subscales . Secondary outcomes included clinical knee examination , muscle strength , physical performance measures , and question naires to measure quality of life variables . RESULTS Patients in the strength training group who completed the trial had a 71 % improvement in knee extension strength in the leg reported as most painful versus a 3 % improvement in the control group ( p < 0.01 ) . In a modified intent to treat analysis , self-reported pain improved by 36 % and physical function by 38 % in the strength training group versus 11 and 21 % , respectively , in the control group ( p = 0.01 for between group comparison ) . In addition , those patients in the strength training group who completed the trial had a 43 % mean reduction in pain ( p = 0.01 vs controls ) , a 44 % mean improvement in self-reported physical function ( p < 0.01 vs controls ) , and improvements in physical performance , quality of life , and self-efficacy when compared to the control group . CONCLUSION High intensity , home based strength training can produce substantial improvements in strength , pain , physical function and quality of life in patients with knee OA OBJECTIVE To assess the optimal duration of daily wear for a laterally wedged insole with subtalar strapping in subjects with medial compartment osteoarthritis of the knee ( knee OA ) . DESIGN The setting was an outpatient clinic . Eighty-one patients with knee OA were prospect ively r and omized according to birth date and to either 2 weeks of treatment with a lateral wedge with subtalar strapping for less than 5 h ( the short group ) , 5 - 10 h ( the medium group ) or greater than 10 h ( the long group ) each day , or to treatment with a subtalar strapping b and without lateral wedge ( the placebo group ) . St and ing radiographs were used to analyze the femorotibial angle for each subject , both with and without their respective orthotic device . The remission scores of Lequesne index were compared among the four groups at the conclusion . RESULTS The short ( n=21 ) , medium ( n=20 ) and long ( n=18 ) groups demonstrated a significant greater valgus correction of the femorotibial angle than the placebo group ( n=22 ) ( P<0.0001 ) . The remission score was significantly improved in the medium group compared to the placebo ( P=0.001 ) and long ( P=0.001 ) groups . CONCLUSIONS An optimal duration of insole with subtalar strapping wear for patients with varus deformity knee OA may be between 5 and 10 h each day BACKGROUND The prevention of disability in activities of daily living ( ADL ) may prolong older persons ' autonomy ( older persons are defined in this study as those aged > or = 60 years ) . However , proved preventive strategies for ADL disability are lacking . A sedentary lifestyle is an important cause of disability . This study examines whether an exercise program can prevent ADL disability . METHODS A 2-center , r and omized , single-blind , controlled trial was conducted in which participants were assigned to an aerobic exercise program , a resistance exercise program , or an attention control group .  Of the 439 community-dwelling persons aged 60 years or older with knee osteoarthritis originally recruited , the 250 participants initially free of ADL disability were used for this study .  Incident ADL disability , defined as developing difficulty in transferring from a bed to a chair , eating , dressing , using the toilet , or bathing , was assessed quarterly during 18 months of follow-up . RESULTS The cumulative incidence of ADL disability was lower in the exercise groups ( 37.1 % ) than in the attention control group ( 52.5 % ) ( P = .02 ) . After adjustment for demographics and baseline physical function , the relative risk of incident ADL disability for assignment to exercise was 0.57 ( 95 % confidence interval , 0.38 - 0.85 ; P = .006 ) . Both exercise programs prevented ADL disability ; the relative risks were 0.60 ( 95 % confidence interval , 0.38 - 0.97 ; P = .04 ) for resistance exercise and 0.53 ( 95 % confidence interval , 0.33 - 0.85 ; P = .009 ) for aerobic exercise . The lowest ADL disability risks were found for participants with the highest compliance to exercise . CONCLUSIONS Aerobic and resistance exercise may reduce the incidence of ADL disability in older persons with knee osteoarthritis .  Exercise may be an effective strategy for preventing ADL disability and , consequently , may prolong older persons ' autonomy The aim of this study was to evaluate the effects of electrical stimulation program on pain , disability , and quadriceps strength in the patients with knee osteoarthritis . Fifty women diagnosed as knee osteoarthritis were r and omized into two groups as electrical stimulation and biofeedback-assisted isometric exercises . Both of the programs were performed 5 days a week , for a duration of 4 weeks . Outcome measures for pain were visual analogue scale pain score and Western Ontario McMaster osteoarthritis index ( WOMAC ) pain score . Disability and stiffness were assessed with WOMAC physical function and stiffness score . One repetition maximum ( RM ) and 10 RM were used for measuring quadriceps strength . In addition , 50 m walking time and 10 steps stairs climbing up-down time were evaluated . Both groups showed significant improvements in pain , physical function , and stiffness scores after the therapy . There were statistically significant improvements in 50 m walking time and 10 steps stairs climbing up-down time and 1 RM and 10 RM values indicating the improvement in muscle strength . In addition , there were no significant differences between the groups after the therapy . We conclude that electrical stimulation treatment was as effective as exercise in knee osteoarthritis and electrical stimulation treatment can be suggested especially for the patients who have difficulty in or contraindications to perform an exercise program Objective To assess the effect of lateral wedge insoles compared with flat control insoles on improving symptoms and slowing structural disease progression in medial knee osteoarthritis . Design R and omised controlled trial . Setting Community in Melbourne , Australia . Participants 200 people aged 50 or more with clinical and radiographic diagnosis of mild to moderately severe medial knee osteoarthritis . Interventions Full length 5 degree lateral wedged insoles or flat control insoles worn inside the shoes daily for 12 months . Main outcome measures Primary symptomatic outcome was change in overall knee pain ( past week ) measured on an 11 point numerical rating scale . Primary structural outcome was change in volume of medial tibial cartilage from magnetic resonance imaging scans . Secondary clinical outcomes included changes in measures of pain , function , stiffness , and health related quality of life . Secondary structural outcomes included progression of medial cartilage defects and bone marrow lesions . Results Between group differences did not differ significantly for the primary outcomes of change in overall pain ( −0.3 points , 95 % confidence intervals −1.0 to 0.3 ) and change in medial tibial cartilage volume ( −0.4 mm3 , 95 % confidence interval −15.4 to 14.6 ) , and confidence intervals did not include minimal clinical ly important differences . None of the changes in secondary outcomes showed differences between groups . Conclusion Lateral wedge insoles worn for 12 months provided no symptomatic or structural benefits compared with flat control insoles . Trial registration Australian New Zeal and Clinical Trials Registry ACTR12605000503628 and Clinical Trials.gov NCT00415259 This paper reports the results of a study of the gait of 102 patients with osteoarthritis of the knee . Functional status was measured by a 6-min test of walking distance ; the stride characteristics associated with the walk test were assessed . Stride characteristics were measured by a Stride Analyzer . Patients were r and omized to an 8-week educational and walking program ( the intervention group ) or to a weekly telephone survey ( the control group ) . The intervention group patients had a 15 % increase in walking distance ( P < 0.0001 ) and increases of 9.1 % in stride length at free walking speeds ( P < 0.007 ) and 17 % in stride length at fast walking speeds ( P < 0.01 ) compared to the control group . The results of this study have shown that the walking and educational program was effective in improving gait function in patients with osteoarthritis of the knee Abstract Objectives To test the hypotheses that therapeutic taping of the knee improves pain and disability in patients with osteoarthritis of the knee and that benefits remain after stopping treatment . Design R and omised single blind controlled trial with three intervention arms ( therapeutic tape , control tape , and no tape ) of three weeks ' duration and three week follow up . Setting Outcome assessment was performed in a university based laboratory . Taping interventions were applied by eight physiotherapists in metropolitan private practice . Participants 87 patients with symptoms of knee osteoarthritis as defined by the American College of Rheumatology . Main outcome measures Primary outcome measure was pain as measured by visual analogue scale and participant perceived rating of change . Secondary measures of pain and disability included the Western Ontario and MacMaster Universities osteoarthritis index , knee pain scale , and the SF-36 . Results The therapeutic tape group reported a greater reduction in pain on all primary outcomes than either of the other two groups . A significant association was evident between intervention and change in pain at three weeks ( P=0.000 ) , with 73 % ( 21/29 ) of the therapeutic tape group reporting improvement compared with 49 % ( 14/29 ) of the control tape group and 10 % ( 3/29 ) of the no tape group . Significantly greater improvement in pain and disability was observed on most secondary outcomes in the therapeutic tape group compared with the no tape group . Benefits of therapeutic tape were maintained three weeks after stopping treatment . Conclusions Therapeutic knee taping is an efficacious treatment for the management of pain and disability in patients with knee osteoarthritis OBJECTIVE To determine the minimal perceptible clinical improvement ( MPCI ) in patients with osteoarthritis ( OA ) with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) question naire , and patient and investigator global assessment of disease status in r and omized clinical trials for treatment of OA . METHODS Subjects with OA of the knee or hip were r and omized to receive either rofecoxib 12.5 or 25 mg once daily , ibuprofen 800 mg 3 times daily , or placebo for 6 weeks . The WOMAC and global assessment s were completed at baseline and Weeks 2 , 4 , and 6 . A patient global assessment of response to therapy ( 0 to 4 scale ) was used to " anchor " the WOMAC scores . MPCI was defined as the difference in mean change from baseline in WOMAC ( 100 mm normalized visual analog scale , VAS ) between patients with 0 = " None " global response to therapy and patients with 1 = " Poor " global response to therapy . RESULTS MPCI was determined to be 9.7 , 9.3 , and 10.0 mm for the WOMAC pain , physical function and stiffness subscales , respectively , and 11.1 mm for WOMAC question 1 : Pain walking on a flat surface . The MPCI for the investigator was 0.4 with investigator assessment of disease status reported on a 0 to 4 Likert scale . Of note , the estimated MPCI for the WOMAC and investigator globals were similar irrespective of treatment , sex , age , or geographic region . CONCLUSION In this analysis , mean changes of roughly 9 to 12 mm ( 100 mm normalized VAS ) on WOMAC scales were perceptible changes to patients with hip and knee OA . A mean decrease of 0.4 in global disease status ( 0 to 4 Likert scale ) as assessed by the investigator corresponded to the patients ' MPCI . Underst and ing the minimal perceptible differences may permit a better assessment of the clinical relevance of therapeutic interventions in OA Patients with knee osteoarthrosis are often referred for physiotherapy and many different types of treatment are given . The value of many of these treatments has been question ed . This study was intended to evaluate the effect of commonly used physiotherapy treatments in a training programme on patients with medial knee osteoarthrosis , scheduled for surgery . The results from this study also provide useful data for further evaluation of different physiotherapy treatments to this patient group . Thirty-four patients were r and omised to physiotherapy three times a week for 5 weeks and the other 34 received no treatment . The training programme is described in detail . The patients were evaluated by clinical examination , step test , gait analysis and isokinetic measurements of thigh muscle strength before and after treatment . The patients in the treatment group experienced a feeling of overall improvement in the knee and the ability to descend steps improved when compared to the control group . There were no significant differences in gait , range of motion or isokinetic measurements of muscle strength between the groups . We conclude that physiotherapy as given here made our patients feel better and their ability to descend stairs improved . These improvements are beneficial to the patients and support the positive effects of exercises and activity . Whilst the objective improvements were small , suggesting that this treatment may not be justified , patients in the treatment group believed that they were improved OBJECTIVES To evaluate the effects of two knee taping techniques , therapeutic tape and neutral tape , on pain and observed disability in symptomatic generalized knee osteoarthritis ( OA ) . METHODS Using a within-subjects study design , 18 participants were tested under three conditions in r and om order : untaped , wearing therapeutic knee tape and wearing neutral knee tape . Outcome measures included assessment of pain during each of four activities ( using a visual analogue scale ) and assessment of observed disability ( walking speed , timed up and go test , and the step test ) . RESULTS Therapeutic tape significantly reduced pain on three of the four activities assessed , when compared with the neutral and untaped conditions ( P<0.017 ) . The only statistically significant change in observed disability was detected in the step test ( P<0.001 ) , in favour of the therapeutic tape . CONCLUSIONS Therapeutic knee tape is a simple , inexpensive strategy that increases the treatment options for therapists and patients in the conservative management of knee OA . Whilst effective in immediately reducing pain , it does not appear to have a significant immediate impact on observed disability associated with the disease . Therapeutic tape may be used as an adjunct to drug and exercise therapies , potentially augmenting the individual benefits of each OBJECTIVE To determine whether a multimodal physiotherapy programme including taping , exercises , and massage is effective for knee osteoarthritis  , and if benefits can be maintained with self management . METHODS R and omised , double blind , placebo controlled trial ; 140 community volunteers with knee osteoarthritis participated and 119 completed the trial .  Physiotherapy and placebo interventions were applied by 10 physiotherapists in private practice s for 12 weeks . Physiotherapy included exercise , massage , taping , and mobilisation , followed by 12 weeks of self management . Placebo was sham ultrasound and light application of a non-therapeutic gel , followed by no treatment . Primary outcomes were pain measured by visual analogue scale and patient global change . Secondary measures included WOMAC , knee pain scale , SF-36 , assessment of quality of life index , quadriceps strength , and balance test . RESULTS Using an intention to treat analysis , physiotherapy and placebo groups showed similar pain reductions at 12 weeks : -2.2 cm ( 95 % CI , -2.6 to -1.7 ) and -2.0 cm ( -2.5 to -1.5 ) , respectively . At 24 weeks , pain remained reduced from baseline in both groups : -2.1 ( -2.6 to -1.6 ) and -1.6 ( -2.2 to -1.0 ) , respectively . Global improvement was reported by 70 % of physiotherapy participants ( 51/73 ) at 12 weeks and by 59 % ( 43/73 ) at 24 weeks . Similarly , global improvement was reported by 72 % of placebo participants ( 48/67 ) at 12 weeks and by 49 % ( 33/67 ) at 24 weeks ( all p>0.05 ) . CONCLUSIONS The physiotherapy programme tested in this trial was no more effective than regular contact with a therapist at reducing pain and disability Abstract Objectives : To determine whether a home based exercise programme can improve outcomes in patients with knee pain .  Design : Pragmatic , factorial r and omised controlled trial of two years ' duration . Setting : Two general practice s in Nottingham . Participants : 786 men and women aged—45 years with self reported knee pain . Interventions : Participants were r and omised to four groups to receive exercise therapy , monthly telephone contact , exercise therapy plus telephone contact , or no intervention . Patients in the no intervention and combined exercise and telephone groups were r and omised to receive or not receive a placebo health food tablet . Main outcome measures : Primary outcome was self reported score for knee pain on the Western Ontario and McMaster universities ( WOMAC ) osteoarthritis index at two years . Secondary outcomes included knee specific physical function and stiffness ( scored on WOMAC index ) , general physical function ( scored on SF-36 question naire ) , psychological outlook ( scored on hospital anxiety and depression scale ) , and isometric muscle strength . Results : 600 ( 76.3 % ) participants completed the study . At 24 months , highly significant reductions in knee pain were apparent for the pooled exercise groups compared with the non-exercise groups ( mean difference -0.82 , 95 % confidence interval -1.3 to -0.3 ) . Similar improvements were observed at 6 , 12 , and 18 months . Regular telephone contact alone did not reduce pain . The reduction in pain was greater the closer patients adhered to the exercise plan . Conclusions : A simple home based exercise programme can significantly reduce knee pain . The lack of improvement in patients who received only telephone contact suggests that improvements are not just due to psychosocial effects because of contact with the therapist OBJECTIVE To determine whether hip abductor and adductor muscle strengthening reduces medial compartment knee load and improves symptoms in people with medial tibiofemoral OA and varus malalignment . METHODS In a r and omised controlled trial , 89 participants were r and omly allocated to a hip strengthening group or to a control group with no intervention . The strengthening group performed a physiotherapist-supervised home exercise program targeting the hip abductor and adductor muscles for 12 weeks . The primary outcome was the peak external knee adduction moment measured using three-dimensional gait analysis by a blinded assessor . Secondary outcomes included a pain numeric rating scale , Western Ontario and McMaster Universities Osteoarthritis Index , step test , stair climb test , maximum isometric strength of hip and quadriceps muscles and participant-perceived rating of overall change . Intention-to-treat analyses were performed using linear regression modelling adjusting for baseline outcomes and other characteristics . RESULTS The trial was completed by 76/89 participants ( 85 % ) . There was no significant between-group difference in change in the knee adduction moment [ mean difference ( 95 % confidence interval ( CI ) ) 0.134 ( -0.069 to 0.337 ) Nm/BW x HT% ] . All pain , physical function and muscle strength measures showed significantly greater improvement in the strengthening group ( all P<0.05 ) . The relative risk ( 95 % CI ) of participant-perceived overall improvement in the strengthening group compared to the control group was 20.02 ( 6.21 - 64.47 ) . CONCLUSIONS Although strengthening the hip muscles improved symptoms and function in this patient group , it did not affect medial knee load as measured by the knee adduction moment . Thus it is unlikely that hip muscle strengthening influences structural disease progression . TRIAL REGISTRATION ACTR12607000001493 OBJECTIVES To assess the feasibility and safety of using the health-promoting traditional Chinese exercise , known as Baduanjin , in treating knee osteoarthritis ( OA ) . SUBJECTS Twenty-eight ( 28 ) female patients who met the American College of Rheumatology criteria for osteoarthritis of the knee signed the informed consent and were r and omized into the Baduanjin group ( n=14 ) and the control group ( n=14 ) . Eleven ( 11 ) patients in the Baduanjin group and 10 patients in the control group completed the trial . INTERVENTION The Baduanjin group patients exercised following taped comm and s in the community entertainment room during 30-minute classes five times a week for 8 weeks , whereas the control group received no treatment . OUTCOME MEASURES Indicators that include knee pain , stiffness , physical disability , general health , quadriceps strength , and aerobic ability were measured using the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , the Medical Outcomes Study Short Form-36 ( SF-36 ) , the 6-Minute Walk Test ( 6-MWT ) , and the Isokinetic Strength of the Knee Extensors ( ISKE ) . RESULTS Compared with the control group , the participants in the Baduanjin group had statistically significant improvements in percentage changes of the WOMAC pain subscale ( -61.8+/-35.7 % versus 44.6+/-102.8 % ; p=0.006 ) , the WOMAC stiffness subscale ( -53.4+/-46.1 % versus 135.8+/-386.7 % ; p=0.029 ) , the WOMAC physical function subscale ( -7.4+/-81.9 % versus 140.5+/-151.9 % ; p=0.024 ) , 6-MWT ( 11.9+/-7.5 % versus 1.6+/-13.0 % ; p=0.036 ) , and Peak Torque of the ISKE ( 15.1+/-33.7 % versus -16.1+/-16.6 % ; p=0.016 ) . The SF-36 's General Health , Social Function , and Mental Health subscales had no significant changes between those in the Baduanjin and control groups . As such , no adverse events from treatment were reported . CONCLUSIONS This study suggested that the Baduanjin exercise provided a safe and feasible treatment option for patients with knee OA , as well as offered reductions in pain , stiffness , and disability , which helped improve the patients ' quadriceps strength and aerobic ability Objective : To evaluate the effects of tai chi consisting of group and home-based sessions in elderly subjects with knee osteoarthritis . Design : A r and omized , controlled , single-blinded 12-week trial with stratification by age and sex , and six weeks of follow-up . Setting : General community . Participants : Forty-one adults ( 709 / 9.2 years ) with knee osteoarthritis . Interventions : The tai chi programme featured six weeks of group tai chi sessions , 40 min/session , three times a week , followed by another six weeks ( weeks 7 -12 ) of home-based tai chi training . Subjects were requested to discontinue tai chi training during a six-week follow-up detraining period ( weeks 13 - 18 ) . Subjects in the attention control group attended six weeks of health lectures following the same schedule as the group-based tai chi intervention ( weeks 0 -6 ) , followed by 12 weeks of no activity ( weeks 7 - 18 ) . Main outcome measures : Knee pain measured by visual analogue scale , knee range of motion and physical function measured by Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) were recorded at baseline and every three weeks throughout the 18-week study period . Data were analysed using a mixed model ANOVA . Results : The six weeks of group tai chi followed by another six weeks of home tai chi training showed significant improvements in mean overall knee pain ( P = 0.0078 ) , maximum knee pain ( P = 0.0035 ) and the WOMAC subscales of physical function ( P = 0.0075 ) and stiffness ( P = 0.0206 ) compared to the baseline . No significant change of any outcome measure was noted in the attention control group throughout the study . The tai chi group reported lower overall pain and better WOMAC physical function than the attention control group at weeks 9 and 12 . All improvements disappeared after detraining OBJECTIVE To evaluate the effect of a brace intended to reduce load in patients with medial or lateral compartmental osteoarthritis ( OA ) and concurrent varus or valgus alignment , respectively . DESIGN This multi-centre r and omized controlled trial ( performed 2001 - 2003 ) studies the additive effect of a brace intended to reduce load in conservative treatment of unicompartmental OA of the knee . SETTING Orthopedic department of a university medical centre and of one general hospital . The follow-up was 12 months . PATIENTS 117 patients with unicompartmental OA of the knee . Intervention group ( n=60 ) comprising conservative treatment with additional brace treatment and a control group ( n=57 ) comprising conservative treatment alone . PRIMARY OUTCOME MEASURES Pain severity and knee function score . SECONDARY OUTCOME MEASURES Walking distance and quality of life . ANALYSIS Multiple linear regression models according to the intention-to-treat-principle were used to assess outcome differences for the entire group of patients . In addition , we performed explorative subgroup analyses on primary overall outcomes stratified for alignment , degree of OA , origin of OA , and age . RESULTS Although the primary outcome measures were improved in the intervention group in comparison with the controls at each assessment point , the differences reached only borderline significance . The reported walking distances at 3 months , 12 months and overall were significantly longer in the brace group ( P=0.03 , P=0.04 and P=0.02 , respectively ) . Subgroup analysis showed a better effect in the varus group , in patients with severe OA , in patients with secondary OA and in patients younger then 60 years . In total 25 patients in the brace group and 14 in the control group changed their initial treatment , mostly ( 74 % ) because of a lack of beneficial effect . CONCLUSIONS The results indicate that a brace intended to reduce load shows small effects in patients with unicompartmental OA . However , many patients do not adhere in the long run to this kind of conservative treatment OBJECTIVE This 8 week r and omized , double blind clinical trial compared the effect of a combined home based progressive exercise program and treatment with the nonsteroidal medication oxaprozin to treatment with oxaprozin alone on pain and physical functioning in older community dwelling patients with unilateral knee osteoarthritis ( OA ) . METHODS Efficacy variables measured before and after 8 weeks included ( 1 ) pain using the Western Ontario McMaster ( WOMAC ) pain , physical disability , and stiffness subscales and a 10 point visual analog scale ( VAS ) before and after self-paced walking ( SPW ) and stepping ( SPS ) functional tasks ; ( 2 ) physical function using the time to complete a self-paced 40 m walk ( SPW ) and 20 cycles of 2 steps ( SPS ) : ( 3 ) physical activity level using the Physical Activity Scale for Elderly ( PASE ) ; ( 4 ) clinical measures of knee functioning ( range of motion ) .  One hundred seventy-nine men and women ( mean age 74 + /- 6 yrs ) with radiographic evidence of mild/moderate medial compartment OA were r and omized to either a progressive home based knee exercise program ( n = 88 ) or a control program ( n = 89 ) . All patients were given oxaprozin 1,200 mg per os daily . RESULTS We observed significant reduction from baseline in activity related pain ( VAS ) ; and improvement in SPW and SPS test time , passive range of motion , and PASE after 8 weeks in both groups . These changes were significantly greater ( p < 0.05 ) in the exercise versus sham group . CONCLUSION Addition of a progressive exercise program to nonsteroidal antiinflammatory therapy in patients with knee OA can improve measures of activity and activity related pain more than medication alone Cetin N , Aytar A , Atalay A , Akman MN : Comparing hot pack , short-wave diathermy , ultrasound , and TENS on isokinetic strength , pain , and functional status of women with osteoarthritic knees : a single-blind , r and omized , controlled trial . Am J Phys Med Rehabil 2008;87:443–451 . Objective : To investigate the therapeutic effects of physical agents administered before isokinetic exercise in women with knee osteoarthritis . Design : One hundred patients with bilateral knee osteoarthritis were r and omized into five groups of 20 patients each : group 1 received short-wave diathermy + hot packs and isokinetic exercise ; group 2 received transcutaneous electrical nerve stimulation + hot packs and isokinetic exercise ; group 3 received ultrasound + hot packs and isokinetic exercise ; group 4 received hot packs and isokinetic exercise ; and group 5 served as controls and received only isokinetic exercise . Results : Pain and disability index scores were significantly reduced in each group . Patients in the study groups had significantly greater reductions in their visual analog scale scores and scores on the Lequesne index than did patients in the control group ( group 5 ) . They also showed greater increases than did controls in muscular strength at all angular velocities . In most parameters , improvements were greatest in groups 1 and 2 compared with groups 3 and 4 . Conclusions : Using physical agents before isokinetic exercises in women with knee osteoarthritis leads to augmented exercise performance , reduced pain , and improved function . Hot pack with a transcutaneous electrical nerve stimulator or short-wave diathermy has the best outcome Objective : To evaluate the effects of Tai Chi Qigong training on the quality of life and physical function of patients with osteoarthritis of the knee . Design : A preliminary , single-blind , r and omized controlled trial . Setting : General community , performed at Hwaseong City Health Center . Participants : Forty-four elderly subjects ( mean age , 69.1 ± 5.4 years ) with knee osteoarthritis . Intervention : The patients were r and omized ( 2:1 ) to : ( 1 ) an eight-week Tai Chi Qigong training programme or ( 2 ) a waiting list control group . The programme involved eight weeks of group Tai Chi Qigong sessions , with 60 minutes per session twice a week . Main outcome measures : The primary outcome was quality of life measured with the Short Form 36 ( SF-36 ) at baseline and week 8 . Secondary outcomes included the Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) and 6-m walking time . Results : The training group had statistically significant improvements in the quality of life ( changes of SF-36 , Qigong versus control : 21.6 ± 16.8 versus 9.8 ± 13.6 , P<0.05 ) and 6-m walking test ( change in walking time , Qigong versus control : —1.6 ± 1.7 versus —0.2 ± 0.8 s , P<0.01 ) . The WOMAC scores in the training group were markedly improved , although the differences were not statistically significant . Conclusions : Tai Chi Qigong training appears to have beneficial effects in terms of the quality of life and physical functioning of elderly subjects with knee osteoarthritis . However , more rigorous trials are needed to confirm the efficacy of this training for patients with osteoarthritis of the knee This study examines and compares the effect of aerobic and resistance exercise on emotional and physical function among older persons with initially high or low depressive symptomatology . Data are from the Fitness , Arthritis and Seniors Trial , a trial among 439 persons 60 years or older with knee osteoarthritis r and omized to health education  ( control ) , resistance exercise , or aerobic exercise groups .  Depressive symptoms ( assessed by the Center for Epidemiologic Studies --Depression scale ) and physical function ( disability , walking speed , and pain ) were assessed at baseline and after 3 , 9 , and 18 months . Compared with results for the control group , aerobic exercise significantly lowered depressive symptoms over time . No such effect was observed for resistance exercise . The reduction in depressive symptoms with aerobic exercise was found both among the 98 participants with initially high depressive symptomatology and among the 340 participants with initially low depressive symptomatology and was the strongest for the most compliant persons . Aerobic and resistance exercise significantly reduced disability and pain and increased walking speed both , and to an equal extent , in persons with high depressive symptomatology and persons with low depressive symptomatology Background Prescription of resistance training ( RT ) exercises is an essential aspect of management for knee osteoarthritis ( OA ) . However , whether patients with knee OA who are r and omly assigned to receive RT simply substitute RT for other modes of physical activity remains unclear . Objective The aim of this study was to determine the effect of a structured RT intervention on overall levels of moderate- and vigorous-intensity physical activity ( MVPA ) in patients with early-onset knee OA . The study compared patients with early-onset OA who participated in an RT program , those who participated in a self-management ( SM ) program  , and those who participated in both RT and SM . Because participants r and omly assigned to receive the RT intervention may simply switch activity modes , result ing in little net effect , we assessed total MVPA in addition to tracking changes in strength ( force-generating capacity ) . Design and Intervention This study was a r and omized controlled trial comparing the effectiveness of SM alone , RT alone , and combined RT+SM on MVPA in patients with early OA of the knee . Setting The study was conducted on a university campus , with patient recruitment from the local community . Participants The participants in this study were 171 patients ( 74 % women , 26 % men ) with knee OA . They had a mean age of 55.1 ( SD=7.1 ) years , a mean body mass index of 27.6 ( SD=4.2 ) kg/m2 , and radiographic status of grade II OA ( and no higher ) in at least one knee , as defined by the Kellgren and Lawrence classification . They wore an accelerometer while awake ( X̄=14.2 [ SD=2.2 ] hours ) for 5 to 7 contiguous days ( X̄=6.8 [ SD=0.5 ] days ) at baseline and at 3 and 9 months of intervention . Results The participants engaged in MVPA a mean of 26.2 ( SD=19.3 ) minutes per day at baseline . Both groups significantly increased their MVPA from baseline to 3 months ( RT group by 18 % [ effect size (d)=0.26 ] ; SM group by 22 % [ effect size (d)=0.25 ] ) , but only the RT group sustained those changes at 9 months ( RT group maintained a 10 % increase [ effect size (d)=0.15 ] ; SM group maintained a 2 % increase [ effect size (d)=0.03 ] ) . A significant group × time interaction for MVPA indicated that the RT group maintained higher MVPA levels than the SM group . Limitations . Lack of direct measures of energy expenditure and physical function was a limitation of the study . Conclusions Patients with early-onset OA of the knee can engage in an RT program without sacrificing their overall MVPA levels . These results support the value of RT for management of knee OA Background and Purpose : Muscle strength training is important for people with knee osteoarthritis ( OA ) .  High-resistance exercise has been demonstrated to be more beneficial than low-resistance exercise for young subjects . The purpose of this study was to compare the effects of high- and low-resistance strength training in elderly subjects with knee OA . Subjects and Methods : One hundred two subjects were r and omly assigned to groups that received 8 weeks of high-resistance exercise ( HR group ) , 8 weeks of low-resistance exercise ( LR group ) , or no exercise ( control group ) . Pain , function , walking time , and muscle torque were examined before and after intervention . Results : Significant improvement for all measures was observed in both exercise groups . There was no significant difference in any measures between HR and LR groups . However , based on effect size between exercise and control groups , the HR group improved more than the LR group . Discussion and Conclusion : Both high- and low-resistance strength training significantly improved clinical effects in this study . The effects of high-resistance strength training appear to be larger than those of low-resistance strength training for people with mild to moderate knee OA , although the differences between the HR and LR groups were not statistically significant OBJECTIVE To determine the effects of structured exercise programs on  self-reported disability in older adults with knee osteoarthritis . SETTING AND DESIGN A r and omized , single-blind clinical trial lasting 18 months conducted at 2 academic medical centers . PARTICIPANTS A total of 439 community-dwelling adults , aged 60 years or older , with radiographically evident knee osteoarthritis , pain , and self-reported physical disability .  INTERVENTIONS An aerobic exercise program , a resistance exercise program , and a health education program . MAIN OUTCOME MEASURES The primary outcome was self-reported disability score ( range , 1 - 5 ) . The secondary outcomes were knee pain score ( range , 1 - 6 ) , performance measures of physical function , x-ray score , aerobic capacity , and knee muscle strength . RESULTS A total of 365 ( 83 % ) participants completed the trial . Overall compliance with the exercise prescription was 68 % in the aerobic training group and 70 % in the resistance training group . Postr and omization , participants in the aerobic exercise group had a 10 % lower adjusted mean ( + /- SE ) score on the physical disability question naire ( 1.71 + /- 0.03 vs 1.90 + /- 0.04 units ; P<.001 ) , a 12 % lower score on the knee pain question naire ( 2.1 + /- 0.05 vs 2.4 + /- 0.05 units ; P=.001 ) , and performed better ( mean [ + /- SE ] ) on the 6-minute walk test ( 1507 + /- 16 vs 1349 + /- 16 ft ; P<.001 ) , mean ( + /-SE ) time to climb and descend stairs ( 12.7 + /- 0.4 vs 13.9 + /- 0.4 seconds ; P=.05 ) , time to lift and carry 10 pounds ( 9.1 + /- 0.2 vs 10.0 + /- 0.1 seconds ; P<.001 ) , and mean ( + /-SE ) time to get in and out of a car ( 8.7 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P<.001 ) than the health education group . The resistance exercise group had an 8 % lower score on the physical disability question naire ( 1.74 + /- 0.04 vs 1.90 + /- 0.03 units ; P=.003 ) , 8 % lower pain score ( 2.2 + /- 0.06 vs 2.4 + /- 0.05 units ; P=.02 ) , greater distance on the 6-minute walk ( 1406 + /- 17 vs 1349 + /- 16 ft ; P=.02 ) , faster times on the lifting and carrying task ( 9.3 + /- 0.1 vs 10.0 + /- 0.16 seconds ; P=.001 ) , and the car task ( 9.0 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P=.003 ) than the health education group . There were no differences in x-ray scores between either exercise group and the health education group . CONCLUSIONS Older disabled persons with osteoarthritis of the knee had modest improvements in measures of disability , physical performance , and pain from participating in either an aerobic or a resistance exercise program . These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis Background : According to a recent meta analysis study , there is strong evidence to support the view that transcutaneous electrical nerve stimulation ( TENS ) is an effective treatment for managing osteoarthritis ( OA ) knee pain . However , there is limited evidence showing its effectiveness in improving physical function . This study examined whether TENS alone can improve physical function in terms of range of knee motion and the Timed-Up- and -Go Test . Methods : Subjects were r and omly allocated into 2 groups receiving TENS at 100 Hz or a placebo TENS . Outcome measures included : 1 ) visual analog scale for measuring the intensity of the present pain , 2 ) Timed-Up- and -Go Test , and 3 ) range of knee motion ( ROM ) . Repeated- measures analysis of variance and Pearson correlation were used for data analyses . Results : By day 10 , TENS produced a significantly greater increase in maximum knee ROM than the placebo group ( P = 0.033 ) . TENS also significantly increased the pain-limited knee ROM across sessions , but the between-group difference was short of significance ( P = 0.067 ) . The decrease in time in performing the Timed-Up- and -Go Test was also not significantly different between the 2 groups . A moderate correlation was observed between the reduction in pain scores and the improvement in the Timed-Up- and -Go Test . Conclusions : Our findings suggested that TENS did improve some of the physical parameters but over 10 days was unable to produce significant improvement in functional performance among people with knee OA . A larger-scale study with the assessment of other functional outcomes may be required to clarify if TENS could improve function in people with knee OA . Also , exercise can be considered to be an important adjunct treatment to TENS to improve function significantly OBJECTIVES To determine whether a home-based pedometer-driven walking program with arthritis self-management education ( Walk + ) would increase physical activity , muscle strength , and functional performance in older adults with osteoarthritis ( OA ) of the knee as opposed to arthritis self-management education alone ( EDU ) . DESIGN A r and omized two-by-three ( group-by-time ) design with participants assigned to  Walk + ( n = 17 , mean age + /- st and ard deviation = 69.6 + /- 6.7 ) or EDU ( n = 17 , age = 70.8 + /- 4.7 ) . SETTING Community located in the Baltimore-Washington area . PARTICIPANTS Thirty-four community-dwelling adults , aged 60 and older with symptomatic knee OA and self-reported functional impairment . INTERVENTIONS Both groups received 12 hours of the Arthritis Self-Management program over 12 weeks and were followed for an additional 12 weeks . In addition , the Walk + group received individualized instruction in the use of a pedometer , with the goal of increasing their step count by 30 % of their baseline step count . MEASUREMENTS The outcome measures were physical activity ( daily step counts and total activity vector magnitude as measured by a pedometer and Tritrac-R3D accelerometer ) , quadriceps femoris strength ( isometric peak torque ) , and functional performance tasks ( 100-foot walk-turn-walk , timed stair climb , timed chair rise , and pain status ) . RESULTS Daily steps walked showed a significant group-by-time interaction ( P = .04 ) after controlling for age . From baseline to completion of training , a 23 % increase in daily steps occurred in the Walk + group and a 15 % decrease in the EDU group . Although steps increased in the Walk + group , total activity vector magnitude was maintained , suggesting a more efficient gait . The Walk + group became quicker than the EDU group in the normal-pace walk-turn-walk ( P = .04 ) . An isometric strength gain of 21 % postintervention was seen in the Walk + group , compared with a loss of 3.5 % in the EDU group . CONCLUSION In older adults with symptomatic knee OA , Walk + appears to increase walking , with improvements in muscle strength and walking performance . The use of a home-based pedometer-driven program to increase physical activity , strength , and function in this population warrants further research OBJECTIVE This is a double blind study that examined the optimal stimulation frequency of transcutaneous electrical nerve stimulation in reducing  pain due to knee osteoarthritis . SUBJECTS Thirty-four subjects were r and omly allocated into 4 groups receiving transcutaneous electrical nerve stimulation at either : ( i ) 2 Hz ; ( ii ) 100 Hz ; ( iii ) an alternating frequency of 2 Hz and 100 Hz ( 2/100 Hz ) ; or ( iv ) a placebo transcutaneous electrical nerve stimulation . METHODS Treatment was administered 5 days a week for 2 weeks . The outcome measures included : ( i ) a visual analogue scale ; ( ii ) a timed up- and -go test ; and ( iii ) a range of knee motion . RESULTS The 3 active transcutaneous electrical nerve stimulation groups ( 2 Hz , 100 Hz , 2/100 Hz ) , but not the placebo group , significantly reduced osteoarthritic knee pain across treatment sessions . However , no significant between-group difference was found . Similarly , the 3 active transcutaneous electrical nerve stimulation groups , but not the placebo group , produced significant reductions in the amount of time required to perform the timed up- and -go test , and an increase in the maximum passive knee range of motion . CONCLUSION Our findings suggested that 2 weeks of repeated applications of transcutaneous electrical nerve stimulation at 2 Hz , 100 Hz or 2/100 Hz produced similar treatment effects for people suffering from osteoarthritic knee BACKGROUND AND PURPOSE Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteoarthritis ( OA ) of the knee . The purpose of this study was to compare outcomes between a home-based physical therapy program and a clinical ly based physical therapy program . SUBJECTS One hundred thirty-four subjects with OA of the knee were r and omly assigned to a  clinic treatment group ( n=66 ; 61 % female , 39 % male ; mean age [+/-SD]=64+/-10 years ) or a home exercise group ( n=68 , 71 % female , 29 % male ; mean age [+/-SD]=62+/-9 years ) . METHODS Subjects in the clinic treatment group received supervised exercise , individualized manual therapy , and a home exercise program over a 4-week period . Subjects in the home exercise group received the same home exercise program initially , reinforced at a clinic visit 2 weeks later . Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . RESULTS Both groups showed clinical ly and statistically significant improvements in 6-minute walk distances and WOMAC scores at 4 weeks ; improvements were still evident in both groups at 8 weeks . By 4 weeks , WOMAC scores had improved by 52 % in the clinic treatment group and by 26 % in the home exercise group . Average 6-minute walk distances had improved about 10 % in both groups . At 1 year , both groups were substantially and about equally improved over baseline measurements . Subjects in the clinic treatment group were less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group . DISCUSSION AND CONCLUSION Although both groups improved by 1 month , subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home . Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program . The results indicate that a home exercise program for patients with OA of the knee provides important benefit . Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief PURPOSE To determine whether transcutaneous electrical nerve stimulation ( TENS ) and focal knee joint cooling will affect the quadriceps central activation ratio ( CAR ) in patients with tibiofemoral osteoarthritis . METHODS Thirty-three participants with diagnosed tibiofemoral osteoarthritis were r and omly allocated to the 45-min TENS treatment ( six males and four females , 56 + /- 10.1 yr , 174.11 + /- 10.78 cm , 89.34 + /- 21.3 kg ) , the 20-min focal knee joint cooling treatment ( six males and five females , 58 + /- 8.4 yr , 176.41 + /- 8.29 cm , 83.18 + /- 17.97 kg ) , or the control group ( five males and seven females , 54 + /- 9.9 yr , 166.37 + /- 13.07 cm , 92.14 + /- 25.37 kg ) . Volitional quadriceps activation , maximal voluntary isometric contraction , and subjective pain measurements were conducted at baseline and at 20 , 30 , and 45 min . The 20-min focal knee joint cooling intervention consisted of two 1.5-L ice bags to the anterior and posterior aspects of the knee . The TENS group received 45 min of a sensory , biphasic square wave stimulation ( 150-mus phase duration and 150 pps ) from four 2 x 2-inch electrodes positioned around the patella . RESULTS : TENS result ed in a significantly higher percent change in CAR scores compared with control at 20 min ( 6.4 + /- 4.8 vs -3.5 + /- 8 , P = 0.006 ) , 30 min ( 9.7 + /- 10.16 vs -1 + /- 7.9 , P = 0.025 ) , and 45 min ( 11.25 + /- 6.96 vs 0.81 + /- 9.4 , P = 0.029 ) . Focal knee joint cooling result ed in significantly higher percent change scores compared with the control group at 20 min ( 5.75 + /- 7.25 vs -3.5 + /- 8 , P = 0.009 ) and trended to be higher at 45 min ( 9.06 + /- 9.63 vs 0.81 + /- 9.4 , P = 0.098 ) . No significant differences in percent change for CAR were found between the TENS and the focal knee joint cooling group . CONCLUSIONS Both TENS and focal knee joint cooling  increased the quadriceps CAR immediately after application in participants with tibiofemoral osteoarthritis OBJECTIVE To compare the influence of concomitant heeled footwear when wearing a lateral wedged insole for medial compartment of osteoarthritis ( OA ) of the knee , between everyday walking shoes for outdoor use and socks or flat footwear without a heel for indoor use . DESIGN A total of 227 out patients were prospect ively r and omized and treated with a neutral wedged insole inserted into shoes ( placebo with shoes ; n=45 ) , a wedged insole inserted into shoes ( inserted insole with shoes ; n=45 ) , a sock-type ankle supporter with a wedged insole when wearing socks or flat footwear ( inserted insole without shoes ; n=46 ) , a subtalar strapped insole when wearing shoes ( strapped insole with shoes ; n=45 ) , and the strapped insole with socks or flat footwear ( strapped insole without shoes ; n=46 ) . The Lequesne index of knee OA at week 12 was compared with the baseline in each treatment group . RESULTS Twenty patients withdrew from the study , and the 207 patients who completed the 12-week study were evaluated . At the final assessment , participants wearing the inserted insole without shoes ( P=0.003 ) , the strapped insole with shoes ( P<0.0001 ) , and the strapped insole without shoes ( P<0.0001 ) demonstrated significantly improved Lequesne index scores in comparison with their baseline assessment s. No significant differences were found in the placebo ( P=0.16 ) or the inserted insole with shoes ( P=0.2 ) groups . CONCLUSION Concomitant heeled footwear may decrease the efficacy of an inserted lateral wedged insole . The optimal usage of a lateral wedged insole for knee OA would be the combination with socks or flat footwear without heels Purpose : The EQ-5D is a brief , multiattribute , preference-based health status measure . This article describes the development of a statistical model for generating US population -based EQ-5D preference weights . Methods : A multistage probability sample was selected from the US adult civilian noninstitutional population . Respondents valued 13 of 243 EQ-5D health states using the time trade-off ( TTO ) method . Data for 12 states were used in econometric modeling . The TTO valuations were linearly transformed to lie on the interval [ −1 , 1 ] . Methods were investigated to account for interaction effects caused by having problems in multiple EQ-5D dimensions . Several alternative model specifications ( eg , pooled least squares , r and om effects ) also were considered . A modified split- sample approach was used to evaluate the predictive accuracy of the models . All statistical analyses took into account the clustering and disproportionate selection probabilities inherent in our sampling design . Results : Our D1 model for the EQ-5D included ordinal terms to capture the effect of departures from perfect health as well as interaction effects . A r and om effects specification of the D1 model yielded a good fit for the observed TTO data , with an overall R2 of 0.38 , a mean absolute error of 0.025 , and 7 prediction errors exceeding 0.05 in absolute magnitude . Conclusions : The D1 model best predicts the values for observed health states . The result ing preference weight estimates represent a significant enhancement of the EQ-5D 's utility for health status assessment and economic analysis in the US OBJECTIVE To examine whether the effects of 12 weeks of quadriceps strengthening on the knee adduction moment , pain , and function in people with medial knee osteoarthritis ( OA ) differ in those with and without varus malalignment . METHODS A single-blind , r and omized controlled trial of 107 community volunteers with medial knee OA was conducted . Participants were stratified according to knee malalignment ( more varus or more neutral ) and then r and omized into either a 12-week supervised home-based quadriceps strengthening group or a control group with no intervention . The primary outcome was the knee adduction moment , measured using 3-dimensional gait analysis . Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index scores ( measuring pain and physical function ) , step test score , stair climb test score , and maximum quadriceps isometric strength . Analyses of covariance were carried out based on intent-to-treat principles . RESULTS Quadriceps strengthening did not significantly alter the knee adduction moment in either the more malaligned or the more neutral group ( unadjusted knee adduction moment 0.12 and 0.05 % Nm/BWxHT , respectively ) . Function did not improve significantly following quadriceps strengthening in either alignment group , but there was a significant improvement in knee pain in the more neutrally aligned group ( P < 0.001 ) . CONCLUSION Quadriceps strengthening did not have any significant effect on the knee adduction moment in participants with either more varus or more neutral alignment . The benefits of quadriceps strengthening on pain were more evident in those with more neutral alignment . Knee alignment thus represents a local mechanical factor that can mediate symptomatic outcome from exercise interventions in knee OA OBJECTIVE To examine changes in mobility-related self efficacy following exercise and dietary weight loss interventions in overweight and obese older adults with knee osteoarthritis ( OA ) , and to determine if self efficacy and pain mediate the effects of the interventions on mobility task performance . METHODS The Arthritis , Diet , and Activity Promotion Trial was an 18-month , single-blind , r and omized , controlled trial comparing the effects of exercise alone , dietary weight loss alone , a combination of exercise plus dietary weight loss , and a healthy lifestyle control intervention in the treatment of 316 overweight or obese older adults with symptomatic knee OA . Participants completed measures of stair-climb time and 6-minute walk distance , self efficacy for completing each mobility task , and self-reported pain at baseline , 6 months , and 18 months during the trial . RESULTS Mixed model analyses of covariance of baseline adjusted change in the outcomes demonstrated that the exercise + dietary weight loss intervention produced greater improvements in mobility-related self efficacy ( P = 0.0035 ) , stair climb ( P = 0.0249 ) and 6-minute walk performance ( P = 0.00031 ) , and pain ( P = 0.09 ) when compared with the healthy lifestyle control intervention . Mediation analyses revealed that self efficacy and pain served as partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb time . CONCLUSION Exercise + dietary weight loss results in improved mobility-related self efficacy ; changes in these task-specific control beliefs and self-reported pain serve as independent partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb performance Objective : To investigate the effects of a sensorimotor training programme in osteoarthritic patients . Design : R and omized , single-blind , controlled trial . Setting : Kinesiology laboratory at School of Physical Therapy . Participants : A total of 60 patients were r and omly assigned to the training group and the control group . Only 29 patients ( training group , 15 ; control group , 14 ) completed the study . Intervention : The training group underwent a sensorimotor training programme using a sling suspension system complemented by a routine physical therapy . The control group underwent a routine physical therapy . Main measures : Active joint repositioning , functional testings , and self-reported function with the Western Ontario & McMaster Universities Arthritis Index before and after the eight-week intervention . Results : There were significant differences between the two groups with respect to the improvement in proprioception as measured by active joint repositioning ( the changes in the absolute error were 1.9± 1.7 ° , training group versus 0.1 ± 2.8 ° , control group ( P<0.05 ) , and in self-reported functional difficulty ( 33.2 ±35.1 , training group versus 8.0± 10.2 , control group ; P<0.05 ) ) . There was no significant difference between the two groups in other outcomes . Conclusion : A sensorimotor training using a sling suspension system improved the patients ' proprioception in the knee joints and their self-reported function . Thus , these exercises may serve as an exercise programme for patients with knee osteoarthritis OBJECTIVE To evaluate the benefit of shortwave diathermy ( SWD ) supplemented to an exercise program for knee osteoarthritis ( OA ) in peri-/post-menopausal women . METHODS A double-blind r and omized placebo-controlled equivalence trial was conducted in a university hospital . Participants including 113 women aged 50 - 85 years with primary knee OA were instructed to do regular quadriceps exercise , and r and omized to control ( n=60 ) and treatment ( n=53 ) groups receiving sham SWD and therapeutic SWD , respectively . The treatment being evaluated was continuous SWD , 20 min/session , 3 sessions/week for 3 weeks . The outcomes including Thai Western Ontario and McMaster Universities OA ( WOMAC ) index , 100-m walking speed , stair ascent- and -descent time , global assessment , patient 's satisfaction , and adverse events were assessed at baseline and end of treatment . RESULTS At the end of treatment , both groups had trivial but statistical improvement in all outcomes . Intention-to-treat analysis showed no statistically significant difference between the two groups in all outcomes . Per protocol analysis demonstrated the equivalence in Thai WOMAC total score , as the 95 % confidence interval of difference ( -0.62 , 0.92 ) was within confidence limits of + /-1 cm . CONCLUSION The addition of SWD to an exercise program for knee OA in peri-/post-menopausal women is not superior to the exercise program alone OBJECTIVE To evaluate the effectiveness of Tai Chi in the treatment of knee osteoarthritis ( OA ) symptoms . METHODS We conducted a prospect i ve , single-blind , r and omized controlled trial of 40 individuals with symptomatic tibiofemoral OA . Patients were r and omly assigned to 60 minutes of Tai Chi ( 10 modified forms from classic Yang style ) or attention control ( wellness education and stretching ) twice weekly for 12 weeks . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain score at 12 weeks . Secondary outcomes included WOMAC function , patient and physician global assessment s , timed chair st and , depression index , self-efficacy scale , and quality of life . We repeated these assessment s at 24 and 48 weeks . Analyses were compared by intent-to-treat principles . RESULTS The 40 patients had a mean age of 65 years and a mean body mass index of 30.0 kg/m(2 ) . Compared with the controls , patients assigned to Tai Chi exhibited significantly greater improvement in WOMAC pain ( mean difference at 12 weeks -118.80 mm [ 95 % confidence interval ( 95 % CI ) -183.66 , -53.94 ; P = 0.0005 ] ) , WOMAC physical function ( -324.60 mm [ 95 % CI -513.98 , -135.22 ; P = 0.001 ] ) , patient global visual analog scale ( VAS ; -2.15 cm [ 95 % CI -3.82 , -0.49 ; P = 0.01 ] ) , physician global VAS ( -1.71 cm [ 95 % CI -2.75 , -0.66 ; P = 0.002 ] ) , chair st and time ( -10.88 seconds [ 95 % CI -15.91 , -5.84 ; P = 0.00005 ] ) , Center for Epidemiologic Studies Depression Scale ( -6.70 [ 95 % CI -11.63 , -1.77 ; P = 0.009 ] ) , self-efficacy score ( 0.71 [ 95 % CI 0.03 , 1.39 ; P = 0.04 ] ) , and Short Form 36 physical component summary ( 7.43 [ 95 % CI 2.50 , 12.36 ; P = 0.004 ] ) . No severe adverse events were observed . CONCLUSION Tai Chi reduces pain and improves physical function , self-efficacy , depression , and health-related quality of life for knee OA Objective : To evaluate the cumulative effect of repeated transcutaneous electrical nerve stimulation ( TENS ) on  chronic osteoarthritic ( OA ) knee pain  over a four-week treatment period , comparing it to that of placebo stimulation and exercise training given alone or in combination with TENS . Design : Sixty-two patients , aged 50–75 , were stratified according to age , gender and body mass ratio before being r and omly assigned to four groups . Interventions : Patients received either ( 1 ) 60 minutes of TENS , ( 2 ) 60 minutes of placebo stimulation , ( 3 ) isometric exercise training , or ( 4 ) TENS and exercise ( TENS & Ex ) five days a week for four weeks . Main outcome measures : Visual analogue scale ( VAS ) was used to measure knee pain intensity before and after each treatment session over a four-week period , and at the four-week follow-up session . Results : Repeated measures ANOVA showed a significant cumulative reduction in the VAS scores across the four treatment sessions ( session 1 , 10 , 20 and the follow-up ) in the TENS group ( 45.9 % by session 20 , p < 0.001 ) and the placebo group ( 43.3 % by session 20 , p = 0.034 ) . However , linear regression of the daily recordings of the VAS indicated that the slope in the TENS group ( slope = -2.415 , r = 0.943 ) was similar to the exercise group ( slope = -2.625 , r = 0.935 ) , which were steeper than the other two groups . Note that the reduction of OA knee pain was maintained in the TENS group and the TENS & Ex group at the four-week follow-up session , but not in the other two groups . Conclusions : The four treatment protocol s did not show significant between-group difference over the study period . It was interesting to note that isometric exercise training of the quadriceps alone also reduced knee pain towards the end of the treatment period OBJECTIVE To determine whether gains in functioning observed immediately following participation in an 8-week program of supervised fitness walking for patients with knee osteoarthritis were sustained at 1-year followup . METHODS Twenty-nine ( 61.1 % ) of 47 original intervention program patients and 23 ( 51.1 % ) of 45 original control patients were interviewed by telephone at 1-year followup . Patients completed the Arthritis Impact Measurement Scales physical activity , arthritis impact , pain , medication use , and general health perceptions subscales , as well as a separate visual analog pain scale and measures of perceived self-efficacy to cope with arthritis pain and other symptoms . RESULTS Adherence to walking was low , and there were no statistically significant differences between intervention and control patients at one year . CONCLUSIONS The failure of intervention patients to maintain regular walking result ed in loss of functional benefits that were observed at 8 weeks in the original study . Long-term adherence to walking is critical to maintenance of initial gains in functional outcomes BACKGROUND The OARSI St and ing Committee for Clinical Trials Response Criteria Initiative had developed two sets of responder criteria to present the results of changes after treatment in three symptomatic domains ( pain , function , and patient 's global assessment ) as a single variable for clinical trials ( 1 ) . For each domain , a response was defined by both a relative and an absolute change , with different cut-offs with regard to the drug , the route of administration and the OA localization . OBJECTIVE To propose a simplified set of responder criteria with a similar cut-off , whatever the drug , the route or the OA localization . METHODS Data driven approach : ( 1 ) Two data bases were considered : the " elaboration " data base with which the formal OARSI sets of responder criteria were elaborated , and the " revisit " data base . ( 2 ) Six different scenarios were evaluated : The two formal OARSI sets of criteria ; Four proposed scenarios of simplified sets of criteria . Data from clinical r and omized blinded placebo controlled trials were used to evaluate the performances of the two formal scenarios with two different data bases ( " elaboration " versus " revisit " ) and those of the four proposed simplified scenarios within the " revisit " data base . The placebo effect , active effect , treatment effect , and the required sample arm size to obtain the placebo effect and the active treatment effect observed were the performances evaluated for each of the six scenarios . Experts ' opinion approach : Results were discussed among the participants of the OMERACT VI meeting , who voted to select the definite OMERACT-OARSI set of criteria ( one of the six evaluated scenarios ) . RESULTS Data driven approach : Fourteen trials totaling 1886 OA patients and fifteen studies involving 8164 OA patients were evaluated in the " elaboration " and the " revisit " data bases respectively . The variability of the performances observed in the " revisit " data base when using the different simplified scenarios was similar to that observed between the two data bases ( " elaboration " versus " revisit " ) when using the formal scenarios . The treatment effect and the required sample arm size were similar for each set of criteria . Experts ' opinion approach : According to the experts , these two previous performances were the most important of an optimal set of responder criteria . They chose the set of criteria considering both pain and function as evaluation domain and requiring an absolute change and a relative change from baseline to define a response , with similar cut-offs whatever the drug , the route of administration or the OA localization . CONCLUSION This data driven and experts ' opinion approach is the basis for proposing an optimal simplified set of responder criteria for OA clinical trials . Other studies , using other sets of OA patients , are required in order to further vali date this proposed OMERACT-OARSI set of criteria This study was design ed to evaluate , by means of a r and omized controlled trial , the effects of a physical activity program incorporating aerobic , strength , and stretching exercises in individuals with osteoarthritis of the knee . We r and omly assigned 137 volunteers ages > /=50 to an experimental group or a control group . The experimental group participated in three 1-hour sessions of supervised exercises per week over a 3-month period . The control participants were instructed to continue their usual daily activities , and they attended 1-hour education sessions twice a month . The effectiveness of the program was evaluated using repeated measurements of parameters related to self-reported health status , physical capacity , and joint tenderness . After 3 months , significantly greater improvements were observed in the experimental group than the control group in terms of : arthritis pain ( p = 0.02 ) , ability to walk and bend ( p = 0.03 ) , aerobic capacity ( p < 0.0001 ) , hamstring and low back flexibility ( p = 0.003 ) , quadriceps and hamstring strength ( p < 0.01 ) , and the perception of changes relating to osteoarthritis of the knee and general condition ( p < 0.0001 ) . However , no significant differences were observed between the groups in isokinetic strength of the quadriceps ( all p 's > = = 0.05 ) , joint tenderness ( p = 0.18 ) , and health perception ( p = 0.7 ) . The overall results suggest that this program is effective for older persons with osteoarthritis of the knee and that it could contribute to maintaining their independence and improving their quality of life OBJECTIVE To compare 16 weeks of isometric versus dynamic resistance training versus a control on knee pain and functioning among patients with knee osteoarthritis ( OA ) . DESIGN R and omized clinical trial . SETTING Outpatient setting . PARTICIPANTS A total of 102 volunteer subjects with OA of the knee r and omized to isometric ( n=32 ) and dynamic ( n=35 ) resistance training groups or a control ( n=35 ) . INTERVENTIONS Strength exercises for the legs , 3 times weekly for 16 weeks . Dynamic group : exercises across a functional range of motion ; isometric : exercises at discrete joint angles . MAIN OUTCOME MEASURES The time to descend and ascend a flight of 27 stairs and to get down and up off of the floor . Knee pain was assessed immediately after each functional task . The Western Ontario and McMaster Universities Osteoarthritis Index was used to assess perceived pain , stiffness , and functional ability . RESULTS In the isometric group , time to perform all 4 functional tasks decreased ( P<.05 ) by 16 % to 23 % . In the dynamic group , time to descend and ascend stairs decreased by 13 % to 17 % . Both groups decreased knee pain while performing the functional tasks by 28 % to 58 % . Other measures of pain and functioning were significantly and favorably affected in the training groups . The improvements in the 2 training groups as a result of their respective therapies were not significantly different . The control group did not change over the duration of the study . CONCLUSION Dynamic or isometric resistance training improves functional ability and reduces knee joint pain of patients with knee OA OBJECTIVE In uncontrolled studies , a lateral-wedge insole has reduced knee pain in patients with medial knee osteoarthritis ( OA ) . The aim of this study was to test the efficacy of this simple , low-cost intervention for pain in patients with medial knee OA . METHODS We conducted a double-blind , r and omized , crossover trial design ed to detect a small effect of treatment . Participants were at least 50 years of age and had medial joint space narrowing on posteroanterior semiflexed radiographs and scores indicating moderate pain for 2 of the 5 items on the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain scale . Participants were r and omized to receive a 5 degrees lateral-wedge insole or a neutral insole for 6 weeks . Following a 4-week washout period , participants crossed over to the other treatment for 6 weeks . Knee pain , the primary outcome , was assessed by the WOMAC pain scale ( visual analog scale version ) . Secondary outcomes included the WOMAC disability subscale , overall knee pain , 50-feet walk time , chair-st and time , and use of medications for knee pain . RESULTS Ninety patients were r and omized . The mean difference in pain between the 2 treatments was 13.8 points on the WOMAC pain scale ( 95 % confidence interval -3.9 , 31.4 [ P=0.13 ] ) . We observed similar small effects for the secondary outcomes . CONCLUSION The effect of treatment with a lateral-wedge insole for knee OA was neither statistically significant nor clinical ly important STUDY DESIGN R and omized clinical trial . OBJECTIVE To investigate the clinical and functional efficacy of 2 different non-weight-bearing exercise regimens , proprioceptive training ( PrT ) versus strength training ( ST ) , for patients with knee osteoarthritis ( OA ) . BACKGROUND Both strength and proprioceptive training are important interventions for individuals with knee OA . The benefits of weight-bearing exercises are generally recognized in the clinical setting . However , exercising in a st and ing or weight-bearing position may aggravate symptoms in patients with knee OA . METHODS AND MEASURES One hundred eight patients were r and omly assigned to the PrT , ST , or no exercise ( control ) group for an 8-week intervention . Both the PrT and ST interventions consisted of non-weight-bearing exercises .  Western Ontario and McMaster Universities Osteoarthritis Index-pain ( WOMAC-pain ) and -function scores , walking time on 3 different terrains , knee strength , and absolute knee reposition error were assessed before and after intervention . Data were analyzed using mixed-model ANOVAs . RESULTS Both PrT and ST significantly improved WOMAC-pain and -function score after intervention ( P<.008 ) . The improvement secondary to ST in the WOMAC-function scores ( 17.2 points ) and for knee extension strength ( 10.3 - 14.9 Nm ) was greater than the minimally clinical ly important difference for these measurements . The PrT group demonstrated greater improvement in walking time on a spongy surface and knee reposition error than the other 2 groups . No improvements were apparent in the control group . CONCLUSION Both types of non-weight-bearing exercises ( PrT and ST ) significantly improved outcomes in this study . PrT led to greater improvements in proprioceptive function , while ST result ed in a greater increase in knee extensor muscle strength & NA ; This study tested the separate and combined effects of spouse‐assisted pain coping skills training ( SA‐CST ) and exercise training ( ET ) in a sample of patients having persistent osteoarthritic knee pain . Seventy‐two married osteoarthritis ( OA ) patients with persistent knee pain and their spouses were r and omly assigned to : SA‐CST alone , SA‐CST plus ET , ET alone , or st and ard care ( SC ) . Patients in SA‐CST alone , together with their spouses , attended 12 weekly , 2‐h group sessions for training in pain coping and couples skills . Patients in SA‐CST+ET received spouse‐assisted coping skills training and attended 12‐weeks supervised ET . Patients in the ET alone condition received just an exercise program . Data analyses revealed : ( 1 ) physical fitness and strength :  the SA‐CST+ET and ET alone groups had significant improvements in physical fitness compared to SA‐CST alone and patients in SA‐CST+ET and ET alone had significant improvements in leg flexion and extension compared to SA‐CST alone and SC , ( 2 ) pain coping : patients in SA‐CST+ET and SA‐CST alone groups had significant improvements in coping attempts compared to ET alone or SC and spouses in SA‐CST+ET rated their partners as showing significant improvements in coping attempts compared to ET alone or SC , and ( 3 ) self‐efficacy : patients in SA‐CST+ET reported significant improvements in self‐efficacy and their spouses rated them as showing significant improvements in self‐efficacy compared to ET alone or SC . Patients receiving SA‐CST+ET who showed increased self‐efficacy were more likely to have improvements in psychological disability . An intervention that combines spouse‐assisted coping skills training and exercise training  can improve physical fitness , strength , pain coping , and self‐efficacy in patients suffering from pain due to osteoarthritis OBJECTIVE To determine the feasibility of conducting a r and omized controlled trial assessing the effect of low-intensity pulsed ultrasound ( US ) therapy on cartilage repair in patients with mild to moderate knee osteoarthritis ( OA ) . DESIGN Pilot , double-blinded , r and omized placebo-controlled trial with 2-months follow-up . SETTING Rehabilitation research facility . PARTICIPANTS Adults ( N=27 ; ≥45y ) with grade s 1 or 2 of medial joint space narrowing ( Osteoarthritis Research Society International atlas ) due to knee OA were r and omly allocated to receive active ( n=14 ) or sham ( n=13 ) US therapy .  Four participants withdrew for personal reasons . INTERVENTIONS Twenty-four sessions of active ( 20 % duty cycle , 1MHz , average temporal intensity : 0.2W/cm(2 ) , therapeutic dose : 112.5J/cm(2 ) ) or sham ( no sound-head crystal ) US therapy . MAIN OUTCOME MEASURES Success of recruitment and adherence rates were established by a priori criteria . Effect on cartilage repair was assessed by measuring cartilage volume and thickness and scoring cartilage injury , subchondral cyst formation , and bone marrow lesions on magnetic resonance images . RESULTS Patient recruitment and adherence rates were successful . No significant age-adjusted differences were seen between groups in the cartilage repair outcomes . Age-adjusted analyses , including only subjects who attended 20 sessions or more , showed an increase in medial tibia cartilage thickness in the active US therapy group ( 90μm ; 95 % confidence interval , 1 - 200 ; P=.05 ) . CONCLUSIONS Conducting a r and omized controlled trial to assess the effects of US therapy on the cartilage repair in people with mild to moderate knee OA is feasible . However , further pilot studies are needed to determine the optimal US dose and application parameters before design ing a full trial OBJECTIVE The safety and effectiveness of pulsed electrical stimulation was evaluated for the treatment of osteoarthritis ( OA ) of the knee . METHODS A multicenter , double blind , r and omized , placebo controlled trial that enrolled 78 patients with OA of the knee incorporated 3 primary efficacy variables of patients ' pain , patients ' function , and physician global evaluation of patients ' condition , and 6 secondary variables that included duration of morning stiffness , range of motion , knee tenderness , joint swelling , joint circumference , and walking time . Measurements were recorded at baseline and during the 4 week treatment period . RESULTS Patients treated with the active devices showed significantly greater improvement than the placebo group for all primary efficacy variables in comparisons of mean change from baseline to the end of treatment ( p < 0.05 ) . Improvement of > or = 50 % from baseline was demonstrated in at least one primary efficacy variable in 50 % of the active device group , in 2 variables in 32 % , and in all 3 variables in 24 % . In the placebo group improvement of > or = 50 % occurred in 36 % for one , 6 % for 2 , and 6 % for 3 variables . Mean morning stiffness decreased 20 min in the active device group and increased 2 min in the placebo group ( p < 0.05 ) . No statistically significant differences were observed for tenderness , swelling , or walking time . CONCLUSION The improvements in clinical measures for pain and function found in this study suggest that pulsed electrical stimulation is effective for treating OA of the knee . Studies for longterm effects are warranted OBJECTIVE The investigation aim ed at determining the effectiveness of pulsed electromagnetic fields ( PEMF ) in the treatment of osteoarthritis ( OA ) of the knee by conducting a r and omized , double-blind , placebo-controlled clinical trial . DESIGN The trial consisted of 2h daily treatment 5 days per week for 6 weeks in 83 patients with knee OA . Patient evaluations were done at baseline and after 2 and 6 weeks of treatment . A follow-up evaluation was done 6 weeks after treatment . Activities of daily living ( ADL ) , pain and stiffness were evaluated using the Western Ontario and McMaster Universities ( WOMAC ) question naire . RESULTS Within group analysis revealed a significant improvement in ADL , stiffness and pain in the PEMF-treated group at all evaluations . In the control group there was no effect on ADL after 2 weeks and a weak significance was seen after 6 and 12 weeks . Significant effects were seen on pain at all evaluations and on stiffness after 6 and 12 weeks . Between group analysis did not reveal significant improvements over time . Analysis of ADL score for the PEMF-treated group revealed a significant correlation between less improvement and increasing age . Analysis of patients < 65 years using between group analysis revealed a significant improvement for stiffness on treated knee after 2 weeks , but this effect was not observed for ADL and pain . CONCLUSIONS Applying between group analysis we were unable to demonstrate a beneficial symptomatic effect of PEMF in the treatment of knee OA in all patients . However , in patients < 65 years of age there is significant and beneficial effect of treatment related to stiffness A r and omized double blind clinical trial was conducted to determine the effectiveness of ultrasound ( US ) therapy in knee osteoarthritis ( OA ) . Sixty-seven patients ( mean age 54.8 + /-7 ) were r and omized to receive either 1 MHz frequency or 1 watt/cm(2 ) power continuous ultrasound for 5 min ( n = 34 ) or sham US ( n = 33 ) as a placebo . Ten sessions of treatment were applied to the target knee of the patient . A blinded evaluation at baseline and after treatment was made . Primary outcome was pain on movement assessed by visual analog scale ( VAS ) . Secondary outcomes consisted of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) scores and 50 meters walking time . Both groups showed significant improvements in knee pain on movement . In the treatment group , the improvement in VAS score was statistically and significantly higher ( p < 0.001 ) and more pronounced than in the placebo group . Pain reduction averaged 47.76 % in the treatment group ( p = 0.013 ) . Secondary outcomes improved in both groups but reached statistical significance only in the treatment group : p = 0.006 for the mean change in total WOMAC scores and p = 0.041 for 50 meters walking time . Results suggest that therapeutic US is safe and effective treatment modality in pain relief and improvement of functions in patients with knee OA OBJECTIVE Quadriceps weakness is a risk factor for incident knee osteoarthritis ( OA ) . We describe a r and omized controlled trial of effects of lower-extremity strength training on incidence and progression of knee OA . METHODS A total of 221 older adults ( mean age 69 years ) were stratified by sex , presence of radiographic knee OA , and severity of knee pain , and were r and omized to strength training ( ST ) or range-of-motion ( ROM ) exercises . Subjects exercised 3 times per week ( twice at a fitness facility , once at home ) for 12 weeks , followed by transition to home-based exercise after 12 months . Assessment s of isokinetic lower-extremity strength and highly st and ardized knee radiographs were obtained at baseline and 30 months . RESULTS Subjects in both groups lost lower-extremity strength over 30 months ; however , the rate of loss was slower with ST than with ROM . Compared with ROM , ST decreased the mean rate of joint space narrowing ( JSN ) in osteoarthritic knees by 26 % ( P = not significant ) . However , the difference between ST and ROM groups with respect to frequency of knee OA progression in JSN consensus ratings was marginally significant ( 18 % versus 28 % ; P = 0.094 ) . In knees that were radiographically normal at baseline , JSN > 0.50 mm was more common in ST than in ROM ( 34 % versus 19 % ; P = 0.038 ) . Incident JSN was unrelated to exercise adherence or changes in quadriceps strength or knee pain . CONCLUSION The ST group retained more strength and exhibited less frequent progressive JSN over 30 months than the ROM group . The increase in incident JSN > 0.50 mm in ST is unexplained and requires confirmation Background Several forms of conservative treatment have been the focus of many recent studies in knee osteoarthritis ( OA ) . Among these techniques , the application of pulsed shortwave ( PSW ) treatment has been widely used , but the optimal dose and application time have not been well established . Objective The purpose s of this study were : ( 1 ) evaluate the effect of PSW treatment in different doses and ( 2 ) to compare low-dose and high-dose PSW groups with control and placebo groups . Design This was a r and omized clinical trial . Setting The study was conducted in the physical therapy department of 2 large urban hospitals . Patients One hundred twenty-one women ( mean age=60 years , SD=9 ) with a diagnosis of knee OA participated in the study . Intervention and Measurements Participants were distributed r and omly into 4 groups : 35 participants did not receive any treatment ( control group ) , 23 received a placebo treatment , 32 received low-dose PSW treatment ( power of 14.5 W , treatment duration of 19 minutes , and total energy of 17 kJ ) , and 31 received high-dose PSW treatment ( power of 14.5 W , treatment duration of 38 minutes , and total energy of 33 kJ ) . An 11-point numerical pain rating scale and the Knee Osteoarthritis Outcome Score were used to assess pain and function in 3 stages : at initial evaluation ( pretreatment ) , immediately after treatment , and at 12-month follow-up . Results The 4 groups were homogeneous prior to treatment with respect to demographics , pain , and functional scale data . The results demonstrated the short-term effectiveness of the PSW at low and high doses in patients with knee OA . Both treatment groups showed a significant reduction in pain and improvement in function compared with the control and placebo groups ( effect size : range=20.0–23.4 for the low-dose PSW group and range=15.7–16.5 for the high-dose PSW group ) . There were no differences in results between PSW doses , although a low dose of PSW appeared to be more effective in the long term . Limitations These results were achieved without physical exercise , which could have positively influenced the results . Conclusions Pulsed shortwave treatment is an effective method for pain relief and improvement of function and quality of life in the short term in women with knee OA . On the basis of the results , application of PSW treatment is recommended in the female population with knee OA . However , conclusions regarding the 12-month follow-up should be analyzed carefully due to the high dropout rate Osteoarthritis ( OA ) is a common chronic and progressive degenerative joint condition . A major consequence of knee OA is physical disability ; especially difficulty with activities requiring ambulation and transfer , which are necessary to maintain independence and a good quality of life . The purpose s of this study were to determine the efficacy of a muscle exercise program along with education about knee care , and investigate the clinical factors which influence its therapeutic efficacy . A prospect i ve study was carried out among elderly Thai people aged 60 years and over , living in an urban community of the Bangkok metropolitan area around Siriraj Hospital , between October 1997 and September 1999 . The number of elderly people with osteoarthritis of the knee was 392 ( male : female=86:306 ) with a mean age of 67.7+/-6 years . They were interviewed for demographic data and information about their symptoms . The range of the knee movement , quadriceps strength and the six-minute walking distance and a knee X-ray were evaluated . Group exercise was arranged twice a week for 8 weeks for the intervention group only . The results of the study revealed that the quadriceps strength in the intervention group had a tendency to increase and the walking distance was significantly improved especially in the first two months but there was a tendency to decline by the sixth and twelfth month after enrollment . On the other h and , there was no statistically significant difference of both important outcomes for the control group when assessed in the second month . The findings at the sixth and twelfth month after enrollment were that the quadriceps strength was slightly increased but the walking distance was decreased when compared with the initial assessment . An exercise frequency of 12 sessions in two months was sufficient to improve muscle strength and walking distance . Group exercise produces a significant improvement in strength and walking ability , especially in the first two months . Deterioration over time could be due to multiple factors , such as lack of regular exercise , lack of motivation , lack of family support or poor economic status , so we should encourage the elderly to exercise regularly BACKGROUND Knee osteoarthritis is a highly prevalent condition with a significant socioeconomic burden to society . It is known to effect sufferers through pain , loss of function and changes in health related quality of life . Management typically involves pharmacologic and /or exercise based therapy approaches to reduce pain . Previous studies have shown multimodal treatment approaches incorporating manual therapy to be efficacious . The aim of this study is to determine if a manual therapy technique knee protocol can alter the self reported pain experienced by a group of chronic knee osteoarthritis sufferers in a r and omised controlled trial . METHODS 43 participants with a chronic , non-progressive history of osteoarthritic knee pain , aged between 47 and 70 years were r and omly allocated following a screening procedure to an intervention group ( n=26 ; 18 men and 8 women , mean age 56.5 years ) or a control group ( n=17 ; 11 men and 6 women , mean age 54.6 years ) . Participants were matched for present knee pain intensity measured on a visual analogue scale . The intervention consisted of the Macquarie Injury Management Group Knee Protocol whilst the control involved a non-forceful manual contact to the knee followed by interferential therapy set at zero . Participants received three treatments per week for two consecutive weeks with a follow up immediately after the final treatment . Post-treatment Participants completed 11 questions including present knee pain intensity and feedback regarding their response to treatment utilizing a visual analogue scale . Results were analysed using descriptive statistics . RESULTS Prior to the intervention , there was no significant differences in age or present knee pain intensity . Following treatment , the intervention group reported a significant decrease in the present pain severity ( mean 1.9 ) when compared to the control group ( mean 3.1 ) . Response to treatment questions indicated that compared to the control group , the intervention group felt the intervention had helped them ( intervention mean 7.0 ; control mean 3.4 ) , felt it decreased their knee symptoms such as crepitus ( intervention mean 6.0 ; control mean 3.4 ) and improved their knee mobility ( intervention mean 6.4 ; control mean 3.4 ) and their ability to perform general activities ( intervention mean 6.5 ; control mean 3.8 ) . Importantly the MIMG Knee Protocol intervention group reported no adverse reactions during treatment . CONCLUSIONS A short-term manual therapy knee protocol significantly reduced pain suffered by participants with osteoarthritic knee pain and result ed in improvements in self-reported knee function immediately after the end of the 2 week treatment period Swank , AM , Kachelman , JB , Bibeau , W , Quesada , PM , Nyl and , J , Malkani , A , and Topp , RV . Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis . J Strength Cond Res 25(2 ) : 318 - 325 , 2011-Preparing for the stress of total knee arthroplasty ( TKA ) surgery by exercise training ( prehabilitation ) may improve strength and function before surgery and , if effective , has the potential to contribute to postoperative recovery . Subjects with severe osteoarthritis ( OA ) , pain intractable to medicine and scheduled for TKA were r and omized into a usual care ( UC ) group ( n = 36 ) or usual care and exercise ( UC + EX ) group ( n = 35 ) . The UC group maintained normal daily activities before their TKA . The UC + EX group performed a comprehensive prehabilitation program that included resistance training using b and s , flexibility , and step training at least 3 times per week for 4 - 8 weeks before their TKA in addition to UC . Leg strength ( isokinetic peak torque for knee extension and flexion ) and ability to perform functional tasks ( 6-minute walk , 30 second sit-to-st and repetitions , and the time to ascend and descend 2 flights of stairs ) were assessed before r and omization at baseline ( T1 ) and 1 week before the subject 's TKA ( T2 ) . Repeated- measures analysis of variance indicated a significant group by time interaction ( p < 0.05 ) for the 30-second sit-to-st and repetitions , time to ascend the first flight of stairs , and peak torque for knee extension in the surgical knee . Prehabilitation increased leg strength and the ability to perform functional tasks for UC + EX when compared to UC before TKA . Short term ( 4 - 8 weeks ) of prehabilitation was effective for increasing strength and function for individuals with severe OA . The program studied is easily transferred to a home environment , and clinicians working with this population should consider prehabilitation before TKA Background : The aim of this study was to vali date the Knee Society Clinical Rating System ( knee and function scores ) and to compare its responsiveness with that of the Western Ontario and McMaster University Osteoarthritis Index ( WOMAC ) and the Medical Outcomes Study Short Form-36 ( SF-36 ) . Methods : Patients were recruited as part of a prospect i ve observational study of the outcomes of primary total knee arthroplasty for the treatment of osteoarthritis in four centers in the United States , six centers in the United Kingdom , and two centers in Australia . Independent research assistants at each site collected the Knee Society clinical data . The WOMAC , SF-36 , patient satisfaction , and demographic data were obtained with self-administered question naires . Results : A total of 862 eligible patients were recruited , and complete preoperative and twelve-month data were available for 697 ( 80.9 % ) of them . The mean age was seventy years ( range , thirty-eight to ninety years ) , and the majority of the patients ( 58.9 % ) were women . Low correlations were found among the items of both the knee and the function score at both assessment times . The Knee Society pain and function scores had moderate-to-strong correlations with the corresponding pain and function domains of the WOMAC and SF-36 ( r = 0.31 to 0.72 ) . Measurement of the st and ardized response mean showed the  Knee Society knee score to be more responsive ( st and ardized response mean , 2.2 ) than the WOMAC ( st and ardized response means , 2.0 for pain and 1.4 for function ) and the SF-36 ( st and ardized response means , 1.0 for bodily pain and 1.1 for physical functioning ) . The Knee Society function score was the least responsive measure ( st and ardized response mean , 0.8 ) . Correlation of changes in scores at twelve months with patient reports of satisfaction and improvement in health status showed the WOMAC and SF-36 to be more responsive than the Knee Society scores . Conclusions : There is a poor correlation among the items of the Knee Society Clinical Rating System , but the rating system has adequate convergent construct validity . The WOMAC and SF-36 are more responsive measures of outcome of total knee arthroplasty . As they are less labor-intensive for research ers to use and as use of these instruments removes observer bias from the study design , they are preferable for knee arthroplasty outcome studies The objective of this study was to examine the short- and long-term effects of a home-based , 12-week neuromuscular electrical stimulation ( NMES ) of the quadriceps femoris to decrease arthritis knee pain in older adults with osteoarthritis of the knee . The study sample ( N = 38 ) was r and omly assigned to the NMES treatment plus education group or the arthritis education-only group .  Pain was measured in both groups with the McGill Pain Question naire ( MPQ ) at baseline , during the intervention at weeks 4 , 8 , 12 , and at follow-up and with the Arthritis Impact Measurement Scale 2-Pain Subscale ( AIMS 2-PS ) at baseline and week 12 . The NMES Pain Diary ( PD ) was completed 15 minutes before and after each stimulation session . There was a significant 22 % decline in pain 15 minutes after as compared with immediately before each NMES treatment ( p < .001 ) , as measured by the PD . No significant group differences were found between the 2 groups over the course of the intervention and follow-up . These findings indicate that a home-based NMES intervention reduced arthritis knee pain 15 minutes after a NMES treatment Objective : To examine the effects of pulsed short-wave diathermy ( PSWD ) , delivered at an intensity sufficient to induce a thermal sensation and at an athermal intensity , in comparison with a placebo short-wave diathermy treatment , on reported pain , stiffness and functional ability and on mobility performance of patients with osteoarthritis of the knee . Design : A placebo-controlled double-blind trial with sequential allocation of patients to different treatment groups . Setting : Outpatient physiotherapy department . Subjects : One hundred and three consecutive patients , mean age 73.7 ( 9 = 6.6 ) years with osteoarthritis of one or both knees for at least three months . Interventions : All participants received three 20-min-long treatments per week for three weeks . One group received PSWD with mean power of 18 W ( thermal effect ) , one group received PSWD with mean power of 1.8 W ( athermal effect ) , and one group received sham short-wave diathermy treatment . Patients were assessed before the initial treatment , immediately following the last treatment , and at a three-month follow-up . Main measures : Outcome measures included the WOMAC Osteoarthritis Index , which assessed reported pain , stiffness , and functional ability , and four measures of mobility performance : Timed Get Up and Go test ( TGUG ) , stair-climbing , stairdescending and a 3-min walk . Results : A difference across time was observed for the pain and stiffness categories of the WOMAC Osteoarthritis Index ( p < 0.033 and p < 0.008 , respectively ) , with no differences between groups . No other significant differences across time or between groups were observed in any of the other measures . Conclusion : The findings do not demonstrate pulsed short-wave diathermy , as it is utilized in clinical setting s , to be effective in the treatment of osteoarthritis of the knee OBJECTIVE To evaluate the effect of a short preoperative exercise intervention on the functional status , pain , and muscle strength of patients before and after total joint arthroplasty . METHODS A total of 108 men and women scheduled for total hip arthroplasty ( THA ) or total knee arthroplasty ( TKA ) were r and omized to a 6-week exercise or education ( control ) intervention immediately prior to surgery . We assessed outcomes through question naires and performance measures . Analyses examined differences between groups over the preoperative and immediate postoperative periods and at 8 and 26 weeks postsurgery . RESULTS Among THA patients , the exercise intervention was associated with improvements in preoperative Western Ontario and McMaster Universities Osteoarthritis Index function score ( improvement of 2.2 in exercisers versus decline of 3.9 in controls ; P = 0.02 ) and Short Form 36 physical function score ( decline of 0.4 in exercisers versus decline of 14.3 in controls ; P = 0.003 ) . No significant differences were seen in TKA patients . Exercise participation increased muscle strength preoperatively ( 18 % in THA patients and 20 % in TKA patients ) , whereas the control patients had essentially no change in strength ( P > 0.05 for exercise versus education in both THA and TKA groups ) . Exercise participation prior to total joint arthroplasty substantially reduced the risk of discharge to a rehabilitation facility in THA and TKA patients ( adjusted odds ratio 0.27 , 95 % confidence interval 0.074 - 0.998 ) . The intervention had no effects on outcomes 8 and 26 weeks postoperatively . CONCLUSION A 6-week presurgical exercise program can safely improve preoperative functional status and muscle strength levels in persons undergoing THA . Additionally , exercise participation prior to total joint arthroplasty dramatically reduces the odds of inpatient rehabilitation OBJECTIVE To evaluate the effects of pulsed shortwave on  osteoarthritis of the knee .  METHODS A double blinded , r and omised , controlled trial . Thirteen female and 14 male patients with radiographic evidence of knee osteoarthritis were r and omly allocated to either low dose ( 10 W ) , or high dose ( 20 W ) or placebo high frequency pulsed shortwave .  Knee radioleucoscintigraphy was performed pre and post treatment as well as objective functional and subjective evaluations . RESULTS There were no significant differences between the groups in the pre and post treatment percentage change for radioleucoscintigraphy ( P > 0.05 ) . Functional and subjective measures also revealed no pre and post treatment differences between the groups ( P > 0.05 ) , except for improved knee range of motion in the placebo group ( P < 0.05 ) . CONCLUSION Joint inflammation in knee osteoarthritis , measured using radioleucoscintigraphy , was not altered significantly by pulsed shortwave , therefore this therapeutic modality has little or no anti-inflammatory effect on conditions such as osteoarthritis of the knee In this study , we planned to investigate the effects of pulse electromagnetic field ( PEMF ) on pain relief and functional capacity of patients with knee osteoarthritis ( OA ) . Fifty-five patients with knee OA were included in a r and omized , placebo-controlled study . At the end of the therapy , there was statistically significant improvement in pain scores in both groups ( P < 0.05 ) . However , no significant difference was observed within the groups ( P > 0.05 ) . We observed statistically significant improvement in some of the subgroups of Lequesne index . These are morning stiffness and activities of daily living activities compared to placebo group . However , we could not observe statistically significant differences in total of the scale between two groups ( P > 0.05 ) . Applying between-group analysis , we were unable to demonstrate a beneficial symptomatic effect of PEMF in the treatment of knee OA in all patients . Further studies using different types of magnetic devices , treatment protocol s and patient population s are warranted to confirm the general efficacy of PEMF therapy in OA and other conditions OBJECTIVE To identify changes in joint pain , stiffness , and functional ability in patients with knee osteoarthritis ( OA ) after use of a knee sleeve  that prevents loss of body heat by the joint . METHODS Subjects with symptomatic knee OA ( n = 52 ) were r and omized to 2 treatment groups : verum sleeve ( specially fabricated to retain body heat ) or placebo sleeve ( st and ard cotton/elastane sleeve ) . Subjects wore the sleeve over the more painful OA knee for at least 12 hours daily for 4 weeks . Pain , stiffness , and functional impairment ( Western Ontario and McMaster Universities Osteoarthritis Index [ WOMAC ] ) in the index knee were measured at baseline and after 4 weeks of wear , after which sleeve use was discontinued . Telephone followup interviews were conducted 2 and 4 weeks later . RESULTS After 4 weeks of sleeve wear , subjects in the active treatment group reported a 16 % decrease in mean WOMAC pain score relative to baseline ( P = 0.001 ) . Those who wore the placebo sleeve reported a 9.7 % decrease from baseline ( P = 0.002 ) . The difference between treatment groups was not statistically significant ( P = 0.12 ) . However , it was found that the 12 subjects who believed correctly that they had received the verum sleeve reported a highly significant decrease in WOMAC pain score ( -27.5 % relative to baseline , P = 0.0001 ) . In comparison , subjects who received the verum sleeve but believed they had received the placebo sleeve exhibited only a marginally significant improvement in pain ( -13.0 % relative to baseline , P = 0.07 ) . In the placebo group , the modest improvement in pain scores appeared unrelated to the subject 's impression of the type of sleeve worn . CONCLUSION This pilot study was insufficiently powered to be a definitive trial of the heat-retaining sleeve . Given the magnitude of changes in knee pain in the active treatment group , heat retention merits further scientific investigation as a treatment modality for patients with knee OA The aim was to assess the self-efficacy and health outcomes of an adopted Arthritis Self-Management Programme ( ASMP ) among osteoarthritic knee sufferers in Hong Kong at 1 year . An experimental study with 95 participants assigned r and omly to the intervention ( n=45 ) or control group ( n=50 ) . Seventy-seven ( 81.1 % ) participants joined at least one out of three follow-ups in the 12 month period . Participants in the intervention group received a 6-week ASMP with an added exercise component in two general clinics . Outcome measures included arthritis self-efficacy ( ASE ) and health outcomes including pain and fatigue rating , self-rated health , daily activities limitation and number of unplanned arthritis-related medical consultations . Mean change ( 12 months minus baseline ) and the effect size of the outcome measures were calculated by Mann – Whitney U test and nQuery Advisor 4.0 . At 12 months , there were significant reductions of current pain ( p=0.0001 ) , pain at night ( p=0.001 ) , pain during walking ( p=0.01 ) and number of unplanned arthritis-related medical consultations ( p=0.03 ) and a significant increase in ASE for pain ( p=0.01 ) and other symptoms ( p=0.02 ) and self-rated health ( p=0.04 ) among the intervention group but not for the control group . However , there were similarities in outcome measures of pain while switching from a sitting to a st and ing position , fatigue rating and physical functional limitation ( p=0.15 ; p=0.22 and p=0.91 , respectively ) for both groups . Our findings add to the evidence that the modified arthritis empowering programme improved perception of control of osteoarthritis and three health outcomes after 12 months of treatment This r and omized , placebo-controlled , double-blind study was design ed to investigate the short-term efficacy of ultrasound therapy in 90 patients with knee osteoarthritis ( OA ) . Patients were r and omly assigned to three groups : group 1 received continuous ultrasound , group 2 received pulsed ultrasound , and group 3 received a ‘ sham ’ ( placebo ) ultrasound for 5 min each session . All treatments were applied once a day for 5 days a week for 2 weeks , i.e. a total treatment duration of 10 days . Compared with baseline , significant improvements were observed in the visual analogue scale pain scores and the Western Ontario and McMaster Universities osteoarthritis index ( WOMAC ) scores in all three groups . The reductions in pain and WOMAC scores were significantly higher in patients treated with pulsed ultrasound than in the placebo group . In conclusion , pulsed ultrasound therapy is a safe and effective treatment modality in patients with knee OA . Further research is required to investigate the long-term efficacy of pulsed ultrasound therapy in knee OA OBJECTIVE To assess the effect of a lateral-wedge insole with elastic strapping of the subtalar joint on the femorotibial angle in patients with varus deformity of the knee . METHODS The efficacy of a wedged insole with subtalar straps and that of a traditional wedged insole shoe insert were compared . Sixty-six female out patients with knee osteoarthritis ( OA ) were r and omized ( according to birth date ) to be treated with either the strapped or the traditional inserted insole .  St and ing radiographs with unilateral insole use were used to analyze the femorotibial angles for each patient . In both groups , the baseline and 6-month visual analog scale ( VAS ) scores for subjective knee pain and the Lequesne index scores for knee OA were compared . RESULTS The 61 patients who completed the 6-month study were evaluated . At baseline , there was no significant difference in the femorotibial angle ( P = 0.66 ) and the VAS score ( P = 0.75 ) between the 2 groups . At the 6-month assessment , the 29 subjects wearing the subtalar-strapped insole demonstrated a significantly decreased femorotibial angle ( P < 0.0001 ) and significantly improved VAS scores ( P = 0.001 ) and Lequesne index scores ( P = 0.033 ) compared with their baseline assessment s. These significant differences were not observed in the 32 subjects assigned to the traditional shoe-inserted wedged insole . CONCLUSION These results suggest that an insole with a subtalar strap maintained the valgus correction of the femorotibial angle in patients with varus knee OA for 6 months , indicating longer-term clinical improvement with the strapped insert compared with the traditional insert Background and aims : Physical exercise is associated with a lower risk of disability . The impact of comorbidity on the benefits from physical exercise has not been clearly investigated . Elders with comorbidity may benefit from physical exercise to preserve physical function . Methods : Data are from 435 participants with knee osteoarthritis aged ≥60 years enrolled in the Fitness and Arthritis in Seniors Trial ( FAST ) , who were r and omly assigned to 18-month health educational ( HE ) , weight training ( WT ) , or aerobic exercise ( AE ) interventions .  Comorbidity was defined as the presence of osteoarthritis and ≥2 clinical conditions . Percent changes in the 6-minute walk test , self-reported disability and knee pain from baseline to 3- , 9- , and 18-month follow-up visits were analyzed according to comorbidity , using analysis of variance . Significance s were adjusted using the Bonferroni method . Results : Mean age of the sample was 68.7 years . In participants with comorbidity ( n=197 ) , those in the AE intervention showed significant improvement in walking speed , compared to WT and HE groups , since the beginning of follow-up . Subjects with comorbidity in AE and WT groups showed improvement of the disability score at the 3-month follow-up visit compared to those in the HE group . This improvement was maintained at the end of the follow-up by the only AE group compared to the HE one ( p=0.06 ) . In participants with comorbidity  , the pain score was improved by the AE intervention . Conclusions : AE and WT interventions improve physical function in individuals with comorbidity . AE improves physical function and knee pain independently of the presence of comorbidity OBJECTIVE To investigate the effects of integrated therapy on the functional status of patients with knee osteoarthritis ( OA ) . METHODS A total of 140 subjects with bilateral knee OA ( Altman grade II ) were r and omized sequentially into 4 groups ( groups I-IV ) . Group I received isokinetic exercises ; group II received isokinetic exercise and pulse ultrasound for periarticular soft tissue pain ; group III received isokinetic exercise , pulse ultrasound , and intraarticular hyaluronan therapy ; and group IV acted as the control group . The therapeutic effects of the interventions were evaluated by changes in Lequesne 's index , knee range of motion , peak muscle torques of knee flexion and extension , and ambulation speed after 8 weeks of treatment and at followup 1 year later . In addition , changes in visual analog scale pain and rates of attrition in each group were also recorded . RESULTS Patients in groups I-III exhibited increased muscle peak torques and significantly reduced pain and disability after treatment and at followup . Groups II and III showed significant improvements in range of motion and ambulation speed after treatment . Group III also showed the greatest increase in walking speed and decrease in disability after treatment and at followup . Both group II and group III had significant gains in muscular strength after treatment and at followup ; group III showed the greatest gains . CONCLUSION An integrated therapy deals with the extra- and intraarticular progressive pathologic changes , and kinesiologic management of OA is suggested for the management of knee OA Abstract Objective : To test the hypothesis that medial taping of the patella reduces the symptoms of  osteoarthritis of the knee when the patellofemoral joint is affected . Design : R and omised , single blind , crossover trial of three different forms of taping of the knee joint . Each tape ( medial , lateral , or neutral ) was applied for four days , with three days of no treatment between tape positions . Subjects : 14 patients with established , symptomatic osteoarthritis of the knee and both clinical and radiographic evidence of patellofemoral compartment disease . Main outcome measures : Daily visual analogue scale ratings for pain ; patients ' rating of change with each treatment ; and tape preference . Results - Medical taping of the patella was significantly better than the neutral or lateral taping for pain scores , symptom change , and patient preference . The medical tape result ed in a 25 % reduction in knee pain . Conclusion : Patella taping is a simple , safe , cheap way of providing short term pain relief in patients with osteoarthritis of the patellofemoral joint Background and Purpose : This study was design ed to evaluate the effectiveness of hydrotherapy in subjects with osteoarthritis ( OA ) of the knee compared with subjects with OA of the knee who performed l and -based exercises .  Subjects and Methods : Sixty-four subjects with OA of the knee were r and omly assigned to 1 of 2 groups that performed exercises for 18 weeks : a water-based exercise group and a l and -based exercise group . The outcome measures included a visual analog scale ( VAS ) for pain in the previous week , the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , pain during gait assessed by a VAS at rest and immediately following a 50-foot ( 15.24-m ) walk test ( 50FWT ) , walking time measured at fast and comfortable paces during the 50FWT , and the Lequesne Index . Measurements were recorded by a blinded investigator at baseline and at 9 and 18 weeks after initiating the intervention . Results : The 2 groups were homogenous regarding all parameters at baseline . Reductions in pain and improvements in WOMAC and Lequesne index scores were similar between groups . Pain before and after the 50FWT decreased significantly over time in both groups . However , the water-based exercise group experienced a significantly greater decrease in pain than the l and -based exercise group before and after the 50FWT at the week-18 follow-up . Discussion and Conclusion : Both water-based and l and -based exercises reduced knee pain and increased knee function in participants with OA of the knee .  Hydrotherapy was superior to l and -based exercise in relieving pain before and after walking during the last follow-up . Water-based exercises are a suitable and effective alternative for the management of OA of the knee Doi T , Akai M , Fujino K , Iwaya T , Kurosawa H , Hayashi K , Marui E : Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs : a r and omized controlled trial . Am J Phys Med Rehabil 2008;87:258–269 . Objectives : To examine the effect of home-based exercise on  knee osteoarthritis among Japanese in comparison with that of nonsteroidal antiinflammatory drugs ( NSAIDs ) . Design : An open-labeled , r and omized , controlled , multiclinic trial compared home-based quadriceps exercise with NSAIDs . Treatments were basically evaluated after 8 wks and compared with the baseline scores . Outcomes were evaluated with a set of psychometric measurements including the Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) , 36-Item Short-Form Health Survey ( SF-36 ) , Japanese Knee Osteoarthritis Measure ( JKOM ) , and pain with the visual analog scale . Results : A total of 142 patients entered this trial to provide the baseline data . After 21 cases withdrew , the final number analyzed was 121 cases : 63 for the exercise group and 58 for the NSAIDs group . Between these two groups , there was no significant difference in gender , age , body height and weight , body mass index , or each score at baseline . The subjects in both groups showed improvements in all scores at the end of intervention . The difference in improvement rate of each score between the two groups was not statistically significant , though the mean rank score measured with JKOM in the exercise was slightly better than that of the NSAIDs . Conclusions : Home-based exercise using quadriceps strengthening improves knee osteoarthritis no less than NSAIDs OBJECTIVE Two lateral wedged insoles were compared : one with , and the other without , subtalar strapping . METHODS Twenty-one patients ( age 58 - 83 , mean 72 ) with medial knee osteoarthritis ( OA ) were enrolled . Thirty-seven knees in the patients were divided into three groups based on the Kellgren and Lawrence OA grading system ; grade s 2 ( cases=20 ) , 3 ( cases=11 ) , and 4 ( cases=6 ) . The subjects were tested during walking barefoot and during walking with a silicon rubber lateral wedged insole with elevation of 10 mm attached to a barefoot .  Gait analysis was performed on a 10 m walkway for each subject under three different walking conditions ; barefoot , wearing a conventional insole , and a subtalar strapping insole .  Peak knee varus moment during gait was measured under each condition , and compared between the three conditions and between the OA grade s. RESULTS On the whole ( cases=37 ) , the peak varus moment was significantly reduced by wearing either of the insoles , compared to walking barefoot . The reduction was more obvious with the strapping insole ( -13 % , P<0.01 ) , compared with the conventional insole ( -8 % , P<0.05 ) . In moderate OA patients ( grade s 2 and 3 ) , the moments were significantly lower with the strapping insole , compared with the conventional insole ( P=0.0048 and 0.005 , respectively ) . However , no significant difference was detected in severe OA patients ( grade 4 ) between the two types of insoles ( P=0.4 ) . CONCLUSIONS Both lateral wedged insoles significantly reduced the peak medial compartment load during gait . The subtalar strapping insole had a greater effect than the conventional insole , particularly in patients with moderate medial knee OA OBJECTIVE To compare the effects of concentric and coupled concentric-eccentric isokinetic resistance training on functional capacity and symptoms of patients with osteoarthrosis ( OA ) of both knees . DESIGN Repeated measures . SETTING A university exercise physiology laboratory . PARTICIPANTS Twenty-three volunteers , ages 41 to 75 years . Patients were r and omly assigned to 3 groups : concentric ( CON , n = 9 ) , concentric-eccentric ( CON-ECC , n = 8) , and nontreatment ( NONTX , n = 6 ) . INTERVENTIONS The CON group performed 12 concentric contractions of each knee extensor and flexor muscles ; the CON-ECC group performed 6 concentric and 6 eccentric contractions of each knee muscle group by using a spectrum of angular velocities ranging from 30 degrees/s to 180 degrees/s with 30 degrees/s intervals , for both sides , 3 days a week for 8 weeks . MAIN OUTCOME MEASURES Functional capacity ( rising from a chair , walking , stair climbing and descending ) and pain during rest and activities , peak torque , and cross-sectional area ( CSA ) of knee muscle groups of subjects were tested before and after training . RESULTS Both training groups showed marked decreases ( P < .001 ) in pain scores and increases ( P < .001 ) in functional capacity together with increases ( P < .05 - -.01 ) in peak torque and CSA of knee muscles . However , the NONTX group did not display these marked changes after the 8-week period . The results also indicated that concentric-eccentric training has a greater influence on functional capacity , especially stair climbing and descending , than that of concentric training when compared with NONTX group ; however , the improvements in pain measurements were better in the CON group compared with the CON-ECC group after the training . CONCLUSIONS The results suggest that with the isokinetic resistance training used in this study , it is possible to improve functional capacity and decrease pain in patients with OA of the knee . The results also showed that extensive training involving a high number of repetitions and eccentric contractions was safe , effective , and well tolerated for the patients with knee OA BACKGROUND In clinical trials , at the group level , results are usually reported as mean and st and ard deviation of the change in score , which is not meaningful for most readers . OBJECTIVE To determine the minimal clinical ly important improvement ( MCII ) of pain , patient 's global assessment of disease activity , and functional impairment in patients with knee and hip osteoarthritis ( OA ) . METHODS A prospect i ve multicentre 4 week cohort study involving 1362 out patients with knee or hip OA was carried out . Data on assessment of pain and patient 's global assessment , measured on visual analogue scales , and functional impairment , measured on the Western Ontario McMaster Universities Osteoarthritis Index ( WOMAC ) function subscale , were collected at baseline and final visits . Patients assessed their response to treatment on a five point Likert scale at the final visit . An anchoring method based on the patient 's opinion was used . The MCII was estimated in a subgroup of 814 patients ( 603 with knee OA , 211 with hip OA ) . RESULTS For knee and hip OA , MCII for absolute ( and relative ) changes were , respectively , ( a ) -19.9 mm ( -40.8 % ) and -15.3 mm ( -32.0 % ) for pain ; ( b ) -18.3 mm ( -39.0 % ) and -15.2 mm ( -32.6 % ) for patient 's global assessment ; ( c ) -9.1 ( -26.0 % ) and -7.9 ( -21.1 % ) for WOMAC function subscale score . The MCII is affected by the initial degree of severity of the symptoms but not by age , disease duration , or sex . CONCLUSION Using criteria such as MCII in clinical trials would provide meaningful information which would help in interpreting the results by expressing them as a proportion of improved patients Abstract Ten patients with pain due to osteoarthritis of the knee were treated in a double‐blind cross‐over study with two weeks of transcutaneous electrical nerve stimulation ( TENS ) and placebo . There was statistically significant pain relief by TENS and half of the patients chose to continue using TENS for pain control after the test month . However , at one year 's follow‐up , only two patients had sufficient benefit to continue using the device OBJECTIVE To investigate the effects of ultrasound ( US ) in isokinetic muscle strengthening exercises on functional status of patients with knee osteoarthritis ( OA ) . DESIGN Effectiveness of isokinetic muscle strengthening exercises for treatment of periarticular soft tissue disorders was compared with and without pulsed and continuous US . SETTING Outpatient exercise program in a Taiwan medical university hospital . PARTICIPANTS One hundred twenty subjects with bilateral knee OA ( Altman grade II ) . INTERVENTION Subjects were r and omized sequentially into 1 of 4 groups . Group I received isokinetic muscular strengthening exercises , group II received isokinetic exercise and continuous US , group III received isokinetic exercise and pulsed US treatment , and group IV was the control group . MAIN OUTCOME MEASURES Therapeutic effects of isokinetic exercise  were evaluated by changes in ambulation speed and the Lequesne index . In addition , changes in knee range of motion ( ROM ) , visual analog scale for pain , and muscle peak torques during knee flexion and extension were compared . Compliance in each group was recorded . RESULTS Each treated group had increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-up . However , only patients in groups II and III had significant improvement in ROM and ambulation speed after treatment . Fewer participants in group III discontinued treatment due to knee pain during exercise . Patients in group III also showed the greatest increase in walking speed and decrease in disability after treatment and at follow-up . Gains in muscular strength in 60 degrees /s angular velocity peak torques were also noted in groups II and III . However , group III showed the greatest muscular strength gains with 180 degrees /s angular velocity peak torques after treatment and follow-up . CONCLUSIONS US treatment could increase the effectiveness of isokinetic exercise for functional improvement of knee OA , and pulsed ultrasound has a greater effect than continuous US Decreases in muscular strength , endurance , and angular velocity have previously been demonstrated in the elderly . Osteoarthritis ( OA ) , especially of the knee , may cause further reductions in these parameters and lead to functional limitations . This study measured the effects of a quantitative progressive exercise muscle rehabilitation program ( QPE ) that was added to a physical therapy ( PT ) program .  Forty subjects ( 20 men and 20 women ) with OA of the knees were r and omly selected from a group of volunteers ( N = 437 ) for the 3-month program . Measurements of strength , endurance , angular velocity , and the Jette Functional Status Index were determined before and after 1 , 2 , and 3 months of the program . The QPE program was composed of isometric , isotonic , isotonic with resistance , endurance , and speed contractions prescribed in a progressive sequence . Muscle strength ( 14 % and 29 % ) and endurance ( 38 % and 43 % ) increased significantly ( p < 0.05 , ANOVA for repeated measures ) for both the quadriceps and hamstrings , respectively , after rehabilitation . There were marked decreases in walking time and the difficulty and pain experienced during functional activities OBJECTIVE To determine whether home-based neuromuscular electrical stimulation ( NMES ) applied to the quadriceps femoris ( QF ) muscle increases strength , physical activity , and physical performance in older adults with knee osteoarthritis ( OA ) . METHODS Thirty-four adults ( > 60 yrs ) with radiographically confirmed symptomatic knee OA were r and omized to NMES plus education or education only ( EDU ) . The primary outcome was isometric QF peak torque ( PTIso ) , with secondary outcomes of daily step counts , total activity vector magnitude , 100-foot walk-turn-walk , timed stair climb , chair rise , and pain . The NMES group used a portable electrical muscle stimulator 3 days a week for unilateral QF training with incremental increases in the intensity of isometric contraction to 30 - 40 % of maximum over 12 weeks . Both groups received the 12-week Arthritis Self-Management course and were followed an additional 12 weeks . RESULTS The stimulated knee-extensor showed a 9.1 % increase in 120 degrees PTIso compared to a 7 % loss in the EDU group ( time x group interaction for 120 degrees PTIso ; p = 0.04 ) . The chair rise time decreased by 11 % in the NMES group , whereas the EDU group saw a 7 % reduction ( p = 0.01 , time ; p = 0.9 , group ) . Similarly , both groups improved their walk time by approximately 7 % ( p = 0.02 , time ; p = 0.61 group ) . Severity of pain reported following intervention did not differ between groups . CONCLUSION In older adults with knee OA , a home-based NMES protocol appears to be a promising therapy for increasing QF strength in adults with knee OA without exacerbating painful symptoms OBJECTIVE To assess the effect of a program of supervised fitness walking and patient education on functional status , pain , and use of medication in patients with osteoarthritis of the knee . DESIGN An 8-week r and omized , controlled trial . SETTING Inpatient and outpatient services of an orthopedic hospital in an academic medical center . PATIENTS A total of 102 patients with a documented diagnosis of primary osteoarthritis of one or both knees participated in the study . Data were obtained on 47 of 51 intervention patients and 45 of 51 control patients . INTERVENTIONS An 8-week program of supervised fitness walking and patient education or st and ard routine medical care . MEASUREMENTS Patients were evaluated and outcomes assessed before and after the intervention using a 6-minute test of walking distance and scores on the physical activity , arthritis impact , pain , and medication subscales of the Arthritis Impact Measurement Scale ( AIMS ) . RESULTS Patients r and omly assigned to the walking program had a 70-meter increase in walking distance relative to their baseline assessment , which represents an improvement of 18.4 % ( 95 % Cl , 9.8 % to 27.0 % ) . In contrast , controls showed a 17-meter decrease in walking distance relative to their baseline assessment ( P less than 0.001 ) . Improvements in functional status as measured by the AIMS physical activity subscale were also observed in the walking group but not in the control group ( P less than 0.001 ) ; patients assigned to the walking program improved 39 % ( Cl , 15.6 % to 60.4 % ) . Although changes in scores on the arthritis impact subscale were similar in the two groups ( P = 0.093 ) , the walking group experienced a decrease in arthritis pain of 27 % ( Cl , 9.6 % to 41.4 % ) ( P = 0.003 ) . Medication use was less frequent in the walking group than in the control group at the post-test ( P = 0.08 ) . CONCLUSIONS A program of supervised fitness walking and patient education can improve functional status without worsening pain or exacerbating arthritis-related symptoms in patients with osteoarthritis of the knee Objective : To examine if the addition of transcutaneous electrical nerve stimulation ( TENS ) to exercise training would produce better physical outcomes than TENS or exercise alone in people with knee osteoarthritis . Design : Sixty-two subjects were r and omly allocated to four groups . Interventions : Patients received either ( 1 ) TENS , ( 2 ) placebo stimulation , ( 3 ) exercise training , or ( 4 ) TENS and exercise training five days a week for four weeks . Main outcome measures : The isometric peak torque , spatiotemporal gait parameters and range of knee movement were assessed in treatment session1 , session10 and session20 and the four-week follow-up . Results : By session20 , the TENS and exercise group demonstrated an average of 26.6 % cumulative gain in the knee extensor peak torque for the different knee positions ( all p < 0.05 ) . Although the between-group difference was short of being statistically significant , the gain found in the TENS and exercise group was greater than that found in the other three groups . The TENS and exercise group also tended to show greater cumulative increase in stride length ( 12.6 % , p-0.006 ) , walking cadence ( 9.3 % , p-0.098 ) and gait velocity ( 22.4 % , p-0.034 ) than the other groups . By session20 , it was the only group that produced a significant increase in the range of knee motion during walking ( 12.0%,p-0.000 ) . The TENS group and the exercise group both demonstrated some improvements in the above physical outcomes , but negligible change was found in the group receiving placebo stimulation ( all p > 0.05 ) . Conclusion : No significant difference was found among the four treatment protocol s , but the addition of TENS to exercise training tended to produce the best overall improvement in physical outcomes in people with knee osteoarthritis OBJECTIVE This study investigated the benefits of the combination of interferential ( IF ) and patterned muscle stimulation in the treatment of osteoarthritis ( OA ) of the knee . DESIGN This was a multi-center , r and omized , single-blind , controlled study with an independent observer . The study r and omized 116 patients with OA of the knee to a test or control group . The test group received 15 min of IF stimulation followed by 20 min of patterned muscle stimulation . The control group received 35 min of low-current transcutaneous electrical nerve stimulation ( TENS ) . Both groups were treated for 8 weeks . Subjects completed question naires at baseline and after 2 , 4 and 8 weeks . Primary outcomes included the pain and physical function subscales of the Western Ontario MacMaster ( WOMAC ) OA Index and Visual Analog Scales ( VAS ) for pain and quality of life . RESULTS Compared to the control group , the test group showed reduced pain and increased function . The test group showed a greater decrease in the WOMAC pain subscale ( P=0.002 ) , function subscale ( P=0.003 ) and stiffness subscale ( P=0.004 ) . More than 70 % of the test group , compared to less than 50 % of the control group , had at least a 20 % reduction in the WOMAC pain subscale . When analyzing only patients who completed the study , the test group had a nominally significant greater decrease in overall pain VAS . No significant between-group differences were observed in incidence of adverse events . CONCLUSIONS In patients with OA of the knee , home-based patterned stimulation appears to be a promising therapy for relieving pain , decreasing stiffness , and increasing function OBJECTIVE To explore the effects of noninvasive interactive neurostimulation used as an adjunct to usual care , on pain and other symptoms in adults with osteoarthritis of the knee . DESIGN R and omized , sham-controlled trial . SETTING A university in the southern United States . SUBJECTS Thirty-seven ( 37 ) adults with knee osteoarthritis ( based on American College of Rheumatology diagnostic criteria ) . INTERVENTIONS Seventeen ( 17 ) noninvasive interactive neurostimulation ( active or sham ) sessions over 8 weeks with a week 12 follow-up . OUTCOME MEASURES Eleven-point numeric rating scale for weekly pain ; Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , patient global assessment , and Short-Form Health Survey ( SF-36 ) completed at baseline and weeks 4 , 8 , and 12 . RESULTS For the main outcome , pain , the differences between the groups over time did not reach statistical significance ( all p > 0.05 ) . However , a clinical ly important reduction in pain ( defined as a 2-point or 30 % reduction on an 11-point numeric rating scale ) was maintained at week 12 by the active noninvasive interactive neurostimulation group ( 2.17 points , 34.55 % reduction ) but not the sham group ( 1.63 , 26.04 % reduction ) . Pain improved over time in participants regardless of group membership ( numeric rating scale average pain , p = 0.002 ; numeric rating scale worst pain , p < 0.001 ; and WOMAC pain , p < 0.001 ) , as did WOMAC function , WOMAC stiffness , and WOMAC total score ( all p < 0.001 ) . Repeated measures ANOVA revealed a statistically significant difference between the groups over time for the SF-36 Vitality scale , F ( 3 , 105 ) = 3.54 , p = 0.017 . In addition , the active device group improved on the patient global assessment from baseline to week 8 compared to the sham device group , F ( 1 , 35 ) = 4.025 , p = 0.053 . CONCLUSIONS In this pilot study , clinical ly important reductions in knee pain were maintained at week 12 in the active , but not the sham , noninvasive interactive neurostimulation group . Further study of this noninvasive therapy is warranted OBJECTIVE To estimate minimal clinical ly important differences ( MCID ) of effects measured by the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) in patients with osteoarthritis ( OA ) of the lower extremities undergoing a comprehensive inpatient rehabilitation intervention . METHODS A prospect i ve cohort study assessed patients ' health by the WOMAC at baseline ( entry into the clinic ) and at the 3 month followup , and by a transition question naire asking about the change of " health in general related to the OA joint " during that time period . The WOMAC section score differences between the " equal " group and the " slightly better " and " slightly worse " groups result ed in the MCID for improvement and for worsening . RESULTS In total 192 patients were followed up . The MCID for improvement ranged from 0.80 to 1.01 points on the continuous WOMAC numerical rating scale from 0 to 10 , reflecting changes of 17 to 22 % of baseline scores . The MCID for worsening conditions ranged from 0.29 ( 6 % ) to 1.03 points ( 22 % ) . In the transition reply subjectively unchanged patients reported a " pessimistic bias " of 0.35 to 0.51 points , except for the stiffness section . Both MCID and pessimistic bias showed regression to the mean and baseline dependency . CONCLUSION The assessment of MCID using the transition method is a heuristic and valid strategy to detect particular rehabilitation effects in patients with OA of the lower extremities with the use of the WOMAC , and it is worth implementing . The size of the MCID and of the systematic bias is comparable to that assessed by other methods and in other therapeutic setting OBJECTIVE Gait biomechanics ( knee adduction moment , center of pressure ) and static alignment were investigated to determine the mechanical effect of foot orthoses in people with medial compartment knee osteoarthritis . DESIGN Repeated measures design in which subjects were exposed to three conditions ( normal footwear , heel wedge and orthosis ) in r and om order . BACKGROUND The knee adduction moment is an indirect measure of medial compartment loading . It was hypothesized that the use of a 5 degrees valgus wedge and 5 degrees valgus modified orthosis would shift the center of pressure laterally during walking , thereby decreasing the adduction moment arm and the adduction moment . METHODS Peak knee adduction moment and center of pressure excursion were obtained in nine subjects with medial compartment knee OA during level walking using an optoelectric system and force plate . Static radiographs were taken in 12 subjects using precision radiographs . RESULTS There was no difference between conditions in static alignment , the peak adduction moment or excursion of the center of pressure in the medial-lateral direction . No relationship was found between the adduction moment and center of pressure excursion in the medial-lateral plane . The displacement of the center of pressure in the anterior-posterior direction , measured relative to the laboratory coordinate system , was decreased with the orthosis compared to the control condition ( P=0.036 ) and this measure was correlated with the adduction moment ( r=0.45 , P=0.019 ) . CONCLUSIONS The proposed mechanism was not supported by the findings . The reduction in the center of pressure excursion in the anterior-posterior direction suggests that foot positioning was altered , possibly to a toe-out position , while subjects wore the orthoses . Based on the current findings , we hypothesize that toe-out positioning may reduce medial joint load . RELEVANCE Knee Osteoarthritis is the most common cause of chronic disability amongst seniors . Developing inexpensive , non-invasive treatment strategies for this large population has potential to impact health care costs , quality of life and clinical outcomes OBJECTIVE To discuss the concepts of the minimal clinical ly important difference ( MCID ) and the smallest detectable difference ( SDD ) and to examine their relation to required sample sizes for future studies using concrete data of the condition-specific Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) and the generic Medical Outcomes Study 36-Item Short Form ( SF-36 ) in patients with osteoarthritis of the lower extremities undergoing a comprehensive inpatient rehabilitation intervention . METHODS  SDD and MCID  were determined in a prospect i ve study of 122 patients before a comprehensive inpatient rehabilitation intervention  and at the 3-month followup .  MCID was assessed by the transition method . Required SDD and sample sizes were determined by applying normal approximation and taking into account the calculation of power . RESULTS In the WOMAC sections the SDD and MCID ranged from 0.51 to 1.33 points ( scale 0 to 10 ) , and in the SF-36 sections the SDD and MCID ranged from 2.0 to 7.8 points ( scale 0 to 100 ) . Both question naires showed 2 moderately responsive sections that led to required sample sizes of 40 to 325 per treatment arm for a clinical study with unpaired data or total for paired followup data . CONCLUSION In rehabilitation intervention , effects larger than 12 % of baseline score ( 6 % of maximal score ) can be attained and detected as MCID by the transition method in both the WOMAC and the SF-36 . Effects of this size lead to reasonable sample sizes for future studies lying below n = 300 . The same holds true for moderately responsive question naire sections with effect sizes higher than 0.25 . When design ing studies , assumed effects below the MCID may be detectable but are clinical ly meaningless BACKGROUND Knee osteoarthritis ( OA ) is a painful condition causing disability and muscle weakness . Shortwave diathermy ( SWD ) is one of several physical therapy modalities and used predominantly as a pain reduction modality in the clinical practice . However , the efficacy of SWD in knee OA is still inconclusive . AIM The aim of this study was to determine if SWD increase the effectiveness of isokinetic exercise on pain , function , muscle strength , quality of life and depression in patients with OA . DESIGN This was a r and omised , controlled clinical trial . SETTING Inpatient Physiotherapy Department . POPULATION Forty women aged between 42 and 74 years , with a diagnosis of bilateral primary knee OA . METHODS Patients were sequentially r and omized into two groups . Group 1 ( N.=20 ) received SWD and isokinetic muscular strengthening exercises . Group 2 ( N.=20 ) served as control group and they received isokinetic exercises only . Both of the programs were performed three days a week , for a duration of four weeks , and a total of 12 sessions . Patients were assessed before treatment ( BT ) , after treatment ( AT ) , and at a three-month follow-up ( F ) . Outcome measures included visual analogue scale , Western Ontario and McMaster University Osteoarthritis Index , six minute walking distance , isokinetic muscle testing , Short Form 36 and Beck depression index . RESULTS The patients with OA in each group had significant improvements in pain , disability , depression , walking distance , muscle strength , and quality of life AT and F when compared with their initial status ( P<0.05 ) . There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test ( P>0.05 ) except some isokinetic peak torque measurements ( F-BT scores of extension right 60 ° , 120 ° and flexion right 60 ° ) . CONCLUSION Use of SWD in addition to isokinetic exercise program seems to have no further significant effect in terms of pain , disability , walking distance , muscle strength , quality of life and depression in patients with knee OA . CLINICAL REHABILITATION IMPACT Considering the time and cost of combination therapy is now , the isokinetic exercise program , as it is efficient , may be preferable for the treatment of knee OA , alone This study was design ed to determine whether an 8-week isokinetic muscle-strength-training program improved the functional health status of patients with osteoarthritis of the knee joint . Twenty volunteers with osteoarthritis of the knee joint were r and omly assigned to either an experimental ( n=10 ) or control ( n=10 ) group . The experimental group completed six sets of five maximal contractions three times per week for 8 weeks on a Cybex II dynamometer at 90 degrees per second . Both groups were pre- and posttest for extension and flexion strength of the right and left legs , the 50-foot walk time , range of motion at the knee joint , the Osteoarthritis Screening Index ( OASI ) , and the Arthritis Impact Measurement Scale ( AIMS ) . There was a significant decrease in pain and stiffness , and a significant increase in mobility . There was also a significant decline in arthritis activity in the experimental group as measured by the OASI and AIMS . The experimental group significantly increased in all strength measures , while the control group increased in only right leg flexion and left leg extension across the training period This investigation examined predictors of compliance with exercise therapy in a clinical trial involving older adults with knee osteoarthritis ( OA ) . The study sample was partitioned into tertiles by level of compliance to determine its effect on several clinical outcome measures in the trial ( i.e. , knee pain , difficulty with activities of daily living , and performance-related disability ) . The participants ( N = 439 ) first completed all baseline assessment s and were then r and omly assigned to one of three treatment conditions : health education control , aerobic exercise , or resistance exercise . The two exercise treatments involved a 3-month center-based phase and a 15-month home-based phase . Variables in five categories ( i.e. , demographic , fitness , health-related quality of life , performance-related disability , and prior exercise behavior ) were entered as predictors of attendance and time spent exercising  during each session for three different periods of time across the course of the study . Results of these analyses revealed that it was possible to explain more variance for time spent exercising ( approximately 40 % ) during the first 3 months than for attendance ( approximately 10 % ) . Furthermore , once participants completed the first 3 months of their training , prior behavior was the strongest predictor of exercise compliance . In most cases , the regression models accounted anywhere from 26 to 46 % of the variance in attendance or time spent exercising ( 7 of the 8 P values < 0.01 ) . In general , demographic , fitness , psychosocial , and disability-related measures did not predict compliance with any consistency across the various phases of the trial . Analysis of the dose-response data suggest that , in the use of aerobic exercise to deter disability in older people with knee OA , consideration should be given to prescribing frequent bouts of activity ( at least 3 times each week ) of moderate duration ( approximately 35 min ) OBJECTIVE To assess the efficacy of a lateral wedge insole with elastic strapping of the subtalar joint for conservative treatment of osteoarthritis ( OA ) of the knee . METHODS The efficacy of a novel insole with elastic subtalar strapping and a traditional shoe insert wedge insole was compared . Ninety female out patients with OA of the knee were treated with wedge insoles for 8 weeks . R and omization was performed according to birth date . St and ing radiographs with unilateral insole use were used to analyze the femorotibial and talar tilt angles for each patient with and without their respective insole . Visual analog scale ( VAS ) score for subjective knee pain at the final assessment was compared with that at baseline in both groups . RESULTS Participants wearing the elastically strapped insole ( n = 46 ) had significantly decreased femorotibial angle ( p < 0.0001 ) and talar tilt angle ( p = 0.005 ) and significantly improved VAS pain score ( p = 0.045 ) in comparison with baseline assessment s. These significant differences were not found in the group with the inserted insole ( n = 44 ) . CONCLUSION The novel strapped insole leads to valgus angulation of the talus , result ing in correction of the femorotibial angle in patients with knee OA with varus deformity , and may have a therapeutic effect similar to that of high tibial osteotomy A prospect i ve r and omized clinical trial was conducted on 162 patients of osteoarthritis of knee were included in the study . The patients were divided into two groups- Group A and Group B. The Group A was treated with shortwave diathermy , exercise , naproxen and activity modification and the Group B was treated with shortwave diathermy , exercise and naproxen . Improvement was found more in Group A than Group B after 4th week ( 95 % CI was -2.59 to 6.56 ) . Then it was found that the improvement was gradually increased in Group A than Group B and finally , it was found that there was highly significant improvement in Group A than Group B after 6th week ( 95 % CI was -3.45 to -0.70 ) . This study suggests that activity modification play an important role for the treatment of the patients with osteoarthritis of knee OBJECTIVE To investigate whether weight-bearing ( WB ) exercise enhances functional capacity to a greater extent than nonweight-bearing ( NWB ) exercise in participants with knee osteoarthritis . DESIGN R and omized controlled trial . SETTING Kinesiology laboratory . PARTICIPANTS Participants ( N=106 ) were r and omly assigned to WB exercise , NWB exercise , or a control group ( no exercise ) . INTERVENTION WB exercise and NWB exercise groups underwent an 8-week knee extension-flexion exercise program . MAIN OUTCOME MEASURES Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) function scale , walking speed , muscle torque , and knee reposition error were assessed before and after intervention . RESULTS Equally significant improvements were apparent for all outcomes after WB exercise and NWB exercise , except for reposition error , for which improvement was greater in the WB exercise group . In contrast , there were no improvements in the control group . CONCLUSIONS Simple knee flexion and extension exercises ( WB and NWB ) performed over 8 weeks result ed in significant improvement in the WOMAC function scale and knee strength compared with the control group . NWB exercise alone may be sufficient enough to improve function and muscle strength . The additional benefit of WB exercise was improved position sense , which may enhance complex walking tasks ( walking on figure of 8 route and spongy surface ) Objective : To determine whether sensory transcutaneous electrical nerve stimulation ( TENS ) augmented with therapeutic exercise and worn for daily activities for four weeks would alter peak gait kinetics and kinematics , compared with placebo electrical stimulation and exercise , and exercise only . Design : R and omized controlled trial . Setting : Motion analysis laboratory . Subjects : Thirty-six participants with radiographically assessed knee osteoarthritis and volitional quadriceps activation below 90 % were r and omly assigned to electrical stimulation , placebo and comparison ( exercise-only ) groups . Interventions : Participants in all three groups completed a four-week quadriceps strengthening programme directed by an experienced rehabilitation clinician . Active electrical stimulation units and placebo units were worn in the electrical stimulation and placebo groups throughout the rehabilitation sessions as well as during all activities of daily living . Main measures : Peak external knee flexion moment and angle during stance phase were analysed at a comfortable walking speed before and after the intervention . Findings : Comfortable walking speed increased for all groups over time ( TENS 1.16 ± 0.15 versus 1.32 ± 0.16 m/s ; placebo 1.21 ± 0.34 versus 1.3 ± 0.24 m/s ; comparison 1.27 ± 0.18 versus 1.5 ± 0.14 m/s ) , yet no group differences in speed were found . No differences were found for peak flexion moment or angle between groups overtime . Conclusions : TENS in conjunction with therapeutic exercise does not seem to affect peak flexion moment and angle during stance over a four-week period in participants with tibiofemoral osteoarthritis
target: Several individual RCTs demonstrated clinical ly important improvements in pain and disability with aerobic exercise .
  Other PT interventions demonstrated no sustained benefit .
  Individual RCTs showed similar benefits with aerobic , aquatic , and strengthening exercise .
  Adverse events were uncommon and did not deter participants from continuing treatment .
  Low-strength evidence suggested that only a few PT interventions were effective .
background: BACKGROUND Osteoarthritis is a leading cause of disability .
  Nonsurgical treatment is a key first step .
  PURPOSE Systematic literature review of physical therapy ( PT ) interventions for community-dwelling adults with knee osteoarthritis .