title: Efficacy of home-based kinesthesia, balance & agility exercise training among persons with symptomatic knee osteoarthritis. A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis. A randomized study of the effects of t'ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis. The effects of electrical stimulation combined with continuous passive motion versus isometric exercise on symptoms, functional capacity, quality of life and balance in knee osteoarthritis: randomized clinical trial The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Effects of Impairment-Based Exercise on Performance of Specific Self-Reported Functional Tasks in Individuals With Knee Osteoarthritis Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial Whole-body vibration decreases the proliferative response of TCD4+ cells in elderly individuals with knee osteoarthritis A four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance: a randomized controlled trial Effectiveness of a home-based exercise therapy and walking program on osteoarthritis of the knee 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. Is neuromuscular electrical stimulation effective for improving pain, function and activities of daily living of knee osteoarthritis patients? A randomized clinical trial. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Does hydrotherapy improve strength and physical function in patients with osteoarthritis--a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis. Risk factors for falls among elderly persons living in the community. Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes. The effect of neuromuscular electrical stimulation on arthritis knee pain in older adults with osteoarthritis of the knee. Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. Effect of whole body vibration exercise on muscle strength and proprioception in females with knee osteoarthritis. Functional performance and inflammatory cytokines after squat exercises and whole-body vibration in elderly individuals with knee osteoarthritis. Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis. Short-term effects of 890-nanometer radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study.
abstract: The purpose of this study was to determine the efficacy of a home-based kinesthesia , balance and agility ( KBA ) exercise program to improve symptoms among persons age ≥ 50 years with knee osteoarthritis ( OA ) . Forty-four persons were r and omly assigned to 8-weeks , 3 times per week KBA , resistance training ( RT ) , KBA + RT , or Control . KBA utilized walking agility exercises and single-leg static and dynamic balancing . RT used elastic resistance b and s for open chain lower extremity exercises . KBA + RT performed selected exercises from each technique . Control applied inert lotion daily . Outcomes included the OA specific WOMAC Index of Pain , Stiffness , and Physical Function ( PF ) , community activity level , exercise self-efficacy , self-report knee stability , and 15 m get up & go walk ( GUG ) . Thirty-three participants [ 70.7 ( SD 8.5 ) years ] completed the trial . Analysis of variance comparing baseline , mid-point , and follow-up measures revealed significant ( p < 0.05 ) improvements in WOMAC scores among KBA , RT , KBA + RT , and Control , with no differences between groups . However , Control WOMAC improvements peaked at mid-point , whereas improvement in the exercise conditions continued at 8-weeks . There were no significant changes in community activity level . Only Control improved exercise self-efficacy . Knee stability was improved in RT and Control . GUG improved in RT and KBA+RT . These results indicate that KBA , RT , or a combination of the two administered as home exercise programs are effective in improving symptoms and quality of life among persons with knee OA . Control results indicate a strong placebo effect in the short term . A combination of KBA and RT should be considered as part of the rehabilitation program , but KBA or RT alone may be appropriate for some patients . Studies with more statistical power are needed to confirm or refute these results . Patient presentation , preferences , costs , and convenience should be considered when choosing an exercise rehabilitation approach for persons with knee OA 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 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 The aim of this study was to evaluate effects of electrical stimulation combined with continuous passive motion ( CPM – ES ) versus isometric exercise on symptoms , functional capacity , quality of life , muscle strength , knee and thigh circle measurements , and balance in knee osteoarthritis ( OA ) . This is a r and omized clinical trial . The study was done in Gulhane Military Medical Academy ( GMMA ) Rehabilitation Center . Forty patients with knee OA were included in this study . Participants were r and omly assigned to two groups : 20 patients placed in Group 1 were treated with conventional physical therapy and CPM – ES combination ; 20 patients in Group 2 were treated with conventional physical therapy and isometric exercise . Therapies were applied 3 weeks , 5 days per week . The following main outcome measures were done : values of pain ( VAS was used ) , WOMAC , SF-36 , knee and thigh circle measurements , isokinetic tests , dynamic and static balance tests were determined at baseline and after the treatment . There were no statistically significant differences in the tested variables between the groups for post-treatment values . Dynamic and static balance test improved statistically strongly significantly in both groups . The findings of this study demonstrate that knee OA patients could improve their balance function in both static and dynamic conditions after CPM – ES combination or isometric exercise therapy . The improvement might prevent knee OA patients from falling down and increase their sense of security during physical activities 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 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 Background Little is known regarding how impairment-based exercises may improve performance of specific functional tasks in people with knee osteoarthritis ( OA ) . Objective The purpose of this study was to compare the probability that participation in an impairment-based exercise program or the same impairment-based program supplemented with agility and perturbation training will improve patient-reported function on specific functional tasks . Design This study was a secondary analysis of data from a r and omized clinical trial . Setting The study was conducted in the outpatient physical therapy clinic of a large , university-based health center . Participants One hundred eighty-three people with knee OA ( 122 women , 61 men ) participated . Interventions Participants were r and omly assigned to either a group that received agility and perturbation training with st and ard exercise therapy or a group that received only the st and ard exercise . Measurements Specific functional items were taken from the physical function subscale of the Western Ontario and McMasters Universities Osteoarthritis Index , the Lower Extremity Function Scale , and the Activities of Daily Living Scale of the Knee Outcome Survey . Results The probability of self-reported improvement in a variety of specific functional tasks was low following participation in either of the exercise programs . When only participants with moderate to severe difficulty performing specific functional tasks were considered in the analysis , the probability of success improved but was still limited . Limitations The results are generalizable only to self-reported assessment of performance of specific functional tasks . Conclusions Impairment-based exercise may not be enough to make substantial improvement in performance of specific functional tasks .  Task-specific exercise approaches need to be explored for people with knee OA Background and Purpose Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis ( OA ) , yet there is little research establishing its efficacy for this population . The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA . Subjects A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study . Methods The study was design ed as a r and omized controlled trial in which participants r and omly received 6 weeks of aquatic physical therapy or no aquatic physical therapy . Outcome measures included pain , physical function , physical activity levels , quality of life , and muscle strength . Results The intervention result ed in less pain and joint stiffness and greater physical function , quality of life , and hip muscle strength . Totals of 72 % and 75 % of participants reported improvements in pain and function , respectively , compared with only 17 % ( each ) of control participants . Benefits were maintained 6 weeks after the completion of physical therapy , with 84 % of participants continuing independently . Discussion and Conclusion Compared with no intervention , a 6-week program of aquatic physical therapy result ed in significantly less pain and improved physical function , strength , and quality of life . It is unclear whether the benefits were attributable to intervention effects or a placebo response The aim of this study was to investigate the effect of adding whole-body vibration ( WBV ; frequency = 35 to 40 Hz ; amplitude = 4 mm ) to squat training on the T-cell proliferative response of elderly patients with osteoarthritis ( OA ) of the knee . This study was a r and omized controlled trial in which the selected variables were assessed before and after 12 weeks of training . Twenty-six subjects ( 72 ± 5 years of age ) were divided into three groups : 1 ) squat training with WBV ( WBV , N = 8) ; 2 ) squat training without WBV ( N = 10 ) , and 3 ) a control group ( N = 8) . Women who were ≥60 years of age and had been diagnosed with OA in at least one knee were eligible . The intervention consisted of 12 uninterrupted weeks of squatting exercise training performed 3 times/week . Peripheral blood mononuclear cells were obtained from peripheral blood collected before and after training . The proliferation of TCD4 + and TCD8 + cells was evaluated by flow cytometry measuring the carboxyfluorescein succinimidyl ester fluorescence decay before and after the intervention ( Δ ) . The proliferative response of TCD4 + cells ( P = 0.02 , effect size = 1.0 ) showed a significant decrease ( 23 % ) in the WBV group compared to the control group , while there was no difference between groups regarding the proliferative response of TCD8 + cells ( P = 0.12 , effect size = 2.23 ) . The data suggest that the addition of WBV to squat exercise training might modulate T-cell-mediated immunity , minimizing or slowing disease progression in elderly patients with OA of the knee Objective : To investigate whether a four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance in older adults with knee osteoarthritis . Design : A r and omized controlled trial with two groups : a walking group and a control group . Subjects : Forty older adults with knee osteoarthritis , 20 participants in each group . Intervention : The walking intervention was design ed to increase the number of steps walked daily . The walking group was instructed to increase their number of steps to 3000 steps more than before the intervention . Main outcome measures : Dual-task performance was computed by an automaticity index : the walking velocity under single-task condition/under dual-task conditions × 100 ( % ) , defined as automaticity . The nearer to 100 % automaticity , the better the dual-task performance . Decrease of the Trail Making Test ( TMT ) performance was defined as ΔTMT . ΔTMT was calculated as the difference between times ( part B – part A ) as a measure of executive function . In addition , functional ability was measured by the Japanese Knee Osteoarthritis Measure . Results : The walking group improved significantly in automaticity ( P < 0.001 , from 75.2 ( 7.6 ) to 86.9 ( 10.4 ) , ΔTMT ( P < 0.001 , from 63.4 ( 43.1 ) to 48.3 ( 29.6 ) ) and Japanese Knee Osteoarthritis Measure score ( P < 0.001 , from 54.4 to 51.9 ) compared with before the intervention , while the control group displayed no significant differences . Conclusions : We found that walking exercise improves executive function and dual-task performance Abstract . Osteoarthritis ( OA ) of the knee is a very common rheumatological disease , and there are various treatment modalities for it . The aim of this study was to investigate the effects of home-based exercise and walking programs in the treatment of OA . A total of 90 patients with knee osteoarthritis were included . Their ages ranged between 48 and 71 years . The patients were separated into three groups . None of them had practice d a daily simple exercise program during the previous year . Group 1 ( n=30 ) was given a home-based exercise program . Group 2 ( n=30 ) had regular a walking program three times per week , starting with 10-min duration . Group 3 ( n=30 ) was accepted as the control group . Patients were assessed according to pain , functional capacity , and quality of life parameters . Pain was evaluated by the Western Ontario McMaster osteoarthritis index ( WOMAC ) of pain score and visual analogue scale ( VAS ) . Functional capacity was measured by WOMAC physical function index . Quality of life was assessed by the Nottingham Health Profile question naire ( NHP ) . All groups continued the program for 3 months . At the end of the therapy , the patients were called and 81 were accepted to come to the hospital . Although WOMAC pain and physical functional scores and VAS scores were statistically lower in both groups than in the control group ( P<0.001 ) , the difference between groups 1 and 2 was not statistically significant ( P>0.05 ) . But the result of the NHP showed a statistically significant improvement in the walking group when compared to the home-based exercise and control groups ( P<0.001 ) . As a result , we conclude that a simple home-based exercise therapy and a regular walking program are effective in treating the symptoms of OA 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 CONTEXT AND OBJECTIVE Neuromuscular electrical stimulation ( NMES ) has been used in rehabilitation protocol s for patients suffering from muscle weakness result ing from knee osteoarthritis . The purpose of the present study was to assess the effectiveness of an eight-week treatment program of NMES combined with exercises , for improving pain and function among patients with knee osteoarthritis . DESIGN AND SETTING R and omized clinical trial at Interlagos Specialty Ambulatory Clinic , Sao Paulo , Brazil . METHODS One hundred were r and omized into two groups : NMES group and control group . The following evaluation measurements were used : numerical pain scale from 0 to 10 , timed up and go ( TUG ) test , Lequesne index and activities of daily living ( ADL ) scale . RESULTS Eighty-two patients completed the study . From intention-to-treat ( ITT ) analysis comparing the groups , the NMES group showed a statistically significant improvement in relation to the control group , regarding pain intensity ( difference between means : 1.67 [ 0.31 to 3.02 ] ; P = 0.01 ) , Lequesne index ( difference between means : 1.98 [ 0.15 to 3.79 ] ; P = 0.03 ) and ADL scale ( difference between means : -11.23 [ -19.88 to -2.57 ] ; P = 0.01 ) . CONCLUSION NMES , within a rehabilitation protocol for patients with knee osteoarthritis , is effective for improving pain , function and activities of daily living , in comparison with a group that received an orientation program . CLINICAL TRIAL REGISTRATION ACTRN012607000357459 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 compare the effects of a hydrotherapy resistance exercise programme with a gym based resistance exercise programme on strength and function in the treatment of osteoarthritis ( OA ) . DESIGN Single blind , three arm , r and omised controlled trial . SUBJECTS 105 community living participants aged 50 years and over with clinical OA of the hip or knee . METHODS Participants were r and omised into one of three groups : hydrotherapy ( n = 35 ) , gym ( n = 35 ) , or control ( n = 35 ) . The two exercising groups had three exercise sessions a week for six weeks . At six weeks an independent physiotherapist unaware of the treatment allocation performed all outcome assessment s ( muscle strength dynamometry , six minute walk test , WOMAC OA Index , total drugs , SF-12 quality of life , Adelaide Activities Profile , and the Arthritis Self-Efficacy Scale ) . RESULTS In the gym group both left and right quadriceps significantly increased in strength compared with the control group , and right quadriceps strength was also significantly better than in the hydrotherapy group . The hydrotherapy group increased left quadriceps strength only at follow up , and this was significantly different from the control group . The hydrotherapy group was significantly different from the control group for distance walked and the physical component of the SF-12 . The gym group was significantly different from the control group for walk speed and self efficacy satisfaction . Compliance rates were similar for both exercise groups , with 84 % of hydrotherapy and 75 % of gym sessions attended . There were no differences in drug use between groups over the study period . CONCLUSION Functional gains were achieved with both exercise programmes compared with the control group AIMS The study aims to compare changes over time among three study groups on the primary outcome , pain , as well as on the secondary outcomes , other symptoms , activities of daily living function , sport and recreation function , knee-related quality of life , knee range of motions and the six-minute walk test and to investigate whether aquatic exercises would be superior compared with l and exercise on pain reduction . BACKGROUND Osteoarthritis is a prevalent musculoskeletal disorder . Appropriate exercise may prevent osteoarthritis-associated disabilities and increase life quality . To date , research that compares the effects of different types of exercise for knee osteoarthritis has been limited . DESIGN The study is a r and omised trial . METHODS Eighty-four participants with knee osteoarthritis were recruited from local community centres . Participants were r and omly assigned to the control , aquatic or l and -based exercise group . Exercise in both groups ran for 60 minutes , three times a week for 12 weeks . Data were collected at baseline , week 6 and week 12 during 2006 - 2007 . The instruments included the Knee Injury and Osteoarthritis Outcome Score , a st and ard plastic goniometer and the six-minute walk test . Generalised estimation equations were used to compare changes over time among groups for key outcomes . RESULTS Results showed statistically significant group-by-time interactions in pain , symptoms , sport/recreation and knee-related quality of life dimensions of Knee Injury and Osteoarthritis Outcome Score , knee range of motions and the six-minute walk test . However , the aquatic group did not show any significant difference from the l and group at both weeks 12 and 6 . CONCLUSIONS Both aquatic and l and -based exercise programmes are effective in reducing pain , improving knee range of motions , six-minute walk test and knee-related quality of life in people with knee osteoarthritis . The aquatic exercise is not superior to l and -based exercise in pain reduction . RELEVANCE TO CLINICAL PRACTICE Similar outcomes could be possible with the two programmes . Health care professionals may consider suggesting well- design ed aquatic or l and -based exercise classes for patients with osteoarthritis , based on their preferences and convenience To study risk factors for falling , we conducted a one-year prospect i ve investigation , using a sample of 336 persons at least 75 years of age who were living in the community . All subjects underwent detailed clinical evaluation , including st and ardized measures of mental status , strength , reflexes , balance , and gait ; in addition , we inspected their homes for environmental hazards . Falls and their circumstances were identified during bimonthly telephone calls . During one year of follow-up , 108 subjects ( 32 percent ) fell at least once ; 24 percent of those who fell had serious injuries and 6 percent had fractures . Predisposing factors for falls were identified in linear-logistic models . The adjusted odds ratio for  sedative use was 28.3 ; for cognitive impairment , 5.0 ; for disability of the lower extremities , 3.8 ; for palmomental reflex , 3.0 ; for abnormalities of balance and gait , 1.9 ; and for foot problems , 1.8 ; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables . The risk of falling increased linearly with the number of risk factors , from 8 percent with none to 78 percent with four or more risk factors ( P less than 0.0001 ) . About 10 percent of the falls occurred during acute illness , 5 percent during hazardous activity , and 44 percent in the presence of environmental hazards . We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE To determine whether Tai Chi or hydrotherapy classes for individuals with chronic symptomatic hip or knee osteoarthritis ( OA ) result in measurable clinical benefits . METHODS A r and omized controlled trial was conducted among 152 older persons with chronic symptomatic hip or knee OA . Participants were r and omly allocated for 12 weeks to hydrotherapy classes ( n = 55 ) , Tai Chi classes ( n = 56 ) , or a waiting list control group ( n = 41 ) . Outcomes were assessed 12 and 24 weeks after r and omization and included pain and physical function ( Western Ontario and McMaster Universities Osteoarthritis Index ) , general health status ( Medical Outcomes Study Short Form 12 Health Survey [ SF-12 ] , version 2 ) , psychological well-being , and physical performance ( Up and Go test , 50-foot walk time , timed stair climb ) . RESULTS At 12 weeks , compared with controls , participants allocated to hydrotherapy classes demonstrated mean improvements ( 95 % confidence interval ) of 6.5 ( 0.4 , 12.7 ) and 10.5 ( 3.6 , 14.5 ) for pain and physical function scores ( range 0 - 100 ) , respectively , whereas participants allocated to Tai Chi classes demonstrated improvements of 5.2 ( -0.8 , 11.1 ) and 9.7 ( 2.8 , 16.7 ) , respectively . Both class allocations achieved significant improvements in the SF-12 physical component summary score , but only allocation to hydrotherapy achieved significant improvements in the physical performance measures . All significant improvements were sustained at 24 weeks . In this almost exclusively white sample , class attendance was higher for hydrotherapy , with 81 % attending at least half of the available 24 classes , compared with 61 % for Tai Chi . CONCLUSION Access to either hydrotherapy or Tai Chi classes can provide large and sustained improvements in physical function for many older , sedentary individuals with chronic hip or knee OA 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 Twelve forms of Sun-style tai chi exercise have been developed specifically to reduce the symptoms and improve the physical functioning of arthritic patients , and this r and omized study examined the changes in symptoms and physical characteristics in older women with osteoarthritis ( OA ) at the completion of a 12-week tai chi exercise program . METHODS Seventy-two patients with OA were r and omly assigned into 2 groups . Due to a 41 % overall dropout rate , 22 experimental subjects and 21 controls completed pre- and post-test measures over a 12 week interval . Outcome variables were physical symptoms and fitness , body mass index , cardiovascular functioning , and perceived difficulties in physical functioning . The independent t test was used to examine group differences . RESULTS The homogeneity test confirmed that there were no significant group differences in demographic data and pretest measures . Mean comparisons of the change scores revealed that the experimental group perceived significantly less pain ( t = -2.19 , p = 0.034 ) and stiffness ( t = -2.13 , p = 0.039 ) in their joints , and reported fewer perceived difficulties in physical functioning ( t = -2.81 , p = 0.008 ) , while the control group showed no change or even deterioration in physical functioning after 12 weeks . In the physical fitness test , there were significant improvements in balance ( t = 3.34 , p = 0.002 ) and abdominal muscle strength ( t = 2.74 , p = 0.009 ) for the tai chi exercise group . No significant group differences were found in flexibility and upper-body or knee muscle strength in the post-test scores . CONCLUSION Older women with OA were able to safely perform the 12 forms of Sun-style tai chi exercise for 12 weeks , and this was effective in improving their arthritic symptoms , balance , and physical functioning . A longitudinal study with a larger sample size is now needed to confirm the potential use of tai chi exercise in arthritis management The purpose of this study was to assess the effect of whole body vibration ( WBV ) exercise on muscle strength and proprioception in female patients with osteoarthritis in the knee ( knee-OA ) . A single blinded , r and omised , controlled trial was performed in an outpatient clinic on 52 female patients diagnosed with knee-OA ( mean age 60.4 years+/-9.6 ) . They were r and omly assigned to one of 3 groups : 1 . WBV-exercise on a stable platform ( VibM ; n=17 ( mean age , 61.5+/-9.2 ) ) , WBV-exercise on a balance board ( VibF ; n=18 ( mean age , 58.7+/-11.0 ) ) , or control group ( Con ; n=18 ( mean age , 61.1+/-8.5 ) ) . The WBV groups trained twice a week for 8 weeks , with a progressively increasing intensity . The WBV groups performed unloaded static WBV exercise . The following were measured : knee muscle strength ( extension/flexion ) and proprioception ( threshold for detection of passive movement ( TDPM ) ) . Self-reported disease status was measured using WOMAC . It was found that muscle strength increased significantly ( p<0.001 ) in VibM compared to Con . Isometric knee-extension significantly increased ( p=0.021 ) in VibM compared to Con . TDPM was significantly improved ( p=0.033 ) in VibF compared to Con , while there was a tendency ( p=0.051 ) for VibM to perform better compared to Con . There were no effects in the self-reported disease status measures . This study showed that the WBV-exercise regime on a stable platform ( VibM ) yielded increased muscle strength , while the WBV-exercise on a balance board ( VibF ) showed improved TDPM . The WBV-exercise is a time-saving and safe method for rehabilitation of women with knee-OA OBJECTIVE To investigate the effects of squat exercises combined with whole-body vibration on the plasma concentration of inflammatory markers and the functional performance of elderly individuals with knee osteoarthritis ( OA ) . DESIGN Clinical , prospect i ve , r and omized , single-blinded study . SETTING Exercise physiology laboratory . PARTICIPANTS Elderly subjects with knee OA ( N=32 ) were divided into 3 groups : ( 1 ) squat exercises on a vibratory platform ( platform group , n=11 ) ; ( 2 ) squat exercises without vibration ( squat group , n=10 ) ; and ( 3 ) the control group ( n=11 ) . INTERVENTIONS The structured program of squat exercises in the platform and squat groups was conducted 3 times per week , on alternate days , for 12 weeks . MAIN OUTCOME MEASURES Plasma soluble tumor necrosis factor-α receptors 1 ( sTNFR1 ) and 2 ( sTNFR2 ) were measured using immunoassays ( the enzyme-linked immunosorbent assay method ) . The Western Ontario and McMaster Universities Osteoarthritis Index question naire was used to evaluate self-reported physical function , pain , and stiffness . The 6-minute walk test , the Berg Balance Scale , and gait speed were used to evaluate physical function . RESULTS In the platform group , there were significant reductions in the plasma concentrations of the inflammatory markers sTNFR1 and sTNFR2 ( P<.001 and P<.05 , respectively ) and self-reported pain ( P<.05 ) compared with the control group , and there was an increase in balance ( P<.05 ) and speed and distance walked ( P<.05 and P<.001 , respectively ) . In addition , the platform group walked faster than the squat group ( P<.01 ) . CONCLUSIONS The results suggest that whole-body vibration training improves self-perception of pain , balance , gait quality , and inflammatory markers in elderly subjects with knee OA Objectives To gain an underst and ing of elderly people ’s fear of falling by exploring the prevalence and determinants of perceived and physiological fall risk and to underst and the role of disparities in perceived and physiological risk in the cause of falls . Design Prospect i ve cohort study . Setting Community sample drawn from eastern Sydney , Australia . Participants 500 men and women aged 70–90 years . Main outcome measures Baseline assessment of medical , physiological , and neuropsychological measures , with physiological fall risk estimated with the physiological profile assessment , and perceived fall risk estimated with the falls efficacy scale international . Participants were followed up monthly for falls over one year . Results Multivariate logistic regression analyses showed that perceived and physiological fall risk were both independent predictors of future falls . Classification tree analysis was used to split the sample into four groups ( vigorous , anxious , stoic , and aware ) based on the disparity between physiological and perceived risk of falling . Perceived fall risk was congruent with physiological fall risk in the vigorous ( 144 ( 29 % ) ) and aware ( 202 ( 40 % ) ) groups . The anxious group ( 54 ( 11 % ) ) had a low physiological risk but high perceived fall risk , which was related to depressive symptoms ( P=0.029 ) , neurotic personality traits ( P=0.026 ) , and decreased executive functioning ( P=0.010 ) . The stoic group ( 100 ( 20 % ) ) had a high physiological risk but low perceived fall risk , which was protective for falling and mediated through a positive outlook on life ( P=0.001 ) and maintained physical activity and community participation ( P=0.048 ) . Conclusion Many elderly people underestimated or overestimated their risk of falling . Such disparities between perceived and physiological fall risk were primarily associated with psychological measures and strongly influenced the probability of falling . Measures of both physiological and perceived fall risk should be included in fall risk assessment s to allow tailoring of interventions for preventing falls in elderly people 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 investigate the efficacy of a water-based exercise program specifically targeting balance to reduce falls risk and improve measures of balance and physical function in older adults with osteoarthritis ( OA ) . DESIGN R and omized controlled trial . SETTING Community . PARTICIPANTS Persons ( N=39 ; mean±SD age , 74±6y ; 26 women ) with mild to moderate OA and at risk for falling met study criteria , were measured at baseline , and were r and omly assigned to the intervention ( n=23 ) and control groups ( n=16 ) . INTERVENTIONS Water-based program ( 12wk , twice weekly ; intervention group ) or a time-matched computer training program ( control group ) . MAIN OUTCOME MEASURE The primary outcome was the short-form Physiological Profile Assessment ( PPA ) . Secondary outcomes included the Step Test , Timed Up and Go Test , Western Ontario and McMaster Universities OA Index ( Likert 3.0 version ) , Arthritis Impact Measurement Scales 2 , and Activity-specific Balance Confidence Scale . RESULTS No statistically significant between-group differences were found for any outcome measured ( n=35 ; 4 lost to follow-up ) . Within-group analysis indicated that Step Test results improved significantly in both groups ( mean change : control group , left leg , 2.07 ; 95 % confidence interval , 3.19-.95 ; P=.002 ; intervention group , 2.14 ; 95 % confidence interval , 3.20 - 1.08 ; P=.000 ) . Two PPA item scores ( reaction time , contrast sensitivity ) improved significantly ( 86.83 ; 95 % confidence interval , 9.86 - 163.79 ; P=.03 ; 1.43 ; 95 % confidence interval , 2.35-.50 ; P=.005 , respectively ) in the control group , result ing in a lower falls risk score . CONCLUSIONS Water-based exercise did not reduce falls risk in our sample compared with attending a computer skills training class . Our study is , to our knowledge , the first to compare water-based exercise in this population with a control group that attended a time-dose-equivalent seated community-based activity . Whether gaining computer skills and going out into the community twice weekly is adequate stimulus to reduce falls risk in people with OA requires further investigation OBJECTIVE To investigate the effects of short-term light therapy with 890-nm radiation on pain , physical activity , and postural stability in patients with knee osteoarthritis ( OA ) . DESIGN A double-blind , r and omized , placebo-controlled study . SETTING Rehabilitation clinic . PARTICIPANTS Women ( n=62 ) and men ( n=10 ) with a mean age of 61.2 years ( range , 40 - 88y ) . All patients fulfilled the combined clinical and radiographic criteria for knee OA as established by the American College of Rheumatology , and all had obtained a Kellgren-Lawrence score of 2 or more . INTERVENTIONS Participants received 6 sessions , lasting 40 minutes each , of active or placebo radiation treatment over the knee joints for 2 weeks ( wavelength , 890 nm ; radiant power output , 6.24W ; power density , 34.7mW/cm(2 ) for 40 minutes ; total energy , 41.6J/cm(2 ) per knee per session ) . MAIN OUTCOME MEASURES Participants were assessed weekly over 4 weeks using the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) for pain , stiffness , and physical function . Physical activity ( timed stair climbing , 10-m fast-speed walking , and chair-rising time ) and postural stability ( using the postural stability evaluation system ) were also assessed . The pain score on WOMAC was the primary outcome variable . Data were analyzed by repeated- measures analysis of covariance . RESULTS Compared with baseline , no significant improvement was observed between groups for pain ( P=.546 ) , stiffness ( P=.573 ) , or physical function ( P=.904 ) . No significant improvement was noted for physical activity including the 10-m fast-speed walking time ( P=.284 ) , stair-climbing time ( P=.202 ) , stair-descending time ( P=.468 ) , chair-rising time ( P=.499 ) , or postural stability ( P=.986 ) at the 4 follow-up assessment s. Follow-up assessment s were conducted after 1 week of treatment ( thus , after 3 treatments ) ; after 2 weeks of treatment ( thus , after 6 treatments ) ; and 1 and 2 weeks , respectively , after treatment was terminated . Although we found a significant time effect for the 10-m fast-speed walking time ( P<.001 ) in the 2 groups , and a significant group effect in the improvement of stair-climbing time in the treatment group ( P=.032 ) , the group × time interaction effects were not significant . CONCLUSIONS Short-term 890-nm radiation therapy for patients with knee OA provided no beneficial effect in improving pain , physical activity , and postural stability
target: CONCLUSION strength training , Tai Chi and aerobics exercises  improved balance and falls risk in older individuals with knee OA , while water-based exercises and light treatment did not significantly improve balance outcomes .
  Strength training , Tai Chi and aerobics exercises can therefore be recommended as falls prevention strategies for individuals with OA .
background: INTRODUCTION osteoarthritis ( OA ) of knee has been reported as a risk factor for falls and reduced  balance in the elderly .
  This systematic review evaluated the effectiveness of physical therapies in improving balance and reducing falls risk among patients with knee OA .