A comparison of strength training, self-management, and the combination for early osteoarthritis of the knee

Abstract

Objective: To assess the relative effectiveness of combining self-management and strength training for improving functional outcomes in patients with early knee osteoarthritis.

Methods: We conducted a randomized intervention trial lasting 24 months at an academic medical center. Community-dwelling middle-aged adults (n = 273) ages 35-64 years with knee osteoarthritis, pain, and self-reported physical disability completed a strength training program, a self-management program, or a combined program. Outcomes included 5 physical function tests (leg press, range of motion, work capacity, balance, and stair climbing) and 2 self-reported measures of pain and disability.

Results: A total of 201 participants (73.6%) completed the 2-year trial. Overall, compliance was modest for the strength training (55.8%), self-management (69.1%), and combined (59.6%) programs. The 3 groups showed a significant and large increase from pre- to posttreatment in all of the physical functioning measures, including leg press (d = 0.85), range of motion (d = 1.00), work capacity (d = 0.60), balance (d = 0.59), and stair climbing (d = 0.59). Additionally, all 3 groups showed decreased self-reported pain (d = -0.51) and disability (d = -0.55). There were no significant differences among the groups.

Conclusion: Middle-aged, sedentary persons with mild early knee osteoarthritis benefited from strength training, self-management, and the combination program. These results suggest that both strength training and self-management are suitable treatments for the early onset of knee osteoarthritis in middle-aged adults. Self-management alone may offer the least burdensome treatment for early osteoarthritis.

Trial registration: ClinicalTrials.gov NCT00586300.

Figure 1

Consort diagram.

Figure 2

The figure represents three repeated measures - measured at baseline, 9-months, and 24-months - for five objective functional outcomes for the three treatment groups. Error bars at each point represent 95% confidence intervals. Higher numbers for all outcomes indicate better functioning.

Figure 3

Five repeated measures - measured at baseline, 3-months, 9-months, 18-months, and 24-months - for self-reported pain and disability for the three treatment groups. Error bars at each point represent 95% confidence intervals. Lower values for both outcomes indicate less pain and disability.