7 articles on knee OA in 2021

#044 – 7 Articles on Knee Osteoarthritis (OA) in 2021

  • The effect of exercise on knee OA
  • Internet-based rehabilitation exercise program on knee OA
  • The effect of blood flow restriction on knee OA
  • The effect of whole-body vibration on knee OA
  • The effect of high-intensity training on knee OA

1 – Effects of exercise on knee osteoarthritis (OA)

A systematic review (Restricted Access)


  • Review the existing evidence regarding the impact of exercise in people with knee osteoarthritis concerning physical and functional outcomes.
  • Provide both healthcare professionals and patients with updated and high‐quality recommendations for the management of this condition.


  • 19 Articles included
  • Beneficial effects of exercise were found on pain and strength. Regarding function, functional performance and quality of life, evidence is controversial.
  • Both strengthening and aerobic exercise showed positive effects and both aquatic and land‐based programmes presented improvement of pain, physical function and quality of life.
  • Relatively to stretching, plyometric and proprioception training, no concrete conclusions can be taken.


  • Exercise programs appear to be safe and effective in knee osteoarthritis patients, mainly regarding pain and strength improvement.
  • Pilates, aerobic and strengthening exercise programs performed for 8–12 weeks, 3–5 sessions per week; each session lasting 1 h appear to be effective.
  • Both aquatic and land‐based programs show comparable and positive effects.

2 – Effect of Internet-Based Rehabilitation Programs on Improvement of Pain and Physical Function in Patients with Knee Osteoarthritis

Systematic Review and Meta-analysis of Randomized Controlled Trials (Open Access)


  • Assess the effect of internet-based rehabilitation programs on the pain and physical function of patients with knee OA.
  • Evaluate the specific components (eg, exercise guidance, knee OA education) designed for each of the internet-based rehabilitation programs reported to date.


  • 6 studies for the systematic review, 4 of which were included in the meta-analysis, involving a total of 791 participants with knee OA.


  • IBET: containing tailored exercises, exercise progression, video demonstrations, automated reminders, and guidance on progression for patients with OA. Participants were encouraged to complete strengthening and stretching exercises at least 3 times per week and to engage in aerobic exercises daily.
  • PainCOACH program, which is a web-based platform that offers physical, psychological, and occupational therapies. PainCOACH includes 8 modules related to cognitive or behavioral pain coping skills in a self-directed manner (eg, without therapist contact) at a frequency of one per week. Each module took 35 to 45 minutes to complete.
  • China: three broad segments: encouragement, educational lectures, and medical issues, each of which could be completed within 20-30 min in an independent manner.
  • iCBT Sadness Program consists of six online lessons assigned as regular homework and provides access to supplementary resources.
  • Brazil: website or YouTube videos for rehabilitation at home 3 times a week. They also provided periodic telephone calls to motivate, clarify, and monitor the performance of patients.
  • Join2move promoting the self-management of behaviors of patients with knee OA when they are at home or in the community setting. The intervention period ranged from 8-10 weeks to 48 weeks.

Effect on pain

  • The meta-analysis showed that internet-based rehabilitation could significantly reduce the pain of patients with knee OA compared with conventional rehabilitation as assessed by the WOMAC pain subscale. (411 participant)

Effect on physical function

  • Internet-based rehabilitation could not significantly improve the physical function of patients with knee OA compared with the control group according to the WOMAC function subscale.


  • The results of this systematic review and meta-analysis indicate that internet-based rehabilitation programs involving personalized modules could improve the pain but not the physical function of patients with knee OA compared with conventional rehabilitation.

3 – Does blood flow restriction training enhance clinical outcomes in knee osteoarthritis

A systematic review and meta-analysis (Open Access)


  • The duration of interventions ranged from 4 to 12 weeks, with two or three exercise sessions per week. The control groups per-formed relatively equivalent exercises to the BFRT group, and the training load was based on 1RM
  • The control group training intensities ranged from low intensity (LI) to high intensity (HI)(30e80% of 1-repetition-maximum (1-RM)), while BFRT group training was always LI (20e30% of 1-RM). Of the five studies, only one used a 3-arm RCT design with a BFRT intervention group and two control groups: a LI resistance training group and HI resistance group. Exercises performed by BFRT and control groups throughout all five studies primarily focused on knee extensor muscles using a leg-press exercise or knee extension with conventional resistance training machines. However, two studies included lower-body general strength training along with flexibility exercises and balance training.


  • 199 Participants, 5 studies in the systematic review and 4 studies in the meta-analysis.
  • The key outcomes analyzed were pain, self-reported function, objective physical function, strength and muscle size.
  • Based on low to moderate quality evidence, between BFRT and traditional resistance training for any of the clinical outcomes examined in people with knee osteoarthritis. These findings do not support the current use of BFRT in the rehabilitation of knee OA.


  • These findings do not support clinicians using BFRT in people with knee OA.
  • Instead, evidence-based messages regarding exercise and education should remain the mainstay of rehabilitation.

4 – Comparison of whole-body vibration training and quadriceps strength training on physical function and neuromuscular function of individuals with knee osteoarthritis

A randomized clinical trial (Open Access)


81 participants.

Outcome measures: Isokinetic muscle strength, Proprioception of the knee, Physical function and knee pain.


  • Whole-body vibration training (WBV): 22 Participants, 3 days per week for 8 weeks. The training was conducted on a vertical vibration device, during training, the participants performed static squat training barefoot on the platform with bent knees (30° and 60°). Parameters of WBV were set at a frequency of 20 Hz and amplitude of 2 mm.
  • Strength training: 23 Participants, 3 training sessions per week for 8 weeks under supervision, similar to the WBV group. The only difference between the two training regimens of the WBV and ST groups was that WBV training was conducted on a vibration platform, whereas ST was conducted on flat ground. The protocol of ST, including the duration time and angle of the bent knee, was similar to WBV training, except for the vibration exposure
  • Health Education (HE): 19 Participants, 8 weeks of HE. They attended one 60-min group session per week. The HE sessions consisted mainly of educational information, including understanding KOA, risk factors associated with KOA, pain management, and recommended treatment options. Furthermore, the participants in the HE group were required to maintain their previous lifestyle and not attend any other regular rehabilitation programs during the study period.


  • No significant difference regarding isokinetic muscle strength at 90 degrees, 180 degrees.
    • Peak torque of flexors and peak work for extensors were significantly improved for WBV compared to HE group.
    • Peak torque and peak work for extensors were significantly improved for WBV compared to strength training.
  • No significant difference for proprioception.
  • No significant difference on pain and physical function, based on TUG, 6MWD, and VAS.


  • The present study showed the advantage of WBV training on muscle strength gain in patients with KOA compared with similar strength training without vibration and health education. Therefore, WBV training may be an effective intervention to improve knee muscle strength for KOA patients.
  • In the management of patients with KOA, WBV may increase muscle strength and be an effective additional treatment option in the rehabilitation program for KOA.

5 – Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis

The iBEAT-OA Randomized Clinical Trial (Open Access)


To compare the effect of an internet-based treatment for knee osteoarthritis vs routine self-management.


Internet-Based Exercise group: (48 Participant)

  • The treatment to the intervention group consisted of a 6-week digitally delivered, open- and closed-chain exercise instructions focused on neuromuscular leg strengthening and core stability and performance, as well as balance enhancement, as exemplified by doing sit-to-stand and stair-climbing exercises.

Usual care group: (57 Participant)

  • The usual care group was advised to continue with the management of knee osteoarthritis, as recommended by their general practitioner prior to trial recruitment. This involves the use of core and adjunctive treatments, per NICE guidelines, and a self-management plan was developed.


  • The intervention group showed a greater decrease in NRS pain score from baseline to 6 weeks compared with the control group.
  • The intervention group improved statistically significantly more than the control group in the WOMAC subscales for pain, stiffness and physical function, the 30-second sit-to-stand test, the TUG test and hamstring isokinetic strength at 60°/s.
  • There were no statistically significant between-group differences regarding change in remaining strength measures, PPT, TS, CPM, or MSK-HQ.


  • Digital delivery was superior to routine self-management.
  • No serious harms were reported.
  • Our findings suggest that digital treatment has the potential to decrease the osteoarthritis burden on both the health care systems and patients.

6 – Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults With Knee Osteoarthritis

The START Randomized Clinical Trial (Restricted Access)


  • Is high-intensity strength training more effective than low-intensity strength training and attention control for the outcomes of knee pain and knee joint compressive forces in participants with knee osteoarthritis?

💉Interventions and participant

  • High-intensity strength training, 127 participants.
  • Low-intensity strength training, 126 participants.
  • Attention control, 124 participants.

📏Outcome measures

  • At 18-month follow-up measurements Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) knee pain (0 best-20 worst; minimally clinically important difference [MCID, 2]) and knee joint compressive force, defined as the maximal tibiofemoral contact force exerted along the long axis of the tibia during walking (MCID, unknown).


  • Mean adjusted WOMAC pain scores at the 18-month follow-up were not statistically significantly different between the high-intensity and control groups, or between high-intensity and low-intensity groups.
  • Mean knee joint compressive forces were not statistically significantly different between the high-intensity and control groups, or between high-intensity and low-intensity groups.


  • High-intensity strength training compared with low-intensity strength training or an attention control did not significantly reduce knee pain or knee joint compressive forces at 18 months.

7 – Effects of a Self-directed Web-Based Strengthening Exercise and Physical Activity Program Supported by Automated Text Messages for People With Knee Osteoarthritis

A Randomized Clinical Trial (Restricted Access)


  • How does adding a 24-week self-directed strengthening exercise regimen and physical activity guidance supported by automated behavior-change text messages to web-based osteoarthritis (OA) information affect pain and function in people with knee OA?


  • The intervention group was given access to the same information plus a prescription for a 24-week self-directed strengthening regimen and guidance to increase physical activity, supported by automated behavior-change text messages encouraging exercise adherence.
  • The control group was given access to a custom-built website with information on OA and the importance of exercise and physical activity.

📏Outcome measures

  • Overall knee pain (numeric rating scale, 0-10)
  • Difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0-68) over 24 weeks.
  • Secondary outcomes were another knee pain measure, sport and recreation function, quality of life, physical activity, self-efficacy, overall improvement, and treatment satisfaction.


  • 180 participants completed both 24-week primary outcomes.
  • The intervention group showed greater improvements in overall knee pain and physical function compared with the control.
  • There was evidence of differences in the proportion of participants exceeding the minimal clinically important improvement in pain and function favoring the intervention.
  • Between-group differences for all secondary outcomes favored the intervention, except for physical activity, self-efficacy for function, and self-efficacy for exercise, for which there was no evidence of differences.


  • Self-directed web-based strengthening exercise regimen and physical activity guidance, supported by automated behavior-change text messages to encourage exercise adherence, improved knee pain, and function at 24 weeks.
  • This unsupervised, free-to-access digital intervention is an effective option to improve patient access to recommended OA exercise and/or to support clinicians in providing exercise management for people with knee OA at scale across the population.

Thank you for reading.

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