A pragmatic, factorial randomised controlled trial conducted over two years in Nottingham has demonstrated that a home-based exercise program can significantly reduce knee pain in individuals aged 45 and over. The study involved 786 participants who were randomised into four groups: exercise therapy, monthly telephone contact, exercise therapy plus telephone contact, or no intervention. The primary outcome was the self-reported score for knee pain on the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index at two years.
Results showed that 600 (76.3%) participants completed the study, with highly significant reductions in knee pain observed for the pooled exercise groups compared to the non-exercise groups. The mean difference in pain reduction was -0.82, with a 95% confidence interval of -1.3 to -0.3. Improvements were noted as early as six months and sustained throughout the study period. The study also found that the reduction in pain was greater the closer patients adhered to the exercise plan, indicating a dose-response effect.
The exercise program, which was designed to maintain and improve the strength of muscles acting around the knee, the range of motion at the knee joint, and locomotor function, was generally well tolerated. However, adherence was moderate, with the most common reasons for non-adherence being health problems and lack of time. The study concluded that simple home-based exercise programs can produce significant reductions in knee pain over two years and are ideally suited for primary care.
This study adds to the body of evidence supporting the efficacy of physiotherapy for the treatment of knee pain, particularly through home-based programs that require minimal supervision and equipment. It also underscores the limited impact of psychosocial support alone on health outcomes in the context of knee pain management.
