Abstract
To compare the efficacy and adherence rates of two parallel home exercise therapy programs—multiple exercise (training and stretching the knee and hip muscles) and control (training the quadriceps muscles)—on knee pain, physical function, and knee extension strength in community-dwelling elderly individuals with pre-radiographic knee osteoarthritis (OA). One hundred patients with medial knee pain were randomly allocated to one of two 4-week home exercise programs. Individuals with a Kellgren/Lawrence (K/L) grade 0 or 1 OA (pre-radiographic knee OA) in the medial compartment were enrolled. Primary outcomes were knee pain (visual analog scale), self-reported physical function (Japanese Knee Osteoarthritis Measure [JKOM]), and isometric maximum muscle strength of the knee extensor measured using a hand-held dynamometer. A total of 52 patients (28 [53.8%] in the multiple exercise group, 24 [46.2%] in the control group) completed the trial. The JKOM activities of daily living and general health conditions outcomes improved significantly in the multiple exercise group compared to the control group (JKOM activities of daily living, beta = − 0.76; 95% confidence interval [CI], − 1.39 to − 0.13; p = 0.01; JKOM general health conditions, beta = − 0.25; 95% CI, − 0.48 to − 0.01; p = 0.03). The home exercise compliance rates of the multiple exercise and control groups were 96.6 and 100%, respectively. When targeting pre-radiographic knee OA in community-dwelling elderly, it is important to implement home exercise programs that aim to improve muscle strength and joint flexibility rather than knee extension muscle power only.
Highlights
Knee osteoarthritis (OA), a painful disease involving degeneration of the articular cartilage, has a prevalence in Japanese people > 60 years of age of 47.0% in men and 70.2% in women, making it a common disease [1]
The JKOM activities of daily living and JKOM general health conditions outcomes improved significantly in the multiple exercise group compared to the control group (JKOM activities of daily living, beta = − 0.76; 95% CI, − 1.39 to − 0.13; p = 0.01; JKOM general health conditions, beta = − 0.25; 95% CI, − 0.48 to − 0.01; p = 0.03)
The JKOM activities of daily living and general health conditions outcomes showed significant improvement in the multiple exercise group compared to the control group, while in the JKOM participation in social activities outcome, an improvement trend was observed in the multiple exercise group over the control group
Summary
Knee osteoarthritis (OA), a painful disease involving degeneration of the articular cartilage, has a prevalence in Japanese people > 60 years of age of 47.0% in men and 70.2% in women, making it a common disease [1]. Worsening knee OA severity leads to decreased activity limitations, creating the need to prevent its onset or progression [2]. Effective treatment and Kellgren/Lawrence (K/L) classification by radiographic evaluation of knee OA is generally performed, and grade increases as joint deformity severity increases [3]. There is reportedly no clear relationship between K/L classification and subjective pain [4] or between K/L classification result and thigh muscle strength or functional capacity [5, 6]. Some subjects have knee pain and dysfunction despite a low K/L classification (pre-radiographic knee OA). When considering the purpose of preventing and treating knee OA in community-dwelling elderly individuals, rather than target a K/ L grade ≥ 2 with knee OA as per the conventional definition, it is considered important to target a K/L grade of 0 or 1
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