Low-dose strength training in addition to neuromuscular exercise and education in patients with knee osteoarthritis in secondary care - a randomized controlled trial.

Summary Objectives To investigate the effects of lower limb strength training in addition to neuromuscular exercise and education (ST+NEMEX-EDU) compared to neuromuscular exercise and education alone (NEMEX-EDU) on self-reported physical function in patients with knee osteoarthritis (KOA). Design Patient-blinded, parallel-group randomized controlled trial (RCT) Methods The trial included 90 patients in secondary care with radiographic and symptomatic KOA, ineligible for knee replacement. Both groups exercised twice weekly for 12 weeks. Additional strength training consisted of a single, fatiguing knee extension set (30-60RM) before four sets of leg-press (8-12RM). Primary outcome was the between-group difference on the subscale activities of daily living from the Knee Injury and Osteoarthritis Outcome Score (KOOSADL) at 12weeks. Secondary outcomes included KOOS symptoms, pain, function during sport and recreation, and quality of life, 40m walk, stair climb, leg extension power, EuroQol-5D-5L, pain medication usage, and adverse events. Results There was no statistically significant between-group difference in KOOSADL at 12-weeks; adjusted mean difference -1.15 (-6.78 to 4.48). Except for the stair climb test, which demonstrated an adjusted mean difference of 1.15 (0.09 to 2.21) in favor of ST+NEMEX-EDU, all other outcomes showed no statistically significant between-group differences. Neither group improved leg extension power. Conclusion The addition of lower-limb strength training, using a low-dose approach, to neuromuscular exercise and education carried no additional benefits on self-reported physical function or on most secondary outcomes. Both groups displayed similar improvements at 12-week follow-up. Hence, the current low-dose strength training approach provided no additional clinical value in this group of KOA patients. Trial identifier (ClinicalTrials.gov): NCT03215602.