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Physical Therapy Interventions for Knee Pain Secondary to Osteoarthritis: A Systematic Review FREE

Shi-Yi Wang, MD, PhD; Becky Olson-Kellogg, PT, DPT, GCS; Tatyana A. Shamliyan, MD, MS; Jae-Young Choi, PhD; Rema Ramakrishnan, MPH; and Robert L. Kane, MD
[+] Article and Author Information

From the University of Minnesota School of Public Health, University of Minnesota Medical School, and Minnesota Evidence-based Practice Center, Minneapolis, Minnesota.

Grant Support: By AHRQ (under contract 290-2007-10064-I).

Potential Conflicts of Interest: Ms. Olson-Kellogg, Drs. Shamliyan and Kane, and Mr. Choi: Grant (money to institution): Agency for Healthcare Research and Quality. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2838.

Requests for Single Reprints: Tatyana A. Shamliyan, MD, MS, Division of Health Policy and Management, University of Minnesota School of Public Health, D330-5 Mayo (MMC 729), 420 Delaware Street Southeast, Minneapolis, MN 55455; e-mail, shaml005@umn.edu.

Current Author Addresses: Dr. Wang: Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, Room 432, New Haven, CT 06520.

Dr. Olson-Kellogg: Program in Physical Therapy, University of Minnesota Medical School, 398 Children's Rehab (MMC 388), 420 Delaware Street Southeast, Minneapolis, MN 55455.

Drs. Shamliyan and Kane: Division of Health Policy and Management, University of Minnesota School of Public Health, D330-5 Mayo (MMC 729), 420 Delaware Street Southeast, Minneapolis, MN 55455.

Dr. Choi: Division of Business, Hallym University, 10314 Dasan Hall, Chuncheon-si, Kangwon-do 200702, Republic of Korea.

Ms. Ramakrishnan: University of South Florida, College of Public Health, 13201 Bruce B. Downs Boulevard, MDC 56, Tampa, FL 33612-3805.

Author Contributions: Conception and design: S.Y. Wang, T.A. Shamliyan, R.L. Kane.

Analysis and interpretation of the data: S.Y. Wang, B. Olson-Kellogg, T.A. Shamliyan, R. Ramakrishnan, R.L. Kane.

Drafting of the article: S.Y. Wang, B. Olson-Kellogg, T.A. Shamliyan.

Critical revision of the article for important intellectual content: S.Y. Wang, T.A. Shamliyan, R.L. Kane.

Final approval of the article: S.Y. Wang, B. Olson-Kellogg, T.A. Shamliyan, R.L. Kane.

Statistical expertise: S.Y. Wang, T.A. Shamliyan.

Obtaining of funding: R.L. Kane.

Administrative, technical, or logistic support: T.A. Shamliyan, R.L. Kane.

Collection and assembly of data: S.Y. Wang, B. Olson-Kellogg, T.A. Shamliyan, J-Y. Choi.


Ann Intern Med. 2012;157(9):632-644. doi:10.7326/0003-4819-157-9-201211060-00007
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Background: Osteoarthritis is a leading cause of disability. Nonsurgical treatment is a key first step.

Purpose: Systematic literature review of physical therapy (PT) interventions for community-dwelling adults with knee osteoarthritis.

Data Sources: MEDLINE, the Cochrane Library, the Physiotherapy Evidence Database, Scirus, Allied and Complementary Medicine, and the Health and Psychosocial Instruments bibliography database.

Study Selection: 193 randomized, controlled trials (RCTs) published in English from 1970 to 29 February 2012.

Data Extraction: Means of outcomes, PT interventions, and risk of bias were extracted to pool standardized mean differences. Disagreements between reviewers abstracting and checking data were resolved through discussion.

Data Synthesis: Meta-analyses of 84 RCTs provided evidence for 13 PT interventions on pain (58 RCTs), physical function (36 RCTs), and disability (29 RCTs). Meta-analyses provided low-strength evidence that aerobic (11 RCTs) and aquatic (3 RCTs) exercise improved disability and that aerobic exercise (19 RCTs), strengthening exercise (17 RCTs), and ultrasonography (6 RCTs) reduced pain and improved function. Several individual RCTs demonstrated clinically important improvements in pain and disability with aerobic exercise. Other PT interventions demonstrated no sustained benefit. Individual RCTs showed similar benefits with aerobic, aquatic, and strengthening exercise. Adverse events were uncommon and did not deter participants from continuing treatment.

Limitation: Variability in PT interventions and outcomes measures hampered synthesis of evidence.

Conclusion: Low-strength evidence suggested that only a few PT interventions were effective. Future studies should compare combined PT interventions (which is how PT is generally administered for pain associated with knee osteoarthritis).

Primary Funding Source: Agency for Healthcare Research and Quality.


Osteoarthritis (OA) is a progressive joint disorder (12). Knee OA affects 28% of adults older than 45 years and 37% of adults older than 65 years in the United States (23). Osteoarthritis is a leading cause of disability among noninstitutionalized adults (2). Its prevalence and health impact are expected to increase as the population ages (4).

Osteoarthritis treatments aim to reduce or control pain, improve physical function, prevent disability, and enhance quality of life (5). Nonsurgical OA management combines pharmacologic treatments with physical therapy (PT) interventions (69). Guidelines recommend exercise as the core treatment of OA (67, 10). The marginal effects of specific exercise types (aerobic, aquatic, strength, and proprioception) have not been systematically reviewed.

This review evaluates the efficacy and comparative effectiveness of available PT interventions for adult patients with knee OA (11).

We developed the protocol for the review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (1213).

Data Sources and Searches

We searched MEDLINE, the Cochrane Library, the Physiotherapy Evidence Database, Scirus, Allied and Complementary Medicine, and the Health and Psychosocial Instruments bibliography database from 1970 to February 29 2012. We manually searched reference lists from systematic reviews and eligible studies. We used relevant Medical Subject Headings (MeSH) terms and text words, including osteoarthritis knee, physical therapy modalities, pain measurement, activities of daily living, and quality of life (Supplement 1). We searched ClinicalTrials.gov for completed trials related to the key questions. We did not contact primary investigators, but we did request additional information from sponsors of ongoing trials.

Study Selection

At least 2 investigators determined study eligibility (14). We included original publications of randomized, controlled trials (RCTs) published in English. Eligible trials enrolled community-dwelling adults with knee OA and reported pain as an inclusion criterion or outcome. Disagreements about the appropriateness of an article were resolved through discussion.

Eligible interventions were those within the scope of PT practice (regardless of whether the articles clearly described the involvement of a physical therapist or physical therapist assistant) (Appendix Table 1) (15). Eligible comparators included sham stimulation, usual care, and no active treatment for analyses of efficacy and PT interventions for the analysis of comparative effectiveness. Eligible patient-centered outcomes included knee pain, disability, quality of life, perceived health status, and global assessments of treatment effectiveness. Eligible intermediate outcomes included gait function, strength, transfers, joint function, or a composite measure of functional performance.

Table Jump PlaceholderAppendix Table 1. 

Physical Therapy Interventions Eligible for Review

We excluded studies involving children, adolescents, hospitalized patients, or patients in long-term care facilities. We also excluded studies of surgical or pharmacologic treatments for knee OA and those that examined PT delivered in rehabilitation programs for adults with knee OA who had knee arthroplasty within 6 months before the study. Because the effects of PT may differ between hip and knee OA, we synthesized the results from studies that enrolled patients with knee or hip OA only if they reported the outcomes separately.

To assess harms of treatments, we included the findings of nonrandomized clinical trials, case series, and observational cohort or case–control studies. Possible adverse events included injuries related to exercise, back or foot pain, falls, blisters related to orthotics, or skin burns related to diathermy and electrical stimulation. We defined harms as a totality of all possible adverse consequences of discontinuing an intervention or treatment because of adverse events (16). We included all evidence of adverse events with eligible interventions regardless of how authors perceived causality of treatments (16).

Data Extraction and Quality Assessment

Two researchers used standardized forms to extract data (17). One reviewer abstracted an article, and a second reviewer checked the data for accuracy. Discrepancies were documented, discussed, and resolved by consensus.

For categorical variables, we abstracted the number of participants randomly assigned to each treatment group and follow-up duration after randomization. For continuous variables, we abstracted means and SDs and the follow-up duration after randomization. For crossover trials, we abstracted the outcome levels after randomization if reported by the authors. We abstracted mean age; mean body mass index; proportions of women, minorities, and participants with disabilities; severity of knee OA; comorbid conditions; multijoint OA; baseline physical activity level; occupation; and concomitant drug and PT interventions. We abstracted settings; supervision of treatments by physical therapists; and dose, length, and intensity of the interventions when reported by the authors.

We assessed risk of bias in RCTs by using predefined criteria from the Cochrane Risk of Bias tool that included adequacy of randomization, allocation concealment, and intention-to-treat principles (14). We assigned studies as having medium risk of bias if at least 1 criterion was not met and high risk of bias if 2 or more criteria were not met. We abstracted masking information, but we did not include it in the assessment of risk of bias. We abstracted loss of follow-up and used the number of randomly assigned participants in calculating mean differences in measurement of pain, disability, and other outcomes.

We assessed strength of evidence according to guidelines from the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ) (Table 1) (18). We focused on direct evidence from head-to-head RCTs. We judged the strength of evidence for each major outcome following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria according to risk of bias, consistency, precision, and when appropriate strength of association (18). We defined treatment effect estimates as precise when pooled estimates had reasonably narrow 95% CIs and pooled sample size was greater than 400 (19). We defined strength of association by using the Cohen criteria of large effect corresponding to standardized mean differences (SMDs) greater than 0.8 (20).

Table Jump PlaceholderTable 1. 

Strength of Evidence Grades, Definitions, and Operationalization

Data Synthesis and Analysis

We focused on patient-centered outcomes, including pain, disability, and quality of life. We categorized intermediate outcomes as measurements of gait function, strength, transfers, or joint function or a composite measure of functional performance. Follow-up duration was categorized as less than 6 weeks, 6 to 13 weeks, 14 to 26 weeks, or more than 26 weeks.

We categorized eligible interventions in accordance with the definitions and hierarchy of interventions found in the Guide to Physical Therapist Practice (15) (Appendix Table 1).

Exercise interventions in eligible RCTs are described in Appendix Table 2. When we found more than 1 study from a particular trial, we used the results from the latest published paper.

Table Jump PlaceholderAppendix Table 2. 

Types of Exercise Interventions

Pooling criteria required that definitions of PT interventions and outcomes be the same. We categorized instruments according to similar domains with respect to pain, disability, quality of life, and composite function (Appendix Table 3). We used SMDs to combine effect estimates obtained from quality-of-life instruments or pain scales (14). Negative direction in absolute values of measured pain, disability, and other outcomes corresponded to improvement in the outcomes.

Table Jump PlaceholderAppendix Table 3. 

Measurement and Frequency of Outcomes in Pooled Analyses

We prioritized pooled analyses over nonpooled results and longer versus shorter follow-up. We used the Hedges methods to calculate SMDs for different continuous measures of the same outcome (21). We evaluated the consistency of findings by comparing the direction and strength of the effect (18) along with the degree of statistical heterogeneity (based on the chi-square and I2 statistics) in effects across studies (2223). We used random-effects models to pool results to account for inevitable variation in patient populations, concomitant treatments, and specific components of PT interventions (24). We used meta-regression and subgroup analyses to evaluate the effects of a priori–defined clinical and study characteristics on pain and physical function.

When heterogeneity was significant, we explored the effects of clinical diversity (age, sex, race, baseline activities of daily living, instrumental activities of daily living, comorbid conditions, inclusion of adults with previous knee arthroplasty, and obesity); exercise type, dose, and duration; specific study quality criteria; and physical therapist supervision. We investigated heterogeneity with individual quality criteria and crossover design rather than global quality scores (2426). We did not use statistical tests for publication bias (14, 2729).

We back-transformed SMDs to mean differences with several measures. For disability, we used EuroQol-5D (EQ-5D) (14), a multiattribute, preference-based health status measuring instrument (30). For quality of life, we used the 36-Item Short Form Health Survey (SF-36) (31). For pain, we used the visual analogue scale (VAS) (32). For composite function, we used the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index function score (33). For gait function, we used walking speed (32). Pooled SDs of these measures were derived from large population-based studies of noninstitutionalized adults (3033).

We multiplied the SMDs by the pooled SDs mentioned previously to yield an estimate of the difference in mean outcome scores (with vs. without intervention) on EQ-5D score (SD, 0.38), SF-36 score (SD, 10.9), VAS score (SD, 22 on a scale of 0 to 100), WOMAC physical function score (SD, 18.5), and walking speed (SD, 0.2 m/s) (3033). We categorized treatment effects by the clinical importance of differences in intermediate outcomes. We used definitions of minimum clinically important differences from published studies and evidence-based reports (Appendix Table 4) (34). To assess the clinical importance of pain reduction with interventions, we did subgroup analyses with a subset of the studies that used the same VAS instrument for pain measures. We then compared mean reduction in pain with the cutoff for minimum clinically important differences in VAS scores, as reported in observational studies (Appendix Table 4).

Table Jump PlaceholderAppendix Table 4. 

MCIDs in Scales Measuring Pain and Function in Adults With Knee Osteoarthritis

We used Stata, version 11 (StataCorp, College Station, Texas), for all analyses (35).

Role of the Funding Source

The study was funded by AHRQ. The questions were developed with stakeholder input as part of AHRQ's Effective Health Care Program. The AHRQ provided copyright release for this manuscript but had no role in the literature search, data analysis, conduct of the study, preparation of the review, or interpretation of the results. It reviewed and approved the submitted manuscript without revisions.

The 4266 retrieved reports yielded 212 eligible articles (from 193 RCTs) that contributed to the evidence synthesis (Figure 1). We excluded 2085 references at screening; 1605 because of ineligible target population, interventions, and outcomes or because they were guidelines or reviews; and 154 of the observational nontherapeutic studies that examined the association between intermediate and patient-centered outcomes. No sponsors of ongoing trials responded to our requests for scientific information packages.

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Figure 1.

Summary of evidence search and selection.

RCT = randomized, controlled trial.

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Most RCTs demonstrated adequacy of randomization (138 of 193 RCTs). Adequacy of allocation concealment was unclear in most studies (129 of 193 RCTs) (Appendix Figure 1). The most common reason for increased risk of bias was no planned intention-to-treat analyses (118 of 193 RCTs). One third of RCTs (68 of 193) reported open-label design with no masking of the outcome assessment. The mean attrition rate was 10.3% (SD, 10.6%).

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Appendix Figure 1.

Risk of bias in 193 randomized, controlled trials (RCTs) that examined physical therapy in adults with knee osteoarthritis.

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Overall, RCTs had good applicability to our target population because they primarily recruited older adults with knee OA. More than 70% of the participants were women. Most participants were overweight; body mass index of participants averaged approximately 29 kg/m2. In 100 RCTs (52%), participants were taking anti-inflammatory drugs or pain relievers. One half of the studies provided no information about exact pharmacologic treatments. Few studies specified that they excluded patients with previous knee surgery. Most studies did not report participants' occupation, knee injury, comorbid conditions, or duration of condition or the proportion of participants who had baseline disability or surgery.

Effectiveness of PT Interventions

Only 84 RCTs met pooling criteria and provided evidence for 13 PT interventions on pain (58 RCTs), physical function (36 RCTs), and disability (29 RCTs). Evidence on long-term PT effects was available for 7 intervention–outcome pairs. We found few statistically significant differences in outcomes between active and control treatments (Supplement 2). We downgraded strength of evidence because of risk of bias and low precision of the estimated treatment effects. Individual RCTs reported the same direction of the effect, but variations in statistical significance and strength of the effects contributed to statistically significant heterogeneity in some cases, which we explored according to a priori–defined characteristics of participants and treatments.

Meta-analyses provided low-strength evidence that aerobic exercise (11 RCTs) and aquatic exercise (3 RCTs) improved disability; aerobic exercise (19 RCTs), strengthening exercise (17 RCTs), and ultrasonography (6 RCTs) reduced pain and improved function; and at short- but not long-term follow-up proprioception exercise reduced pain and Tai Chi improved function. Nonpooled results from individual RCTs did not show consistent statistically significant, strong, or clinically important changes in outcomes. Despite differences in interventions and outcome measures, the results from RCTs consistently demonstrated no benefits from specific education programs, diathermy, orthotics, or magnetic stimulation.

Education Program

Two RCTs (511 participants) studied the effectiveness of education programs (3638). Low-strength evidence suggested that education programs had no statistically significant effect on pain relief (3637).

Proprioception Exercise

The effects of proprioception exercise were examined in 4 RCTs (247 participants) (3942). Proprioception exercise improved pain (SMD, −0.71 [95% CI, −1.31 to −0.11], corresponding to a back-transformed VAS score difference of −15.6 on a scale of 0 to 100 [CI, −28.8 to −2.4]), but not composite function or gait function. The improvement was clinically important. Strength of evidence was low due to a high risk of bias in included trials.

Aerobic Exercise

Aerobic exercise effects were analyzed in 11 RCTs (1553 participants) (3638, 4352). Aerobic exercise led to statistically significant improvements in long-term pain (> 26 weeks) (SMD, −0.21 [CI, −0.35 to −0.08], corresponding to a back-transformed VAS score difference of −4.6 [CI, −7.7 to −1.8]) (3637, 4649), and disability (SMD, −0.21 [CI, −0.37 to −0.04], corresponding to a back-transformed EQ-5D score difference of −0.08 [CI, −0.14 to −0.02]) (38, 4648), but not psychological disability (4345, 51) or health perception (38, 4748). Within 3 months, aerobic exercise also improved composite function (WOMAC function score difference, −15.4 [CI, −24.8 to −5.92]) (45, 49, 53) and gait function (walking speed difference, −0.11 m/s [CI, −0.15 to −0.08 m/s]) (43, 45, 51, 5356). At 12 months, the benefits of aerobic exercise continued for gait function (walking speed difference, −0.11 m/s [CI, −0.17 to −0.05 m/s]) (46, 52) but not for composite function (37, 46, 49). The pooled results showed that improvement in disability (but not in pain) was clinically important. Strength of evidence was low due to high risk of bias of the included trials. Several individual RCTs demonstrated clinically important improvements in pain and disability with aerobic exercise.

Effect estimates were statistically homogeneous. A meta-regression analysis exploring pain relief after approximately 3 months of aerobic exercise compared with placebo found no factor that could have consistently modified PT effects. Pain relief at approximately 3 months was consistent in RCTs that examined aerobic exercise supervised by a physical therapist. However, improvement in composite function at 3 months with aerobic exercise was greater in RCTs that reported no supervision of a physical therapist. Subgroup analyses with a subset of the studies that used the VAS instrument for pain measures found that the effect size of aerobic exercise at 3 months exceeded the minimum clinically importance difference; however, the result was not statistically significant.

Aquatic Exercise

Three RCTs (348 participants) studied the effectiveness of aquatic exercise (5759). Aquatic exercise reduced disability (SMD, −0.28 [CI, −0.51 to −0.05], corresponding to a back-transformed EQ-5D score difference of −0.11 [CI, −0.19 to −0.02]), but had no statistically significant effects on pain relief or quality of life (5758).

Strengthening Exercise

The effects of strengthening exercise were examined in 9 RCTs (1982 participants) (39, 46, 58, 6065). Strengthening exercise had no statistically significant effect on disability or quality of life (46, 58, 60, 62). However, we saw a persistent improvement in pain relief (SMD, −0.68 [CI, −1.23 to −0.14], corresponding to a back-transformed VAS score difference of −15.0 [CI, −27.1 to −3.1]); composite function (SMD, −1.00 [CI, −1.95 to −0.05], corresponding to a back-transformed WOMAC function score difference of −18.5 [CI, −36.1 to −0.93]); and gait function (SMD, −0.39 [CI, −0.59 to −0.20], corresponding to a back-transformed walking speed difference of −0.08 m/s [CI, −0.12 to −0.04 m/s]) at 3 to 12 months of follow-up (3940, 46, 58, 6064, 6673). The improvements in pain and composite function were clinically important. Strength of evidence was low due to medium risk of bias and significant heterogeneity.

Magnitude of the effect differed across the studies, with the I2 statistic greater than 0.64 and the chi-square P values less than 0.004. We used meta-regression to explore heterogeneity in gait function or composite function at 3 months after strengthening exercise compared with placebo, and we found no factor that could explain the heterogeneity. However, meta-regression exploring heterogeneity in pain relief approximately 3 months after strengthening exercise indicated that younger participants had significantly better outcomes (P = 0.020). In contrast with aerobic exercises, the involvement of a physical therapist in strengthening exercise did not demonstrate consistent association with outcomes. For example, in comparison with studies without PT involvement, studies with PT involvement demonstrated smaller effect size for gait function 3 months after strengthening exercise, yet the same studies showed greater effect size in long-term pain relief after strengthening exercise.

Subgroup analyses with a subset of the studies using the VAS instrument for pain measures found that strengthening exercise resulted in statistically and clinically significant long-term pain reduction (transformed mean difference, −12.8 [CI, −22.9 to −2.7], which exceeded the cutoff for minimum clinically important difference).

Tai Chi

Tai Chi effects were analyzed in 3 RCTs (167 participants) (7476). Tai Chi improved composite function measures (SMD, −0.44 [CI, −0.88 to 0], corresponding to a back-transformed WOMAC function score difference of −8.14 [CI, −16.3 to 0]), at approximately 3 months but had no statistically significant effects on pain or disability. The improvement in composite function was not clinically important. Strength of evidence was low due to medium risk of bias and imprecision.

Massage

Three RCTs (162 participants) studied the effectiveness of massage (7779). Massage improved composite function (SMD, −0.55 [CI, −0.93 to −0.18], corresponding to a back-transformed WOMAC function score difference of −10.2 [CI, −17.3 to −3.33]) (7778). The improvement was clinically important. Strength of evidence was low due to high risk of bias and imprecision.

Orthotics

The effects of orthotics were examined in 7 RCTs (364 participants) (8086). Orthotics had no effect on short-term outcomes of composite function or gait function. Three Japanese studies offered low strength of evidence that elastic subtalar strapping improved composite function at approximately 3 months (SMD, −0.27 [CI, −0.53 to −0.02], corresponding to a back-transformed WOMAC function score difference of −5.00 [CI, −9.81 to −0.37]) (8789). The improvement was not clinically important. Strength of evidence was low due to high risk of bias and imprecision.

Taping

Two RCTs (105 participants) studied the effectiveness of taping (9091). Low-strength evidence suggested that taping did not improve pain, disability, composite function, or gait function (9091). Different reporting formats precluded pooled analyses. Individual studies suggested that taping may provide short-term pain relief (9092).

Electrical Stimulation

Electrical stimulation effects were analyzed in 7 RCTs (390 participants) (69, 9398). Electrical stimulation led to statistically significant short-term improvements in pain (SMD, −0.71 [CI, −0.98 to −0.43], corresponding to a back-transformed VAS score difference of −15.6 [CI, −21.6 to −9.5]) (68, 96, 99103). However, electrical stimulation worsened pain at 6 months (SMD, 0.57 [CI, 0.09 to 1.06], corresponding to a back-transformed VAS score difference of 12.5 [CI, 2.0 to 23.3]) (Appendix Figure 2) (93, 97). Low-strength evidence showed statistically significant improvements from electrical stimulation at 3 months for global assessment (9596) and muscle strength (measured at 60-degree extension) (69, 94). Pooled analyses provided moderate-strength evidence of no improvement in disability or joint function and low-strength evidence of no improvement in composite or gait functional measures (69, 9396, 102105).

Subgroup analyses with a subset of the studies using the VAS instrument for pain measures found that electrical stimulation resulted in clinically significant short-term pain reduction (mean reduction, −17.2 [CI, −23.1 to −11.4], which exceeded the cutoff for minimum clinically important difference). At 3-month follow-up, however, electrical stimulation tended to worsen pain measured with VAS (effect size, 0.1 [CI, −6.2 to 6.3]).

Pulsed Electromagnetic Fields

The effects of pulsed electromagnetic fields were examined in 4 RCTs (267 participants) (106109). We found moderate-strength evidence that pulsed electromagnetic fields neither reduced pain nor improved composite function.

Ultrasonography

Six RCTs (387 participants) studied the effectiveness of ultrasonography (94, 110114). Low-strength evidence demonstrated that ultrasonography led to statistically and clinically significant reductions in pain (SMD, −0.74 [CI, −0.95 to −0.53], corresponding to a back-transformed VAS score difference of −16.3 [CI, −20.9 to −11.7]). Ultrasonography also resulted in statistically and clinically significant improvements in composite function (SMD, −1.14 [CI, −1.85 to −0.42], corresponding to a back-transformed WOMAC function score difference of −21.2 [CI, −29.8 to −12.8]) and gait function (SMD, −1.48 [CI, −2.08 to −0.89], corresponding to back-transformed walking speed difference of −0.30 m/s [CI, −0.42 to −0.18 m/s]) (94, 110111). Ultrasonography did not improve disability (112113). Strength of evidence was low due to medium risk of bias and an imprecise estimate of the treatment effect.

Subgroup analyses with a subset of the studies by using the VAS instrument for pain measures found that ultrasonography resulted in statistically and clinically significant short-term pain reduction (transformed mean reduction, −10.5 [CI, −18.6 to −2.4], which exceeded the cutoff for minimum clinically important difference). At 3-month follow-up, however, the effect size of −6.9 (CI, −11.7 to −2.0) no longer exceeded the minimum clinically importance difference despite being statistically significant.

Diathermy

Diathermy effects were analyzed in 5 RCTs (382 participants) (94, 115118). Diathermy led to statistically significant pain reduction at 1 month (SMD, −0.53 [CI, −0.96 to −0.10], corresponding to a back-transformed VAS score difference of −11.7 [CI, −21.1 to −2.2]) (116119), but the effect was statistically insignificant at 3 months (94, 117118). Diathermy had no effect on disability, composite function, joint function, or gait function (94, 116119). Strength of evidence was low due to medium risk of bias and an imprecise estimate of the treatment effect. Subgroup analyses with a subset of the studies using the VAS instrument for pain measures found that diathermy resulted in clinically significant short-term pain reduction (mean reduction, −18.4 [CI, −28.0 to −8.8], which exceeded the cutoff for minimum clinically important difference). At 3-month follow-up, however, the effect size of −0.7 (CI, −8.2 to 6.8]) no longer exceeded the minimum clinically important difference.

We could not do a pooled analysis to draw meaningful conclusions about the effects of joint mobilization (120122), heat (94, 123124), or cryotherapy (103, 123) because of differences in outcomes examined, reporting formats, and time to follow-up.

Comparative Effectiveness of PT Interventions

In individual RCTs, PT interventions demonstrated similar effects on patient-centered outcomes (Table 2). Aerobic and aquatic exercise had the same benefits for disability and pain relief (126, 128), a finding consistent with the similar effect sizes demonstrated by these interventions in efficacy studies. One study demonstrated that Tai Chi was better than stretching exercise for physical disability, psychological disability, global assessment, and transfer function (129).

Table Jump PlaceholderTable 2. 

Comparative Effectiveness of Physical Therapy Interventions in Adults With Knee Osteoarthritis

Role of Patient Characteristics on Outcomes

Moderate-strength evidence suggested that with exercise (aerobic and strengthening), high adherence (defined as the percentage of classes attended) was associated with better outcomes (Figure 2) (57, 130133). The higher exercise adherence subgroup had the lowest risk for incident disability in activities of daily living (130), a lower average depression score (131), a higher mean Quality of Well-Being Scale score (57), and greater improvements in 6-minute walking distance and disability (131). These results highlight the importance of exercise adherence.

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Figure 2.

Risk for disability in activities of daily living in adherence subgroups.

The attention control group is used as the reference.

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Evidence was inconclusive for the treatment-modifying effects of patient age (46, 107, 134), body mass index (46, 135), race (46), knee malalignment (72, 134), and comorbid conditions (131, 136). Evidence from 5 RCTs showed no statistically significant differences in effects between men and women (46, 81, 89, 137138). Baseline OA severity may modify the effects of PT interventions on clinical outcomes, but the effect varied depending on the treatments, outcomes, or OA severity definitions (8485, 134135, 137, 139).

Adverse Events

Adverse events were uncommon and varied across interventions (Table 3). Skin irritation was reported with braces, insoles, taping, and electrical stimulation; swelling with braces, diathermy, and exercise; muscle soreness with electrical stimulation; throbbing sensation with diathermy, electrical stimulation, and pulsed electromagnetic fields; increased pain with diathermy, exercise, insoles, and pulsed electromagnetic fields; falls with insoles; and need for surgery with diathermy. Adverse events were not severe enough to deter participants from continuing treatment.

Table Jump PlaceholderTable 3. 

Adverse Events Reported With Physical Therapy for Knee Osteoarthritis

Our comprehensive analysis of patient-centered outcomes with PT interventions has implications for clinical practice. Our findings reflect previously published guidelines (7, 10) and systematic reviews (145147) about core PT interventions. Specifically, interventions that empower patients to actively self-manage knee OA (such as aerobic, strength, and proprioception exercise) improved patient-centered outcomes. No single intervention, however, improved all outcomes. Pooled analyses provided low-strength evidence of no benefits from diathermy, orthotics, and magnetic stimulation.

Because of variability in the definitions of outcomes, we had to calculate SMDs. Statistically significant differences in SMDs do not necessarily reflect the clinical importance of improvement in outcomes. We evaluated clinical importance of improvement in outcomes on the basis of back-transformation of pooled SMDs and whether the results from individual RCTs met established criteria for clinically important changes. Aerobic, strength, and proprioception exercise demonstrated consistent effects for pain and disability. Yet, we must use caution when inferring clinically important benefits of PT interventions in clinical settings.

Our analyses further indicate a possible association between high adherence to exercise and improvement in knee pain and function. Thus, therapeutic exercise programs should focus on achieving higher adherence rather than increasing the amount or intensity of exercise.

Our review was complicated by the discrepancy between the recommended practice of PT and the design of studies that examined the interventions. Current practice guidelines recommend that PT be delivered with a combination of interventions (15). Most notably, current PT practice would not administer taping or bracing alone, but rather in combination with therapeutic exercise and possibly other interventions. Published RCTs have focused on the effects of combining several PT interventions; however, the varied components in these studies preclude meta-analyses (94, 111, 121, 148).

In addition, clinical care for adults with knee OA includes pharmacologic interventions (69, 147, 149150). Randomized trials equally distribute concomitant treatments among treatment groups and, thus, can provide valid estimates of effects of the examined PT interventions. Examined trials rarely reported other treatments that patients may have received, which impeded meta-regression analyses, nor did they analyze outcomes separately in patient subgroups by concomitant treatments.

In most cases, strength of evidence was low due to imprecision and risk of bias. Sample sizes were small; total study participants reached 400 with only a few interventions (education and aerobic and strengthening exercise). Most trials had moderate risk of bias because they frequently excluded patients from the analyses. Many trials did not sufficiently describe the nature and intensity of interventions or the involvement of physical therapists, which further impeded our ability to conduct meta-analyses (151152).

Inconsistent definitions and measurements of the outcomes hampered synthesis of evidence. Validated measurements of functional impairments relevant to PT practice are listed in the Guide to Physical Therapist Practice (15); however, the guide recommends neither clinically important thresholds for such measures nor monitoring treatment effects according to patient-centered outcomes. The Osteoarthritis Research Society International has recommended evaluating treatment success according to patient-centered outcomes and clinically important differences in the WOMAC scale (153154). However, most trials reported outcomes as average scores for all patients in each treatment group without evaluating how many patients had clinically meaningful improvement in pain, function, or quality of life.

Our review has limitations. We included only studies published in English in journals or reported in ClinicalTrials.gov. Despite a comprehensive review, we do not know how many funded but unregistered studies we may have missed. We assumed publication bias without conducting formal statistical tests for publication bias (29). We did not contact the principal investigators of the completed registered studies for unpublished data. We relied on published information about methods and treatment adherence and did not contact the authors for clarifications of poorly reported information (155156). We focused on interventions applicable to PT practice and did not analyze the benefits of weight loss in adults who were obese and had knee OA, which is associated with statistically significant reductions in self-reported disability (157).

Our report has implications for future research. First, consensus is needed about methods to judge the benefits of PT interventions (158). Benefits should be defined as rates of clinically important improvements in pain, independence in daily activities, and quality of life. Through meta-analyses of individual-patient data from previously conducted RCTs, researchers could categorize patients according to the clinical importance of any changes they experienced. Such meta-analyses may also provide good estimates of treatment effects in patient subpopulations by age, comorbid condition, severity of knee OA, and concomitant treatments. Fully powered trials should examine comprehensive and multimodal interventions that more closely resemble PT practice.

In conclusion, our analysis suggests that only a few PT interventions were effective, specifically exercise (aerobic, aquatic, strengthening, and proprioception) and ultrasonography. Limited direct evidence of comparative effectiveness demonstrated similar benefits in disability measures with aerobic, aquatic, and strengthening exercise. Pain relief was consistent with aerobic exercise supervised by physical therapists. No single PT intervention improved all outcomes, and some interventions, specifically diathermy, orthotics, and magnetic stimulation, demonstrated no benefit. Adverse events were uncommon and did not deter participants from continuing treatment. Most studies tested single interventions; evidence is sparse on the effectiveness of PT interventions delivered in combination, as is typical in practice.

Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al, National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008; 58:26-35.
PubMed
CrossRef
 
Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol. 2006; 33:2271-9.
PubMed
 
Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2007; 34:172-80.
PubMed
 
Bernstein AB, Hing E, Moss AJ, Allen KF, Siller AB, Tiggle RB.  Health Care in America: Trends in Utilization. Hyattsville, MD: National Center for Health Statistics; 2003. Accessed at www.cdc.gov/nchs/data/misc/healthcare.pdf on 10 September 2012.
 
Imboden J. CURRENT Rheumatology: Diagnosis & Treatment. 2nd ed. New York: McGraw-Hill; 2007.
 
National Collaborating Centre for Chronic Conditions.  Osteoarthritis: National Clinical Guideline for Care and Management in Adults. London, UK: Royal Coll Physicians; 2008. Accessed at www.nice.org.uk/nicemedia/pdf/CG059FullGuideline.pdf on 10 September 2012.
 
American Academy of Orthopaedic Surgeons.  Treatment of Osteoarthritis of the Knee (Non-arthroplasty). Rosemont, IL: American Acad Orthopaedic Surgeons; 2008. Accessed at www.aaos.org/research/guidelines/oakguideline.pdf on 10 September 2012.
 
Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008; 16:137-62.
PubMed
 
Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al, Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003; 62:1145-55.
PubMed
CrossRef
 
Richmond J, Hunter D, Irrgang J, Jones MH, Snyder-Mackler L, Van Durme D, et al, American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am. 2010; 92:990-3.
PubMed
CrossRef
 
Shamliyan T, Wang SY, Olson-Kellogg B, Kane R. Physical Therapy for Knee Pain Secondary to Osteoarthritis. Comparative Effectiveness Review no. 12-EHC115-EF (Prepared by the University of Minnesota Evidence-based Practice Center under contract 290-2007-10064 I.). Rockville, MD: Agency for Healthcare Research and Quality; 2012.
 
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009; 151:W65-94.
PubMed
 
Agency for Healthcare Research and Quality.  Evidence-based Practice Center Systematic Review Protocol. Comparative Effectiveness of Physical Therapy for Knee Pain Secondary to Osteoarthritis. Rockville, MD: Agency for Healthcare Research and Quality; 2011. Accessed at www.effectivehealthcare.ahrq.gov/ehc/products/241/637/Knee%20Pain%20Protocol.pdf on 31 May 2012.
 
Higgins JPT, Green S. The Cochrane Handbook for Systematic Reviews of Interventions, version 4.2.5. Chichester, UK: J Wiley; 2005.
 
American Physical Therapy Association. Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation. In: American Physical Therapy Association. Guide to Physical Therapist Practice. Second Edition. Phys Ther. 2001; 81:9-746.
PubMed
 
Chou R, Aronson N, Atkins D, Ismaila AS, Santaguida P, Smith DH, et al. AHRQ series paper 4: assessing harms when comparing medical interventions: AHRQ and the effective health-care program. J Clin Epidemiol. 2010; 63:502-12.
PubMed
CrossRef
 
Shamliyan TA, Wang S-Y, Olson-Kellogg B, Kane RL.  Comparative Effectiveness of Physical Therapy for Knee Pain Secondary to Osteoarthritis. Data Abstraction Forms. 2012. Accessed at https://netfiles.umn.edu/xythoswfs/webui/_xy-20731563_1-t_wzpHYqhT on 10 September 2012.
 
Owens DK, Lohr KN, Atkins D, Treadwell JR, Reston JT, Bass EB, et al. AHRQ series paper 5: grading the strength of a body of evidence when comparing medical interventions—Agency for Healthcare Research and Quality and the Effective Health-Care Program. J Clin Epidemiol. 2010; 63:513-23.
PubMed
CrossRef
 
Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence—imprecision. J Clin Epidemiol. 2011; 64:1283-93.
PubMed
 
Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. London, UK: Routledge Academic; 1988.
 
Borenstein DM, Hedges LV, Higgins DJPT, Rothstein HR. Introduction to Meta-Analysis. Statistics in Practice. Chichester, UK: J Wiley; 2009.
 
Viechtbauer W. Confidence intervals for the amount of heterogeneity in meta-analysis. Stat Med. 2007; 26:37-52.
PubMed
CrossRef
 
Knapp G, Biggerstaff BJ, Hartung J. Assessing the amount of heterogeneity in random-effects meta-analysis. Biom J. 2006; 48:271-85.
PubMed
CrossRef
 
Fu R, Gartlehner G, Grant M, Shamliyan T, Sedrakyan A, Wilt TJ, et al. Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program. J Clin Epidemiol. 2011; 64:1187-97.
PubMed
CrossRef
 
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327:557-60.
PubMed
CrossRef
 
Herbison P, Hay-Smith J, Gillespie WJ. Adjustment of meta-analyses on the basis of quality scores should be abandoned. J Clin Epidemiol. 2006; 59:1249-56.
PubMed
CrossRef
 
Dickersin K, Min YI.  NIH clinical trials and publication bias. Online J Curr Clin Trials. 1993;Doc No 50. [PMID: 8306005]
 
Thornton A, Lee P. Publication bias in meta-analysis: its causes and consequences. J Clin Epidemiol. 2000; 53:207-16.
PubMed
CrossRef
 
Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011; 343:d4002.
PubMed
CrossRef
 
Shaw JW, Johnson JA, Coons SJ. US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care. 2005; 43:203-20.
PubMed
CrossRef
 
Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995; 33:AS264-79.
PubMed
CrossRef
 
White DK, Keysor JJ, Lavalley MP, Lewis CE, Torner JC, Nevitt MC, et al. Clinically important improvement in function is common in people with or at high risk of knee OA: the MOST study. J Rheumatol. 2010; 37:1244-51.
PubMed
CrossRef
 
Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB, Kinemax Outcomes Group. Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am. 2001; 83-A:1856-64.
PubMed
 
Chou R, Helfand M, Peterson K, Dana T, Roberts C.  Comparative Effectiveness and Safety of Analgesics for Osteoarthritis. Comparative Effectiveness Review no. 4. AHRQ Publication no. 06-EHC009-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2006. Accessed at http://effectivehealthcare.ahrq.gov/ehc/assets/File/AnalgesicsFinal.pdf on 10 September 2012.
 
Egger M, Smith GD, Altman D. Systematic Reviews in Health Care: Meta-Analysis in Context. 2nd ed. London, UK: BMJ Books; 2001.
 
Farr JN, Going SB, McKnight PE, Kasle S, Cussler EC, Cornett M. Progressive resistance training improves overall physical activity levels in patients with early osteoarthritis of the knee: a randomized controlled trial. Phys Ther. 2010; 90:356-66.
PubMed
CrossRef
 
Messier SP, Loeser RF, Miller GD, Morgan TM, Rejeski WJ, Sevick MA, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum. 2004; 50:1501-10.
PubMed
CrossRef
 
Rejeski WJ, Focht BC, Messier SP, Morgan T, Pahor M, Penninx B. Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life. Health Psychol. 2002; 21:419-26.
PubMed
CrossRef
 
Weng MC, Lee CL, Chen CH, Hsu JJ, Lee WD, Huang MH, et al. Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis. Kaohsiung J Med Sci. 2009; 25:306-15.
PubMed
CrossRef
 
Lin DH, Lin CH, Lin YF, Jan MH. Efficacy of 2 non-weight-bearing interventions, proprioception training versus strength training, for patients with knee osteoarthritis: a randomized clinical trial. J Orthop Sports Phys Ther. 2009; 39:450-7.
PubMed
 
Tsauo JY, Cheng PF, Yang RS. The effects of sensorimotor training on knee proprioception and function for patients with knee osteoarthritis: a preliminary report. Clin Rehabil. 2008; 22:448-57.
PubMed
CrossRef
 
Jan MH, Tang PF, Lin JJ, Tseng SC, Lin YF, Lin DH. Efficacy of a target-matching foot-stepping exercise on proprioception and function in patients with knee osteoarthritis. J Orthop Sports Phys Ther. 2008; 38:19-25.
PubMed
 
Péloquin L, Bravo G, Gauthier P, Lacombe G, Billiard JS. Effects of a cross-training exercise program in persons with osteoarthritis of the knee. A randomized controlled trial. J Clin Rheumatol. 1999; 5:126-136.
PubMed
CrossRef
 
Keefe FJ, Blumenthal J, Baucom D, Affleck G, Waugh R, Caldwell DS, et al. Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study. Pain. 2004; 110:539-49.
PubMed
 
An B, Dai K, Zhu Z, Wang Y, Hao Y, Tang T, et al. Baduanjin alleviates the symptoms of knee osteoarthritis. J Altern Complement Med. 2008; 14:167-74.
PubMed
CrossRef
 
Ettinger WH Jr, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA. 1997; 277:25-31.
PubMed
CrossRef
 
Yip YB, Sit JW, Wong DY, Chong SY, Chung LH. A 1-year follow-up of an experimental study of a self-management arthritis programme with an added exercise component of clients with osteoarthritis of the knee. Psychol Health Med. 2008; 13:402-14.
PubMed
 
Sullivan T, Allegrante JP, Peterson MG, Kovar PA, MacKenzie CR. One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education. Arthritis Care Res. 1998; 11:228-33.
PubMed
CrossRef
 
Hay EM, Foster NE, Thomas E, Peat G, Phelan M, Yates HE, et al. Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trial. BMJ. 2006; 333:995.
PubMed
CrossRef
 
Thorstensson CA, Roos EM, Petersson IF, Ekdahl C. Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858]. BMC Musculoskelet Disord. 2005; 6:27.
PubMed
CrossRef
 
Aglamis B, Toraman NF, Yaman H. The effect of a 12-week supervised multicomponent exercise program on knee OA in Turkish women. J Back Musculoskelet Rehabil. 2008; 21:121-8.
 
Focht BC, Rejeski WJ, Ambrosius WT, Katula JA, Messier SP. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2005; 53:659-65.
PubMed
CrossRef
 
Jan MH, Lin CH, Lin YF, Lin JJ, Lin DH. Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. Arch Phys Med Rehabil. 2009; 90:897-904.
PubMed
CrossRef
 
Peterson MG, Kovar-Toledano PA, Otis JC, Allegrante JP, Mackenzie CR, Gutin B, et al. Effect of a walking program on gait characteristics in patients with osteoarthritis. Arthritis Care Res. 1993; 6:11-6.
PubMed
 
Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 2000; 132:173-81.
PubMed
 
Messier SP, Thompson CD, Ettinger WH. Effects of long-term aerobic or weight training regimes on gait in an older, osteoarthritic population. J Appl Biomech. 1997; 13:205-25.
 
Patrick DL, Ramsey SD, Spencer AC, Kinne S, Belza B, Topolski TD. Economic evaluation of aquatic exercise for persons with osteoarthritis. Med Care. 2001; 39:413-24.
PubMed
CrossRef
 
Lund H, Weile U, Christensen R, Rostock B, Downey A, Bartels EM, et al. A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis. J Rehabil Med. 2008; 40:137-44.
PubMed
 
Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, et al. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum. 2006; 55:700-8.
PubMed
CrossRef
 
Kuptniratsaikul V, Tosayanonda O, Nilganuwong S, Thamalikitkul V. The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis. J Med Assoc Thai. 2002; 85:33-40.
PubMed
 
Baker KR, Nelson ME, Felson DT, Layne JE, Sarno R, Roubenoff R. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. J Rheumatol. 2001; 28:1655-65.
PubMed
 
Doi T, Akai M, Fujino K, Iwaya T, Kurosawa H, Hayashi K, et al. Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial. Am J Phys Med Rehabil. 2008; 87:258-69.
PubMed
CrossRef
 
Topp R, Woolley S, Hornyak J 3rd, Khuder S, Kahaleh B. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. Arch Phys Med Rehabil. 2002; 83:1187-95.
PubMed
CrossRef
 
Börjesson M, Robertson E, Weidenhielm L, Mattsson E, Olsson E. Physiotherapy in knee osteoarthrosis: effect on pain and walking. Physiother Res Int. 1996; 1:89-97.
PubMed
CrossRef
 
Thomas KS, Muir KR, Doherty M, Jones AC, O'Reilly SC, Bassey EJ. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ. 2002; 325:752.
PubMed
CrossRef
 
Schilke JM, Johnson GO, Housh TJ, O'Dell JR. Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Nurs Res. 1996; 45:68-72.
PubMed
CrossRef
 
Gür H, Cakin N, Akova B, Okay E, Küçükoğlu S. Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee. Arch Phys Med Rehabil. 2002; 83:308-16.
PubMed
 
Cheing GL, Hui-Chan CW, Chan KM. Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain? Clin Rehabil. 2002; 16:749-60.
PubMed
CrossRef
 
Cheing GL, Hui-Chan CW. Would the addition of TENS to exercise training produce better physical performance outcomes in people with knee osteoarthritis than either intervention alone? Clin Rehabil. 2004; 18:487-97.
PubMed
CrossRef
 
Jan MH, Lin JJ, Liau JJ, Lin YF, Lin DH. Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial. Phys Ther. 2008; 88:427-36.
PubMed
CrossRef
 
Lim BW, Hinman RS, Wrigley TV, Sharma L, Bennell KL. Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis Rheum. 2008; 59:943-51.
PubMed
 
Bennell KL, Hunt MA, Wrigley TV, Hunter DJ, McManus FJ, Hodges PW, et al. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthritis Cartilage. 2010; 18:621-8.
PubMed
CrossRef
 
Swank AM, Kachelman JB, Bibeau W, Quesada PM, Nyland J, Malkani A, et al. Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis. J Strength Cond Res. 2011; 25:318-25.
PubMed
CrossRef
 
Lee HJ, Park HJ, Chae Y, Kim SY, Kim SN, Kim ST, et al. Tai Chi Qigong for the quality of life of patients with knee osteoarthritis: a pilot, randomized, waiting list controlled trial. Clin Rehabil. 2009; 23:504-11.
PubMed
CrossRef
 
Brismée JM, Paige RL, Chyu MC, Boatright JD, Hagar JM, McCaleb JA, et al. Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2007; 21:99-111.
PubMed
CrossRef
 
Song R, Roberts BL, Lee EO, Lam P, Bae SC. A randomized study of the effects of t'ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis. J Altern Complement Med. 2010; 16:227-33.
PubMed
CrossRef
 
Yip YB, Tam AC. An experimental study on the effectiveness of massage with aromatic ginger and orange essential oil for moderate-to-severe knee pain among the elderly in Hong Kong. Complement Ther Med. 2008; 16:131-8.
PubMed
CrossRef
 
Ko T, Lee S, Lee D. Manual therapy and exercise for OA knee: effects on muscle strength, proprioception, and functional performance. Journal of Physical Therapy Science. 2009; 21:293-9.
CrossRef
 
Perlman AI, Sabina A, Williams AL, Njike VY, Katz DL. Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Arch Intern Med. 2006; 166:2533-8.
PubMed
CrossRef
 
Toda Y, Tsukimura N, Segal N. An optimal duration of daily wear for an insole with subtalar strapping in patients with varus deformity osteoarthritis of the knee. Osteoarthritis Cartilage. 2005; 13:353-60.
PubMed
CrossRef
 
Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N. A treatment applying a biomechanical device to the feet of patients with knee osteoarthritis results in reduced pain and improved function: a prospective controlled study. BMC Musculoskelet Disord. 2010; 11:179.
PubMed
CrossRef
 
Hinman RS, Bowles KA, Bennell KL. Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear? BMC Musculoskelet Disord. 2009; 10:146.
PubMed
CrossRef
 
Maly MR, Culham EG, Costigan PA. Static and dynamic biomechanics of foot orthoses in people with medial compartment knee osteoarthritis. Clin Biomech (Bristol, Avon). 2002; 17:603-10.
PubMed
CrossRef
 
Kerrigan DC, Lelas JL, Goggins J, Merriman GJ, Kaplan RJ, Felson DT. Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis. Arch Phys Med Rehabil. 2002; 83:889-93.
PubMed
CrossRef
 
Kuroyanagi Y, Nagura T, Matsumoto H, Otani T, Suda Y, Nakamura T, et al. The lateral wedged insole with subtalar strapping significantly reduces dynamic knee load in the medial compartment gait analysis on patients with medial knee osteoarthritis. Osteoarthritis Cartilage. 2007; 15:932-6.
PubMed
CrossRef
 
Nigg BM, Emery C, Hiemstra LA. Unstable shoe construction and reduction of pain in osteoarthritis patients. Med Sci Sports Exerc. 2006; 38:1701-8.
PubMed
 
Toda Y, Segal N, Kato A, Yamamoto S, Irie M. Effect of a novel insole on the subtalar joint of patients with medial compartment osteoarthritis of the knee. J Rheumatol. 2001; 28:2705-10.
PubMed
 
Toda Y, Tsukimura N. A six-month followup of a randomized trial comparing the efficacy of a lateral-wedge insole with subtalar strapping and an in-shoe lateral-wedge insole in patients with varus deformity osteoarthritis of the knee. Arthritis Rheum. 2004; 50:3129-36.
PubMed
CrossRef
 
Toda Y, Tsukimura N. Influence of concomitant heeled footwear when wearing a lateral wedged insole for medial compartment osteoarthritis of the knee. Osteoarthritis Cartilage. 2008; 16:244-53.
PubMed
 
Hinman RS, Crossley KM, McConnell J, Bennell KL. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial. BMJ. 2003; 327:135.
PubMed
CrossRef
 
Hinman RS, Bennell KL, Crossley KM, McConnell J. Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis. Rheumatology (Oxford). 2003; 42:865-9.
PubMed
CrossRef
 
Cushnaghan J, McCarthy C, Dieppe P. Taping the patella medially: a new treatment for osteoarthritis of the knee joint? BMJ. 1994; 308:753-5.
PubMed
CrossRef
 
Talbot LA, Gaines JM, Ling SM, Metter EJ. A home-based protocol of electrical muscle stimulation for quadriceps muscle strength in older adults with osteoarthritis of the knee. J Rheumatol. 2003; 30:1571-8.
PubMed
 
Cetin N, Aytar A, Atalay A, Akman MN. Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial. Am J Phys Med Rehabil. 2008; 87:443-51.
PubMed
CrossRef
 
Garland D, Holt P, Harrington JT, Caldwell J, Zizic T, Cholewczynski J. A 3-month, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of a highly optimized, capacitively coupled, pulsed electrical stimulator in patients with osteoarthritis of the knee. Osteoarthritis Cartilage. 2007; 15:630-7.
PubMed
CrossRef
 
Selfe TK, Bourguignon C, Taylor AG. Effects of noninvasive interactive neurostimulation on symptoms of osteoarthritis of the knee: a randomized, sham-controlled pilot study. J Altern Complement Med. 2008; 14:1075-81.
PubMed
CrossRef
 
Gaines JM, Metter EJ, Talbot LA. The effect of neuromuscular electrical stimulation on arthritis knee pain in older adults with osteoarthritis of the knee. Appl Nurs Res. 2004; 17:201-6.
PubMed
CrossRef
 
Kang RW, Lewis PB, Kramer A, Hayden JK, Cole BJ. Prospective randomized single-blinded controlled clinical trial of percutaneous neuromodulation pain therapy device versus sham for the osteoarthritic knee: a pilot study. Orthopedics. 2007; 30:439-45.
PubMed
 
Law PP, Cheing GL. Optimal stimulation frequency of transcutaneous electrical nerve stimulation on people with knee osteoarthritis. J Rehabil Med. 2004; 36:220-5.
PubMed
CrossRef
 
Taylor P, Hallett M, Flaherty L. Treatment of osteoarthritis of the knee with transcutaneous electrical nerve stimulation. Pain. 1981; 11:233-40.
PubMed
CrossRef
 
Itoh K, Hirota S, Katsumi Y, Ochi H, Kitakoji H. A pilot study on using acupuncture and transcutaneous electrical nerve stimulation (TENS) to treat knee osteoarthritis (OA). Chin Med. 2008; 3:2.
PubMed
CrossRef
 
Grimmer K. A controlled double-blind study comparing the effects of strong burst method TENS and high rate TENS on painful osteoarthritic knees. Aust J Physiother. 1992; 38:49-56.
 
Pietrosimone BG, Hart JM, Saliba SA, Hertel J, Ingersoll CD. Immediate effects of transcutaneous electrical nerve stimulation and focal knee joint cooling on quadriceps activation. Med Sci Sports Exerc. 2009; 41:1175-81.
PubMed
 
Yurtkuran M, Kocagil T. TENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee. Am J Acupunct. 1999; 27:133-40.
PubMed
 
Law PP, Cheing GL, Tsui AY. Does transcutaneous electrical nerve stimulation improve the physical performance of people with knee osteoarthritis? J Clin Rheumatol. 2004; 10:295-9.
PubMed
CrossRef
 
Ay S, Evcik D. The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: a randomized, placebo-controlled trial. Rheumatol Int. 2009; 29:663-6.
PubMed
CrossRef
 
Thamsborg G, Florescu A, Oturai P, Fallentin E, Tritsaris K, Dissing S. Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study. Osteoarthritis Cartilage. 2005; 13:575-81.
PubMed
CrossRef
 
Trock DH, Bollet AJ, Markoll R. The effect of pulsed electromagnetic fields in the treatment of osteoarthritis of the knee and cervical spine. Report of randomized, double blind, placebo controlled trials. J Rheumatol. 1994; 21:1903-11.
PubMed
 
Nicolakis P, Kollmitzer J, Crevenna R, Bittner C, Erdogmus CB, Nicolakis J. Pulsed magnetic field therapy for osteoarthritis of the knee—a double-blind sham-controlled trial. Wien Klin Wochenschr. 2002; 114:678-84.
PubMed
 
Huang MH, Lin YS, Lee CL, Yang RC. Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis. Arch Phys Med Rehabil. 2005; 86:1545-51.
PubMed
 
Huang MH, Yang RC, Lee CL, Chen TW, Wang MC. Preliminary results of integrated therapy for patients with knee osteoarthritis. Arthritis Rheum. 2005; 53:812-20.
PubMed
CrossRef
 
Ozgönenel L, Aytekin E, Durmuşoglu G. A double-blind trial of clinical effects of therapeutic ultrasound in knee osteoarthritis. Ultrasound Med Biol. 2009; 35:44-9.
PubMed
CrossRef
 
Tascioglu F, Kuzgun S, Armagan O, Ogutler G. Short-term effectiveness of ultrasound therapy in knee osteoarthritis. J Int Med Res. 2010; 38:1233-42.
PubMed
 
Sayers SP, Gibson K, Cook CR. Effect of high-speed power training on muscle performance, function, and pain in older adults with knee osteoarthritis: a pilot investigation. Arthritis Care Res (Hoboken). 2012; 64:46-53.
PubMed
CrossRef
 
Rattanachaiyanont M, Kuptniratsaikul V. No additional benefit of shortwave diathermy over exercise program for knee osteoarthritis in peri-/post-menopausal women: an equivalence trial. Osteoarthritis Cartilage. 2008; 16:823-8.
PubMed
CrossRef
 
Fukuda TY, Alves da Cunha R, Fukuda VO, Rienzo FA, Cazarini C Jr, Carvalho Nde A, et al. Pulsed shortwave treatment in women with knee osteoarthritis: a multicenter, randomized, placebo-controlled clinical trial. Phys Ther. 2011; 91:1009-17.
PubMed
CrossRef
 
Laufer Y, Zilberman R, Porat R, Nahir AM. Effect of pulsed short-wave diathermy on pain and function of subjects with osteoarthritis of the knee: a placebo-controlled double-blind clinical trial. Clin Rehabil. 2005; 19:255-63.
PubMed
CrossRef
 
Akyol Y, Durmus D, Alayli G, Tander B, Bek Y, Canturk F, et al. Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. Eur J Phys Rehabil Med. 2010; 46:325-36.
PubMed
 
Callaghan MJ, Whittaker PE, Grimes S, Smith L. An evaluation of pulsed shortwave on knee osteoarthritis using radioleucoscintigraphy: a randomised, double blind, controlled trial. Joint Bone Spine. 2005; 72:150-5.
PubMed
CrossRef
 
Pollard H, Ward G, Hoskins W, Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. J Can Chiropr Assoc. 2008; 52:229-42.
PubMed
 
Deyle GD, Allison SC, Matekel RL, Ryder MG, Stang JM, Gohdes DD, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005; 85:1301-17.
PubMed
 
Moss P, Sluka K, Wright A. The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Man Ther. 2007; 12:109-18.
PubMed
CrossRef
 
Denegar CR, Dougherty DR, Friedman JE, Schimizzi ME, Clark JE, Comstock BA, et al. Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response. Clin Interv Aging. 2010; 5:199-206.
PubMed
 
Mazzuca SA, Page MC, Meldrum RD, Brandt KD, Petty-Saphon S. Pilot study of the effects of a heat-retaining knee sleeve on joint pain, stiffness, and function in patients with knee osteoarthritis. Arthritis Rheum. 2004; 51:716-21.
PubMed
 
Durmuş D, Alayli G, Cantürk F. Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis. Clin Rheumatol. 2007; 26:674-8.
PubMed
CrossRef
 
Wyatt FB, Milam S, Manske RC, Deere R. The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. J Strength Cond Res. 2001; 15:337-40.
PubMed
 
Maillefert JF, Hudry C, Baron G, Kieffert P, Bourgeois P, Lechevalier D, et al. Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a prospective randomized controlled study. Osteoarthritis Cartilage. 2001; 9:738-45.
PubMed
CrossRef
 
Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, et al. Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Phys Ther. 2008; 88:12-21.
PubMed
CrossRef
 
Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, et al. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum. 2009; 61:1545-53.
PubMed
CrossRef
 
Penninx BW, Messier SP, Rejeski WJ, Williamson JD, DiBari M, Cavazzini C, et al. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Arch Intern Med. 2001; 161:2309-16.
PubMed
CrossRef
 
Penninx BW, Rejeski WJ, Pandya J, Miller ME, Di Bari M, Applegate WB, et al. Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Gerontol B Psychol Sci Soc Sci. 2002; 57:P124-32.
PubMed
CrossRef
 
Rejeski WJ, Brawley LR, Ettinger W, Morgan T, Thompson C. Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Med Sci Sports Exerc. 1997; 29:977-85.
PubMed
 
van Gool CH, Penninx BW, Kempen GI, Rejeski WJ, Miller GD, van Eijk JT, et al. Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis. Arthritis Rheum. 2005; 53:24-32.
PubMed
CrossRef
 
Brouwer RW, van Raaij TM, Verhaar JA, Coene LN, Bierma-Zeinstra SM. Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. Osteoarthritis Cartilage. 2006; 14:777-83.
PubMed
CrossRef
 
Baker K, Goggins J, Xie H, Szumowski K, LaValley M, Hunter DJ, et al. A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Arthritis Rheum. 2007; 56:1198-203.
PubMed
CrossRef
 
Mangani I, Cesari M, Kritchevsky SB, Maraldi C, Carter CS, Atkinson HH, et al. Physical exercise and comorbidity. Results from the Fitness and Arthritis in Seniors Trial (FAST). Aging Clin Exp Res. 2006; 18:374-80.
PubMed
 
Mikesky AE, Mazzuca SA, Brandt KD, Perkins SM, Damush T, Lane KA. Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis Rheum. 2006; 55:690-9.
PubMed
CrossRef
 
Fisher NM, Gresham G, Pendergast DR. Effects of a quantitative progressive rehabilitation program applied unilaterally to the osteoarthritic knee. Arch Phys Med Rehabil. 1993; 74:1319-26.
PubMed
 
Huang MH, Chen CH, Chen TW, Weng MC, Wang WT, Wang YL. The effects of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity. Arthritis Care Res. 2000; 13:398-405.
PubMed
CrossRef
 
Zizic TM, Hoffman KC, Holt PA, Hungerford DS, O'Dell JR, Jacobs MA, et al. The treatment of osteoarthritis of the knee with pulsed electrical stimulation. J Rheumatol. 1995; 22:1757-61.
PubMed
 
Burch FX, Tarro JN, Greenberg JJ, Carroll WJ. Evaluating the benefits of patterned stimulation in the treatment of osteoarthritis of the knee: a multi-center, randomized, single-blind, controlled study with an independent masked evaluator. Osteoarthritis Cartilage. 2008; 16:865-72.
PubMed
CrossRef
 
Petrella RJ, Bartha C. Home based exercise therapy for older patients with knee osteoarthritis: a randomized clinical trial. J Rheumatol. 2000; 27:2215-21.
PubMed
 
Toda Y, Tsukimura N, Kato A. The effects of different elevations of laterally wedged insoles with subtalar strapping on medial compartment osteoarthritis of the knee. Arch Phys Med Rehabil. 2004; 85:673-7.
PubMed
CrossRef
 
Bennell KL, Bowles KA, Payne C, Cicuttini F, Williamson E, Forbes A, et al. Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial. BMJ. 2011; 342:d2912.
PubMed
CrossRef
 
Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009; CD002823.
PubMed
 
Rutjes AW, Nüesch E, Sterchi R, Jüni P. Therapeutic ultrasound for osteoarthritis of the knee or hip. Cochrane Database Syst Rev. 2010; CD003132.
PubMed
 
Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000; 43:1905-15.
PubMed
 
Bennell KL, Hinman RS, Metcalf BR, Buchbinder R, McConnell J, McColl G, et al. Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2005; 64:906-12.
PubMed
CrossRef
 
Brand C, Buchbinder R, Wluka A, Jones K, Ruth D, McKenzie S, et al.  Guideline for the non-surgical management of hip and knee osteoarthritis. South Melbourne, Victoria, Australia: The Royal Australian Coll General Practitioners; 2009. Accessed at www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp117-hip-knee-osteoarthritis.pdf on 10 September 2012.
 
Mazières B, Bannwarth B, Dougados M, Lequesne M. EULAR recommendations for the management of knee osteoarthritis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials. Joint Bone Spine. 2001; 68:231-40.
PubMed
CrossRef
 
Bruckenthal P, Broderick JE. Assessing treatment fidelity in pilot studies assist in designing clinical trials: an illustration from a nurse practitioner community-based intervention for pain. ANS Adv Nurs Sci. 2007; 30:72-84.
PubMed
 
Doherty M, Jones A. Design of clinical trials in knee osteoarthritis: practical issues for debate [Editorial]. Osteoarthritis Cartilage. 1998; 6:371-3.
PubMed
 
Pham T, Van Der Heijde D, Lassere M, Altman RD, Anderson JJ, Bellamy N, et al, OMERACT-OARSI. Outcome variables for osteoarthritis clinical trials: The OMERACT-OARSI set of responder criteria. J Rheumatol. 2003; 30:1648-54.
PubMed
 
Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M, et al. OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartilage. 2004; 12:389-99.
PubMed
 
Viswanathan M, Ansari MT, Berkman ND, Chang S, Hartling L, McPheeters LM, et al.  Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions. In: Methods Guide for Comparative Effectiveness Reviews. AHRQ Publication no. 12-EHC047-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2012. Accessed at http://effectivehealthcare.ahrq.gov/ehc/products/322/998/MethodsGuideforCERs_Viswanathan_IndividualStudies.pdf on 10 September 2012.
 
Keller C, Fleury J, Sidani S, Ainsworth B. Fidelity to theory in PA intervention research. West J Nurs Res. 2009; 31:289-311.
PubMed
 
Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007; 66:433-9.
PubMed
 
Fitzgerald GK, Delitto A. Considerations for planning and conducting clinic-based research in physical therapy. Phys Ther. 2001; 81:1446-54.
PubMed
 
Ehrich EW, Davies GM, Watson DJ, Bolognese JA, Seidenberg BC, Bellamy N. Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities osteoarthritis index questionnaire and global assessments in patients with osteoarthritis. J Rheumatol. 2000; 27:2635-41.
PubMed
 
Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum. 2001; 45:384-91.
PubMed
CrossRef
 
Angst F, Aeschlimann A, Michel BA, Stucki G. Minimal clinically important rehabilitation effects in patients with osteoarthritis of the lower extremities. J Rheumatol. 2002; 29:131-8.
PubMed
 
Stratford PW, Kennedy DM, Woodhouse LJ, Spadoni GF. Measurement properties of the WOMAC LK 3.1 pain scale. Osteoarthritis Cartilage. 2007; 15:266-72.
PubMed
CrossRef
 
Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis. 2005; 64:29-33.
PubMed
 
Tubach F, Wells GA, Ravaud P, Dougados M. Minimal clinically important difference, low disease activity state, and patient acceptable symptom state: methodological issues. J Rheumatol. 2005; 32:2025-9.
PubMed
 
Eberle E, Ottillinger B. Clinically relevant change and clinically relevant difference in knee osteoarthritis. Osteoarthritis Cartilage. 1999; 7:502-3.
PubMed
CrossRef
 
Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004; 8:283-91.
PubMed
CrossRef
 
Redelmeier DA, Lorig K. Assessing the clinical importance of symptomatic improvements. An illustration in rheumatology. Arch Intern Med. 1993; 153:1337-42.
PubMed
CrossRef
 
Kennedy DM, Stratford PW, Wessel J, Gollish JD, Penney D. Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord. 2005; 6:3.
PubMed
CrossRef
 
Mangione KK, Craik RL, McCormick AA, Blevins HL, White MB, Sullivan-Marx EM, et al. Detectable changes in physical performance measures in elderly African Americans. Phys Ther. 2010; 90:921-7.
PubMed
 
Khanna D, Maranian P, Palta M, Kaplan RM, Hays RD, Cherepanov D, et al. Health-related quality of life in adults reporting arthritis: analysis from the National Health Measurement Study. Qual Life Res. 2011; 20:1131-40.
PubMed
CrossRef
 
Shakoor MA, Taslim MA, Hossain MS. Effects of activity modification on the patients with osteoarthritis of the knee. Bangladesh Med Res Counc Bull. 2007; 33:55-9.
PubMed
 
Yip YB, Sit JW, Fung KK, Wong DY, Chong SY, Chung LH, et al. Impact of an Arthritis Self-Management Programme with an added exercise component for osteoarthritic knee sufferers on improving pain, functional outcomes, and use of health care services: an experimental study. Patient Educ Couns. 2007; 65:113-21.
PubMed
CrossRef
 
Kovar PA, Allegrante JP, MacKenzie CR, Peterson MG, Gutin B, Charlson ME. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 1992; 116:529-34.
PubMed
 
Bautch JC, Malone DG, Vailas AC. Effects of exercise on knee joints with osteoarthritis: a pilot study of biologic markers. Arthritis Care Res. 1997; 10:48-55.
PubMed
CrossRef
 
Talbot LA, Gaines JM, Huynh TN, Metter EJ. A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. J Am Geriatr Soc. 2003; 51:387-92.
PubMed
CrossRef
 
Pietrosimone BG, Saliba SA, Hart JM, Hertel J, Kerrigan DC, Ingersoll CD. Effects of disinhibitory transcutaneous electrical nerve stimulation and therapeutic exercise on sagittal plane peak knee kinematics and kinetics in people with knee osteoarthritis during gait: a randomized controlled trial. Clin Rehabil. 2010; 24:1091-101.
PubMed
CrossRef
 
Loyola-Sánchez A, Richardson J, Beattie KA, Otero-Fuentes C, Adachi JD, MacIntyre NJ. Effect of low-intensity pulsed ultrasound on the cartilage repair in people with mild to moderate knee osteoarthritis: a double-blinded, randomized, placebo-controlled pilot study. Arch Phys Med Rehabil. 2012; 93:35-42.
PubMed
 

Figures

Grahic Jump Location
Figure 1.

Summary of evidence search and selection.

RCT = randomized, controlled trial.

Grahic Jump Location
Grahic Jump Location
Appendix Figure 1.

Risk of bias in 193 randomized, controlled trials (RCTs) that examined physical therapy in adults with knee osteoarthritis.

Grahic Jump Location
Grahic Jump Location
Figure 2.

Risk for disability in activities of daily living in adherence subgroups.

The attention control group is used as the reference.

Grahic Jump Location

Tables

Table Jump PlaceholderAppendix Table 1. 

Physical Therapy Interventions Eligible for Review

Table Jump PlaceholderTable 1. 

Strength of Evidence Grades, Definitions, and Operationalization

Table Jump PlaceholderAppendix Table 2. 

Types of Exercise Interventions

Table Jump PlaceholderAppendix Table 3. 

Measurement and Frequency of Outcomes in Pooled Analyses

Table Jump PlaceholderAppendix Table 4. 

MCIDs in Scales Measuring Pain and Function in Adults With Knee Osteoarthritis

Table Jump PlaceholderTable 2. 

Comparative Effectiveness of Physical Therapy Interventions in Adults With Knee Osteoarthritis

Table Jump PlaceholderTable 3. 

Adverse Events Reported With Physical Therapy for Knee Osteoarthritis

References

Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al, National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008; 58:26-35.
PubMed
CrossRef
 
Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol. 2006; 33:2271-9.
PubMed
 
Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2007; 34:172-80.
PubMed
 
Bernstein AB, Hing E, Moss AJ, Allen KF, Siller AB, Tiggle RB.  Health Care in America: Trends in Utilization. Hyattsville, MD: National Center for Health Statistics; 2003. Accessed at www.cdc.gov/nchs/data/misc/healthcare.pdf on 10 September 2012.
 
Imboden J. CURRENT Rheumatology: Diagnosis & Treatment. 2nd ed. New York: McGraw-Hill; 2007.
 
National Collaborating Centre for Chronic Conditions.  Osteoarthritis: National Clinical Guideline for Care and Management in Adults. London, UK: Royal Coll Physicians; 2008. Accessed at www.nice.org.uk/nicemedia/pdf/CG059FullGuideline.pdf on 10 September 2012.
 
American Academy of Orthopaedic Surgeons.  Treatment of Osteoarthritis of the Knee (Non-arthroplasty). Rosemont, IL: American Acad Orthopaedic Surgeons; 2008. Accessed at www.aaos.org/research/guidelines/oakguideline.pdf on 10 September 2012.
 
Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008; 16:137-62.
PubMed
 
Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al, Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003; 62:1145-55.
PubMed
CrossRef
 
Richmond J, Hunter D, Irrgang J, Jones MH, Snyder-Mackler L, Van Durme D, et al, American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis (OA) of the knee. J Bone Joint Surg Am. 2010; 92:990-3.
PubMed
CrossRef
 
Shamliyan T, Wang SY, Olson-Kellogg B, Kane R. Physical Therapy for Knee Pain Secondary to Osteoarthritis. Comparative Effectiveness Review no. 12-EHC115-EF (Prepared by the University of Minnesota Evidence-based Practice Center under contract 290-2007-10064 I.). Rockville, MD: Agency for Healthcare Research and Quality; 2012.
 
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009; 151:W65-94.
PubMed
 
Agency for Healthcare Research and Quality.  Evidence-based Practice Center Systematic Review Protocol. Comparative Effectiveness of Physical Therapy for Knee Pain Secondary to Osteoarthritis. Rockville, MD: Agency for Healthcare Research and Quality; 2011. Accessed at www.effectivehealthcare.ahrq.gov/ehc/products/241/637/Knee%20Pain%20Protocol.pdf on 31 May 2012.
 
Higgins JPT, Green S. The Cochrane Handbook for Systematic Reviews of Interventions, version 4.2.5. Chichester, UK: J Wiley; 2005.
 
American Physical Therapy Association. Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation. In: American Physical Therapy Association. Guide to Physical Therapist Practice. Second Edition. Phys Ther. 2001; 81:9-746.
PubMed
 
Chou R, Aronson N, Atkins D, Ismaila AS, Santaguida P, Smith DH, et al. AHRQ series paper 4: assessing harms when comparing medical interventions: AHRQ and the effective health-care program. J Clin Epidemiol. 2010; 63:502-12.
PubMed
CrossRef
 
Shamliyan TA, Wang S-Y, Olson-Kellogg B, Kane RL.  Comparative Effectiveness of Physical Therapy for Knee Pain Secondary to Osteoarthritis. Data Abstraction Forms. 2012. Accessed at https://netfiles.umn.edu/xythoswfs/webui/_xy-20731563_1-t_wzpHYqhT on 10 September 2012.
 
Owens DK, Lohr KN, Atkins D, Treadwell JR, Reston JT, Bass EB, et al. AHRQ series paper 5: grading the strength of a body of evidence when comparing medical interventions—Agency for Healthcare Research and Quality and the Effective Health-Care Program. J Clin Epidemiol. 2010; 63:513-23.
PubMed
CrossRef
 
Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. GRADE guidelines 6. Rating the quality of evidence—imprecision. J Clin Epidemiol. 2011; 64:1283-93.
PubMed
 
Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. London, UK: Routledge Academic; 1988.
 
Borenstein DM, Hedges LV, Higgins DJPT, Rothstein HR. Introduction to Meta-Analysis. Statistics in Practice. Chichester, UK: J Wiley; 2009.
 
Viechtbauer W. Confidence intervals for the amount of heterogeneity in meta-analysis. Stat Med. 2007; 26:37-52.
PubMed
CrossRef
 
Knapp G, Biggerstaff BJ, Hartung J. Assessing the amount of heterogeneity in random-effects meta-analysis. Biom J. 2006; 48:271-85.
PubMed
CrossRef
 
Fu R, Gartlehner G, Grant M, Shamliyan T, Sedrakyan A, Wilt TJ, et al. Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program. J Clin Epidemiol. 2011; 64:1187-97.
PubMed
CrossRef
 
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327:557-60.
PubMed
CrossRef
 
Herbison P, Hay-Smith J, Gillespie WJ. Adjustment of meta-analyses on the basis of quality scores should be abandoned. J Clin Epidemiol. 2006; 59:1249-56.
PubMed
CrossRef
 
Dickersin K, Min YI.  NIH clinical trials and publication bias. Online J Curr Clin Trials. 1993;Doc No 50. [PMID: 8306005]
 
Thornton A, Lee P. Publication bias in meta-analysis: its causes and consequences. J Clin Epidemiol. 2000; 53:207-16.
PubMed
CrossRef
 
Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011; 343:d4002.
PubMed
CrossRef
 
Shaw JW, Johnson JA, Coons SJ. US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care. 2005; 43:203-20.
PubMed
CrossRef
 
Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995; 33:AS264-79.
PubMed
CrossRef
 
White DK, Keysor JJ, Lavalley MP, Lewis CE, Torner JC, Nevitt MC, et al. Clinically important improvement in function is common in people with or at high risk of knee OA: the MOST study. J Rheumatol. 2010; 37:1244-51.
PubMed
CrossRef
 
Lingard EA, Katz JN, Wright RJ, Wright EA, Sledge CB, Kinemax Outcomes Group. Validity and responsiveness of the Knee Society Clinical Rating System in comparison with the SF-36 and WOMAC. J Bone Joint Surg Am. 2001; 83-A:1856-64.
PubMed
 
Chou R, Helfand M, Peterson K, Dana T, Roberts C.  Comparative Effectiveness and Safety of Analgesics for Osteoarthritis. Comparative Effectiveness Review no. 4. AHRQ Publication no. 06-EHC009-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2006. Accessed at http://effectivehealthcare.ahrq.gov/ehc/assets/File/AnalgesicsFinal.pdf on 10 September 2012.
 
Egger M, Smith GD, Altman D. Systematic Reviews in Health Care: Meta-Analysis in Context. 2nd ed. London, UK: BMJ Books; 2001.
 
Farr JN, Going SB, McKnight PE, Kasle S, Cussler EC, Cornett M. Progressive resistance training improves overall physical activity levels in patients with early osteoarthritis of the knee: a randomized controlled trial. Phys Ther. 2010; 90:356-66.
PubMed
CrossRef
 
Messier SP, Loeser RF, Miller GD, Morgan TM, Rejeski WJ, Sevick MA, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum. 2004; 50:1501-10.
PubMed
CrossRef
 
Rejeski WJ, Focht BC, Messier SP, Morgan T, Pahor M, Penninx B. Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life. Health Psychol. 2002; 21:419-26.
PubMed
CrossRef
 
Weng MC, Lee CL, Chen CH, Hsu JJ, Lee WD, Huang MH, et al. Effects of different stretching techniques on the outcomes of isokinetic exercise in patients with knee osteoarthritis. Kaohsiung J Med Sci. 2009; 25:306-15.
PubMed
CrossRef
 
Lin DH, Lin CH, Lin YF, Jan MH. Efficacy of 2 non-weight-bearing interventions, proprioception training versus strength training, for patients with knee osteoarthritis: a randomized clinical trial. J Orthop Sports Phys Ther. 2009; 39:450-7.
PubMed
 
Tsauo JY, Cheng PF, Yang RS. The effects of sensorimotor training on knee proprioception and function for patients with knee osteoarthritis: a preliminary report. Clin Rehabil. 2008; 22:448-57.
PubMed
CrossRef
 
Jan MH, Tang PF, Lin JJ, Tseng SC, Lin YF, Lin DH. Efficacy of a target-matching foot-stepping exercise on proprioception and function in patients with knee osteoarthritis. J Orthop Sports Phys Ther. 2008; 38:19-25.
PubMed
 
Péloquin L, Bravo G, Gauthier P, Lacombe G, Billiard JS. Effects of a cross-training exercise program in persons with osteoarthritis of the knee. A randomized controlled trial. J Clin Rheumatol. 1999; 5:126-136.
PubMed
CrossRef
 
Keefe FJ, Blumenthal J, Baucom D, Affleck G, Waugh R, Caldwell DS, et al. Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study. Pain. 2004; 110:539-49.
PubMed
 
An B, Dai K, Zhu Z, Wang Y, Hao Y, Tang T, et al. Baduanjin alleviates the symptoms of knee osteoarthritis. J Altern Complement Med. 2008; 14:167-74.
PubMed
CrossRef
 
Ettinger WH Jr, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA. 1997; 277:25-31.
PubMed
CrossRef
 
Yip YB, Sit JW, Wong DY, Chong SY, Chung LH. A 1-year follow-up of an experimental study of a self-management arthritis programme with an added exercise component of clients with osteoarthritis of the knee. Psychol Health Med. 2008; 13:402-14.
PubMed
 
Sullivan T, Allegrante JP, Peterson MG, Kovar PA, MacKenzie CR. One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education. Arthritis Care Res. 1998; 11:228-33.
PubMed
CrossRef
 
Hay EM, Foster NE, Thomas E, Peat G, Phelan M, Yates HE, et al. Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trial. BMJ. 2006; 333:995.
PubMed
CrossRef
 
Thorstensson CA, Roos EM, Petersson IF, Ekdahl C. Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858]. BMC Musculoskelet Disord. 2005; 6:27.
PubMed
CrossRef
 
Aglamis B, Toraman NF, Yaman H. The effect of a 12-week supervised multicomponent exercise program on knee OA in Turkish women. J Back Musculoskelet Rehabil. 2008; 21:121-8.
 
Focht BC, Rejeski WJ, Ambrosius WT, Katula JA, Messier SP. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2005; 53:659-65.
PubMed
CrossRef
 
Jan MH, Lin CH, Lin YF, Lin JJ, Lin DH. Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. Arch Phys Med Rehabil. 2009; 90:897-904.
PubMed
CrossRef
 
Peterson MG, Kovar-Toledano PA, Otis JC, Allegrante JP, Mackenzie CR, Gutin B, et al. Effect of a walking program on gait characteristics in patients with osteoarthritis. Arthritis Care Res. 1993; 6:11-6.
PubMed
 
Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 2000; 132:173-81.
PubMed
 
Messier SP, Thompson CD, Ettinger WH. Effects of long-term aerobic or weight training regimes on gait in an older, osteoarthritic population. J Appl Biomech. 1997; 13:205-25.
 
Patrick DL, Ramsey SD, Spencer AC, Kinne S, Belza B, Topolski TD. Economic evaluation of aquatic exercise for persons with osteoarthritis. Med Care. 2001; 39:413-24.
PubMed
CrossRef
 
Lund H, Weile U, Christensen R, Rostock B, Downey A, Bartels EM, et al. A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis. J Rehabil Med. 2008; 40:137-44.
PubMed
 
Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, et al. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum. 2006; 55:700-8.
PubMed
CrossRef
 
Kuptniratsaikul V, Tosayanonda O, Nilganuwong S, Thamalikitkul V. The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis. J Med Assoc Thai. 2002; 85:33-40.
PubMed
 
Baker KR, Nelson ME, Felson DT, Layne JE, Sarno R, Roubenoff R. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. J Rheumatol. 2001; 28:1655-65.
PubMed
 
Doi T, Akai M, Fujino K, Iwaya T, Kurosawa H, Hayashi K, et al. Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial. Am J Phys Med Rehabil. 2008; 87:258-69.
PubMed
CrossRef
 
Topp R, Woolley S, Hornyak J 3rd, Khuder S, Kahaleh B. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. Arch Phys Med Rehabil. 2002; 83:1187-95.
PubMed
CrossRef
 
Börjesson M, Robertson E, Weidenhielm L, Mattsson E, Olsson E. Physiotherapy in knee osteoarthrosis: effect on pain and walking. Physiother Res Int. 1996; 1:89-97.
PubMed
CrossRef
 
Thomas KS, Muir KR, Doherty M, Jones AC, O'Reilly SC, Bassey EJ. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ. 2002; 325:752.
PubMed
CrossRef
 
Schilke JM, Johnson GO, Housh TJ, O'Dell JR. Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Nurs Res. 1996; 45:68-72.
PubMed
CrossRef
 
Gür H, Cakin N, Akova B, Okay E, Küçükoğlu S. Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee. Arch Phys Med Rehabil. 2002; 83:308-16.
PubMed
 
Cheing GL, Hui-Chan CW, Chan KM. Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain? Clin Rehabil. 2002; 16:749-60.
PubMed
CrossRef
 
Cheing GL, Hui-Chan CW. Would the addition of TENS to exercise training produce better physical performance outcomes in people with knee osteoarthritis than either intervention alone? Clin Rehabil. 2004; 18:487-97.
PubMed
CrossRef
 
Jan MH, Lin JJ, Liau JJ, Lin YF, Lin DH. Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial. Phys Ther. 2008; 88:427-36.
PubMed
CrossRef
 
Lim BW, Hinman RS, Wrigley TV, Sharma L, Bennell KL. Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial. Arthritis Rheum. 2008; 59:943-51.
PubMed
 
Bennell KL, Hunt MA, Wrigley TV, Hunter DJ, McManus FJ, Hodges PW, et al. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthritis Cartilage. 2010; 18:621-8.
PubMed
CrossRef
 
Swank AM, Kachelman JB, Bibeau W, Quesada PM, Nyland J, Malkani A, et al. Prehabilitation before total knee arthroplasty increases strength and function in older adults with severe osteoarthritis. J Strength Cond Res. 2011; 25:318-25.
PubMed
CrossRef
 
Lee HJ, Park HJ, Chae Y, Kim SY, Kim SN, Kim ST, et al. Tai Chi Qigong for the quality of life of patients with knee osteoarthritis: a pilot, randomized, waiting list controlled trial. Clin Rehabil. 2009; 23:504-11.
PubMed
CrossRef
 
Brismée JM, Paige RL, Chyu MC, Boatright JD, Hagar JM, McCaleb JA, et al. Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2007; 21:99-111.
PubMed
CrossRef
 
Song R, Roberts BL, Lee EO, Lam P, Bae SC. A randomized study of the effects of t'ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis. J Altern Complement Med. 2010; 16:227-33.
PubMed
CrossRef
 
Yip YB, Tam AC. An experimental study on the effectiveness of massage with aromatic ginger and orange essential oil for moderate-to-severe knee pain among the elderly in Hong Kong. Complement Ther Med. 2008; 16:131-8.
PubMed
CrossRef
 
Ko T, Lee S, Lee D. Manual therapy and exercise for OA knee: effects on muscle strength, proprioception, and functional performance. Journal of Physical Therapy Science. 2009; 21:293-9.
CrossRef
 
Perlman AI, Sabina A, Williams AL, Njike VY, Katz DL. Massage therapy for osteoarthritis of the knee: a randomized controlled trial. Arch Intern Med. 2006; 166:2533-8.
PubMed
CrossRef
 
Toda Y, Tsukimura N, Segal N. An optimal duration of daily wear for an insole with subtalar strapping in patients with varus deformity osteoarthritis of the knee. Osteoarthritis Cartilage. 2005; 13:353-60.
PubMed
CrossRef
 
Bar-Ziv Y, Beer Y, Ran Y, Benedict S, Halperin N. A treatment applying a biomechanical device to the feet of patients with knee osteoarthritis results in reduced pain and improved function: a prospective controlled study. BMC Musculoskelet Disord. 2010; 11:179.
PubMed
CrossRef
 
Hinman RS, Bowles KA, Bennell KL. Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear? BMC Musculoskelet Disord. 2009; 10:146.
PubMed
CrossRef
 
Maly MR, Culham EG, Costigan PA. Static and dynamic biomechanics of foot orthoses in people with medial compartment knee osteoarthritis. Clin Biomech (Bristol, Avon). 2002; 17:603-10.
PubMed
CrossRef
 
Kerrigan DC, Lelas JL, Goggins J, Merriman GJ, Kaplan RJ, Felson DT. Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis. Arch Phys Med Rehabil. 2002; 83:889-93.
PubMed
CrossRef
 
Kuroyanagi Y, Nagura T, Matsumoto H, Otani T, Suda Y, Nakamura T, et al. The lateral wedged insole with subtalar strapping significantly reduces dynamic knee load in the medial compartment gait analysis on patients with medial knee osteoarthritis. Osteoarthritis Cartilage. 2007; 15:932-6.
PubMed
CrossRef
 
Nigg BM, Emery C, Hiemstra LA. Unstable shoe construction and reduction of pain in osteoarthritis patients. Med Sci Sports Exerc. 2006; 38:1701-8.
PubMed
 
Toda Y, Segal N, Kato A, Yamamoto S, Irie M. Effect of a novel insole on the subtalar joint of patients with medial compartment osteoarthritis of the knee. J Rheumatol. 2001; 28:2705-10.
PubMed
 
Toda Y, Tsukimura N. A six-month followup of a randomized trial comparing the efficacy of a lateral-wedge insole with subtalar strapping and an in-shoe lateral-wedge insole in patients with varus deformity osteoarthritis of the knee. Arthritis Rheum. 2004; 50:3129-36.
PubMed
CrossRef
 
Toda Y, Tsukimura N. Influence of concomitant heeled footwear when wearing a lateral wedged insole for medial compartment osteoarthritis of the knee. Osteoarthritis Cartilage. 2008; 16:244-53.
PubMed
 
Hinman RS, Crossley KM, McConnell J, Bennell KL. Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial. BMJ. 2003; 327:135.
PubMed
CrossRef
 
Hinman RS, Bennell KL, Crossley KM, McConnell J. Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis. Rheumatology (Oxford). 2003; 42:865-9.
PubMed
CrossRef
 
Cushnaghan J, McCarthy C, Dieppe P. Taping the patella medially: a new treatment for osteoarthritis of the knee joint? BMJ. 1994; 308:753-5.
PubMed
CrossRef
 
Talbot LA, Gaines JM, Ling SM, Metter EJ. A home-based protocol of electrical muscle stimulation for quadriceps muscle strength in older adults with osteoarthritis of the knee. J Rheumatol. 2003; 30:1571-8.
PubMed
 
Cetin N, Aytar A, Atalay A, Akman MN. Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial. Am J Phys Med Rehabil. 2008; 87:443-51.
PubMed
CrossRef
 
Garland D, Holt P, Harrington JT, Caldwell J, Zizic T, Cholewczynski J. A 3-month, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of a highly optimized, capacitively coupled, pulsed electrical stimulator in patients with osteoarthritis of the knee. Osteoarthritis Cartilage. 2007; 15:630-7.
PubMed
CrossRef
 
Selfe TK, Bourguignon C, Taylor AG. Effects of noninvasive interactive neurostimulation on symptoms of osteoarthritis of the knee: a randomized, sham-controlled pilot study. J Altern Complement Med. 2008; 14:1075-81.
PubMed
CrossRef
 
Gaines JM, Metter EJ, Talbot LA. The effect of neuromuscular electrical stimulation on arthritis knee pain in older adults with osteoarthritis of the knee. Appl Nurs Res. 2004; 17:201-6.
PubMed
CrossRef
 
Kang RW, Lewis PB, Kramer A, Hayden JK, Cole BJ. Prospective randomized single-blinded controlled clinical trial of percutaneous neuromodulation pain therapy device versus sham for the osteoarthritic knee: a pilot study. Orthopedics. 2007; 30:439-45.
PubMed
 
Law PP, Cheing GL. Optimal stimulation frequency of transcutaneous electrical nerve stimulation on people with knee osteoarthritis. J Rehabil Med. 2004; 36:220-5.
PubMed
CrossRef
 
Taylor P, Hallett M, Flaherty L. Treatment of osteoarthritis of the knee with transcutaneous electrical nerve stimulation. Pain. 1981; 11:233-40.
PubMed
CrossRef
 
Itoh K, Hirota S, Katsumi Y, Ochi H, Kitakoji H. A pilot study on using acupuncture and transcutaneous electrical nerve stimulation (TENS) to treat knee osteoarthritis (OA). Chin Med. 2008; 3:2.
PubMed
CrossRef
 
Grimmer K. A controlled double-blind study comparing the effects of strong burst method TENS and high rate TENS on painful osteoarthritic knees. Aust J Physiother. 1992; 38:49-56.
 
Pietrosimone BG, Hart JM, Saliba SA, Hertel J, Ingersoll CD. Immediate effects of transcutaneous electrical nerve stimulation and focal knee joint cooling on quadriceps activation. Med Sci Sports Exerc. 2009; 41:1175-81.
PubMed
 
Yurtkuran M, Kocagil T. TENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee. Am J Acupunct. 1999; 27:133-40.
PubMed
 
Law PP, Cheing GL, Tsui AY. Does transcutaneous electrical nerve stimulation improve the physical performance of people with knee osteoarthritis? J Clin Rheumatol. 2004; 10:295-9.
PubMed
CrossRef
 
Ay S, Evcik D. The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: a randomized, placebo-controlled trial. Rheumatol Int. 2009; 29:663-6.
PubMed
CrossRef
 
Thamsborg G, Florescu A, Oturai P, Fallentin E, Tritsaris K, Dissing S. Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study. Osteoarthritis Cartilage. 2005; 13:575-81.
PubMed
CrossRef
 
Trock DH, Bollet AJ, Markoll R. The effect of pulsed electromagnetic fields in the treatment of osteoarthritis of the knee and cervical spine. Report of randomized, double blind, placebo controlled trials. J Rheumatol. 1994; 21:1903-11.
PubMed
 
Nicolakis P, Kollmitzer J, Crevenna R, Bittner C, Erdogmus CB, Nicolakis J. Pulsed magnetic field therapy for osteoarthritis of the knee—a double-blind sham-controlled trial. Wien Klin Wochenschr. 2002; 114:678-84.
PubMed
 
Huang MH, Lin YS, Lee CL, Yang RC. Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis. Arch Phys Med Rehabil. 2005; 86:1545-51.
PubMed
 
Huang MH, Yang RC, Lee CL, Chen TW, Wang MC. Preliminary results of integrated therapy for patients with knee osteoarthritis. Arthritis Rheum. 2005; 53:812-20.
PubMed
CrossRef
 
Ozgönenel L, Aytekin E, Durmuşoglu G. A double-blind trial of clinical effects of therapeutic ultrasound in knee osteoarthritis. Ultrasound Med Biol. 2009; 35:44-9.
PubMed
CrossRef
 
Tascioglu F, Kuzgun S, Armagan O, Ogutler G. Short-term effectiveness of ultrasound therapy in knee osteoarthritis. J Int Med Res. 2010; 38:1233-42.
PubMed
 
Sayers SP, Gibson K, Cook CR. Effect of high-speed power training on muscle performance, function, and pain in older adults with knee osteoarthritis: a pilot investigation. Arthritis Care Res (Hoboken). 2012; 64:46-53.
PubMed
CrossRef
 
Rattanachaiyanont M, Kuptniratsaikul V. No additional benefit of shortwave diathermy over exercise program for knee osteoarthritis in peri-/post-menopausal women: an equivalence trial. Osteoarthritis Cartilage. 2008; 16:823-8.
PubMed
CrossRef
 
Fukuda TY, Alves da Cunha R, Fukuda VO, Rienzo FA, Cazarini C Jr, Carvalho Nde A, et al. Pulsed shortwave treatment in women with knee osteoarthritis: a multicenter, randomized, placebo-controlled clinical trial. Phys Ther. 2011; 91:1009-17.
PubMed
CrossRef
 
Laufer Y, Zilberman R, Porat R, Nahir AM. Effect of pulsed short-wave diathermy on pain and function of subjects with osteoarthritis of the knee: a placebo-controlled double-blind clinical trial. Clin Rehabil. 2005; 19:255-63.
PubMed
CrossRef
 
Akyol Y, Durmus D, Alayli G, Tander B, Bek Y, Canturk F, et al. Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. Eur J Phys Rehabil Med. 2010; 46:325-36.
PubMed
 
Callaghan MJ, Whittaker PE, Grimes S, Smith L. An evaluation of pulsed shortwave on knee osteoarthritis using radioleucoscintigraphy: a randomised, double blind, controlled trial. Joint Bone Spine. 2005; 72:150-5.
PubMed
CrossRef
 
Pollard H, Ward G, Hoskins W, Hardy K. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. J Can Chiropr Assoc. 2008; 52:229-42.
PubMed
 
Deyle GD, Allison SC, Matekel RL, Ryder MG, Stang JM, Gohdes DD, et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Phys Ther. 2005; 85:1301-17.
PubMed
 
Moss P, Sluka K, Wright A. The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Man Ther. 2007; 12:109-18.
PubMed
CrossRef
 
Denegar CR, Dougherty DR, Friedman JE, Schimizzi ME, Clark JE, Comstock BA, et al. Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response. Clin Interv Aging. 2010; 5:199-206.
PubMed
 
Mazzuca SA, Page MC, Meldrum RD, Brandt KD, Petty-Saphon S. Pilot study of the effects of a heat-retaining knee sleeve on joint pain, stiffness, and function in patients with knee osteoarthritis. Arthritis Rheum. 2004; 51:716-21.
PubMed
 
Durmuş D, Alayli G, Cantürk F. Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis. Clin Rheumatol. 2007; 26:674-8.
PubMed
CrossRef
 
Wyatt FB, Milam S, Manske RC, Deere R. The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. J Strength Cond Res. 2001; 15:337-40.
PubMed
 
Maillefert JF, Hudry C, Baron G, Kieffert P, Bourgeois P, Lechevalier D, et al. Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis: a prospective randomized controlled study. Osteoarthritis Cartilage. 2001; 9:738-45.
PubMed
CrossRef
 
Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, et al. Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Phys Ther. 2008; 88:12-21.
PubMed
CrossRef
 
Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, et al. Tai Chi is effective in treating knee osteoarthritis: a randomized controlled trial. Arthritis Rheum. 2009; 61:1545-53.
PubMed
CrossRef
 
Penninx BW, Messier SP, Rejeski WJ, Williamson JD, DiBari M, Cavazzini C, et al. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Arch Intern Med. 2001; 161:2309-16.
PubMed
CrossRef
 
Penninx BW, Rejeski WJ, Pandya J, Miller ME, Di Bari M, Applegate WB, et al. Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Gerontol B Psychol Sci Soc Sci. 2002; 57:P124-32.
PubMed
CrossRef
 
Rejeski WJ, Brawley LR, Ettinger W, Morgan T, Thompson C. Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Med Sci Sports Exerc. 1997; 29:977-85.
PubMed
 
van Gool CH, Penninx BW, Kempen GI, Rejeski WJ, Miller GD, van Eijk JT, et al. Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis. Arthritis Rheum. 2005; 53:24-32.
PubMed
CrossRef
 
Brouwer RW, van Raaij TM, Verhaar JA, Coene LN, Bierma-Zeinstra SM. Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. Osteoarthritis Cartilage. 2006; 14:777-83.
PubMed
CrossRef
 
Baker K, Goggins J, Xie H, Szumowski K, LaValley M, Hunter DJ, et al. A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis. Arthritis Rheum. 2007; 56:1198-203.
PubMed
CrossRef
 
Mangani I, Cesari M, Kritchevsky SB, Maraldi C, Carter CS, Atkinson HH, et al. Physical exercise and comorbidity. Results from the Fitness and Arthritis in Seniors Trial (FAST). Aging Clin Exp Res. 2006; 18:374-80.
PubMed
 
Mikesky AE, Mazzuca SA, Brandt KD, Perkins SM, Damush T, Lane KA. Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis Rheum. 2006; 55:690-9.
PubMed
CrossRef
 
Fisher NM, Gresham G, Pendergast DR. Effects of a quantitative progressive rehabilitation program applied unilaterally to the osteoarthritic knee. Arch Phys Med Rehabil. 1993; 74:1319-26.
PubMed
 
Huang MH, Chen CH, Chen TW, Weng MC, Wang WT, Wang YL. The effects of weight reduction on the rehabilitation of patients with knee osteoarthritis and obesity. Arthritis Care Res. 2000; 13:398-405.
PubMed
CrossRef
 
Zizic TM, Hoffman KC, Holt PA, Hungerford DS, O'Dell JR, Jacobs MA, et al. The treatment of osteoarthritis of the knee with pulsed electrical stimulation. J Rheumatol. 1995; 22:1757-61.
PubMed
 
Burch FX, Tarro JN, Greenberg JJ, Carroll WJ. Evaluating the benefits of patterned stimulation in the treatment of osteoarthritis of the knee: a multi-center, randomized, single-blind, controlled study with an independent masked evaluator. Osteoarthritis Cartilage. 2008; 16:865-72.
PubMed
CrossRef
 
Petrella RJ, Bartha C. Home based exercise therapy for older patients with knee osteoarthritis: a randomized clinical trial. J Rheumatol. 2000; 27:2215-21.
PubMed
 
Toda Y, Tsukimura N, Kato A. The effects of different elevations of laterally wedged insoles with subtalar strapping on medial compartment osteoarthritis of the knee. Arch Phys Med Rehabil. 2004; 85:673-7.
PubMed
CrossRef
 
Bennell KL, Bowles KA, Payne C, Cicuttini F, Williamson E, Forbes A, et al. Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial. BMJ. 2011; 342:d2912.
PubMed
CrossRef
 
Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009; CD002823.
PubMed
 
Rutjes AW, Nüesch E, Sterchi R, Jüni P. Therapeutic ultrasound for osteoarthritis of the knee or hip. Cochrane Database Syst Rev. 2010; CD003132.
PubMed
 
Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000; 43:1905-15.
PubMed
 
Bennell KL, Hinman RS, Metcalf BR, Buchbinder R, McConnell J, McColl G, et al. Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2005; 64:906-12.
PubMed
CrossRef
 
Brand C, Buchbinder R, Wluka A, Jones K, Ruth D, McKenzie S, et al.  Guideline for the non-surgical management of hip and knee osteoarthritis. South Melbourne, Victoria, Australia: The Royal Australian Coll General Practitioners; 2009. Accessed at www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp117-hip-knee-osteoarthritis.pdf on 10 September 2012.
 
Mazières B, Bannwarth B, Dougados M, Lequesne M. EULAR recommendations for the management of knee osteoarthritis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials. Joint Bone Spine. 2001; 68:231-40.
PubMed
CrossRef
 
Bruckenthal P, Broderick JE. Assessing treatment fidelity in pilot studies assist in designing clinical trials: an illustration from a nurse practitioner community-based intervention for pain. ANS Adv Nurs Sci. 2007; 30:72-84.
PubMed
 
Doherty M, Jones A. Design of clinical trials in knee osteoarthritis: practical issues for debate [Editorial]. Osteoarthritis Cartilage. 1998; 6:371-3.
PubMed
 
Pham T, Van Der Heijde D, Lassere M, Altman RD, Anderson JJ, Bellamy N, et al, OMERACT-OARSI. Outcome variables for osteoarthritis clinical trials: The OMERACT-OARSI set of responder criteria. J Rheumatol. 2003; 30:1648-54.
PubMed
 
Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M, et al. OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthritis Cartilage. 2004; 12:389-99.
PubMed
 
Viswanathan M, Ansari MT, Berkman ND, Chang S, Hartling L, McPheeters LM, et al.  Assessing the Risk of Bias of Individual Studies in Systematic Reviews of Health Care Interventions. In: Methods Guide for Comparative Effectiveness Reviews. AHRQ Publication no. 12-EHC047-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2012. Accessed at http://effectivehealthcare.ahrq.gov/ehc/products/322/998/MethodsGuideforCERs_Viswanathan_IndividualStudies.pdf on 10 September 2012.
 
Keller C, Fleury J, Sidani S, Ainsworth B. Fidelity to theory in PA intervention research. West J Nurs Res. 2009; 31:289-311.
PubMed
 
Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007; 66:433-9.
PubMed
 
Fitzgerald GK, Delitto A. Considerations for planning and conducting clinic-based research in physical therapy. Phys Ther. 2001; 81:1446-54.
PubMed
 
Ehrich EW, Davies GM, Watson DJ, Bolognese JA, Seidenberg BC, Bellamy N. Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities osteoarthritis index questionnaire and global assessments in patients with osteoarthritis. J Rheumatol. 2000; 27:2635-41.
PubMed
 
Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum. 2001; 45:384-91.
PubMed
CrossRef
 
Angst F, Aeschlimann A, Michel BA, Stucki G. Minimal clinically important rehabilitation effects in patients with osteoarthritis of the lower extremities. J Rheumatol. 2002; 29:131-8.
PubMed
 
Stratford PW, Kennedy DM, Woodhouse LJ, Spadoni GF. Measurement properties of the WOMAC LK 3.1 pain scale. Osteoarthritis Cartilage. 2007; 15:266-72.
PubMed
CrossRef
 
Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis. 2005; 64:29-33.
PubMed
 
Tubach F, Wells GA, Ravaud P, Dougados M. Minimal clinically important difference, low disease activity state, and patient acceptable symptom state: methodological issues. J Rheumatol. 2005; 32:2025-9.
PubMed
 
Eberle E, Ottillinger B. Clinically relevant change and clinically relevant difference in knee osteoarthritis. Osteoarthritis Cartilage. 1999; 7:502-3.
PubMed
CrossRef
 
Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004; 8:283-91.
PubMed
CrossRef
 
Redelmeier DA, Lorig K. Assessing the clinical importance of symptomatic improvements. An illustration in rheumatology. Arch Intern Med. 1993; 153:1337-42.
PubMed
CrossRef
 
Kennedy DM, Stratford PW, Wessel J, Gollish JD, Penney D. Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord. 2005; 6:3.
PubMed
CrossRef
 
Mangione KK, Craik RL, McCormick AA, Blevins HL, White MB, Sullivan-Marx EM, et al. Detectable changes in physical performance measures in elderly African Americans. Phys Ther. 2010; 90:921-7.
PubMed
 
Khanna D, Maranian P, Palta M, Kaplan RM, Hays RD, Cherepanov D, et al. Health-related quality of life in adults reporting arthritis: analysis from the National Health Measurement Study. Qual Life Res. 2011; 20:1131-40.
PubMed
CrossRef
 
Shakoor MA, Taslim MA, Hossain MS. Effects of activity modification on the patients with osteoarthritis of the knee. Bangladesh Med Res Counc Bull. 2007; 33:55-9.
PubMed
 
Yip YB, Sit JW, Fung KK, Wong DY, Chong SY, Chung LH, et al. Impact of an Arthritis Self-Management Programme with an added exercise component for osteoarthritic knee sufferers on improving pain, functional outcomes, and use of health care services: an experimental study. Patient Educ Couns. 2007; 65:113-21.
PubMed
CrossRef
 
Kovar PA, Allegrante JP, MacKenzie CR, Peterson MG, Gutin B, Charlson ME. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 1992; 116:529-34.
PubMed
 
Bautch JC, Malone DG, Vailas AC. Effects of exercise on knee joints with osteoarthritis: a pilot study of biologic markers. Arthritis Care Res. 1997; 10:48-55.
PubMed
CrossRef
 
Talbot LA, Gaines JM, Huynh TN, Metter EJ. A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. J Am Geriatr Soc. 2003; 51:387-92.
PubMed
CrossRef
 
Pietrosimone BG, Saliba SA, Hart JM, Hertel J, Kerrigan DC, Ingersoll CD. Effects of disinhibitory transcutaneous electrical nerve stimulation and therapeutic exercise on sagittal plane peak knee kinematics and kinetics in people with knee osteoarthritis during gait: a randomized controlled trial. Clin Rehabil. 2010; 24:1091-101.
PubMed
CrossRef
 
Loyola-Sánchez A, Richardson J, Beattie KA, Otero-Fuentes C, Adachi JD, MacIntyre NJ. Effect of low-intensity pulsed ultrasound on the cartilage repair in people with mild to moderate knee osteoarthritis: a double-blinded, randomized, placebo-controlled pilot study. Arch Phys Med Rehabil. 2012; 93:35-42.
PubMed
 

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Supplemental Content
Supplement 1. Literature Search Strings
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Supplement 2. Results From Trials That Examined Patient-Centered and Intermediate Outcomes With Physical Therapy Interventions in Adults With Knee Osteoarthritis

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