The effect of exercise therapy on knee osteoarthritis: a randomized clinical trial Cohort profile: research on Osteoarthritis/Osteoporosis Against Disability study. The effectiveness of a self-management program on quality of life for knee osteoarthritis (OA) patients. Incorporating Novel Mobile Health Technologies Into Management of Knee Osteoarthritis in Patients Treated With Intra-Articular Hyaluronic Acid: Rationale and Protocol of a Randomized Controlled Trial Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain. A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Preliminary results of integrated therapy for patients with knee osteoarthritis. Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee The Bristol 'OA500 study': progression and impact of the disease after 8 years. Nonrandom evolution of end-stage osteoarthritis of the lower limbs. Reduction of joint pain in patients with knee osteoarthritis who have received monthly telephone calls from lay personnel and whose medical treatment regimens have remained stable. The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial. Does hand osteoarthritis predict future hip or knee osteoarthritis? Capturing lay perspectives in a randomized control trial of a health promotion intervention for people with osteoarthritis of the knee. A 10-day course of SPA therapy is beneficial for people with severe knee osteoarthritis The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial.
Background : Knee osteoarthritis ( OA ) is the most common musculoskeletal disease among old individuals which affects ability for sitting on the chair , st and ing , walking and climbing stairs . Our objective was to investigate the short and long-term effects of the most simple and the least expensive exercise protocol s in combination to conventional conservative therapy for knee OA . Methods : It was a single blind RCT study with a 12-months follow-up . Totally , 56 patients with knee OA were assigned into 2 r and om groups . The patients in exercise group received exercise for knee muscles in combination with non-steroid anti-inflammatory drugs ( NSAIDs ) and 10 sessions acupuncture and physiotherapy modalities . Non-exercise group received similar treatments except exercise program . The changes in patients ’ pain and functional status were evaluated by visual analog scale ( VAS ) , knee and osteoarthritis outcome score ( KOOS ) question naire and functional tests ( 4 steps , 5 sit up , and 6 min walk test ) before and after treatment ( 1 and 3 months after intervention ) , and 1 year later at the follow-up . Results : The results showed that the patients with knee OA in exercise group had significant improvement in pain , disability , walking , stair climbing , and sit up speed after treatment at first and second follow-up when compared with their initial status and when compared with non-exercise group . At third follow up ( 1 year later ) there was significant difference between groups in VAS and in three items of KOOS question naire in functional status . Conclusion : Non aerobic exercises for muscles around knee can augment the effect of other therapeutic interventions like medical therapy , acupuncture , and modalities for knee OA Since the proportion of the ageing population in Japan is increasing , a comprehensive and evidence based strategy is urgently required for the prevention of musculoskeletal diseases , including osteoarthritis ( OA ) and osteoporosis ( OP ) , both of which affect the activities of daily living ( ADL ) and quality of life ( QOL ) and increase morbidity and mortality . However , few prospect i ve , longitudinal studies for the purpose of developing such a strategy have been conducted , and little information is available regarding the prevalence and incidence of musculoskeletal disorders , including OA and OP , as well as pain and disability in the Japanese population . It is difficult to design rational clinical and public health approaches for the diagnosis , evaluation and prevention of OA and OP without such epidemiological data . The Research on Osteoarthritis/osteoporosis Against Disability ( ROAD ) study was established in 2005 by N.Y. , T.A. , H.O. , S.M. , H.K. and K.N. ( principal investigators ) . The principal investigators are affiliated with the 22nd Century Medical and Research Center , University of Tokyo PURPOSE To evaluate the effectiveness of the Taipei Osteoarthritis Program ( TOAP ) for community elderly persons who suffer from knee OA . METHODS A quasi-experimental study was conducted between January 2008 and December 2008 . Two hundred and five community-dwelling individuals aged 67±10 years with knee OA were recruited from four districts in Taipei City and r and omized . By a clustered r and omization according to the districts , 114 participants were in the intervention group ( IG ) with a 4-week TOAP program and 91 participants were in the control group ( CG ) with routine care . The main outcome measures included health-related quality of life ( HRQOL ) and disability level , which were assessed by the Short Form-36 Taiwan Version ( T-SF36 ) and the Western Ontario McMaster Universities Arthritis Index Taiwan Version ( T-WOMAC ) , respectively , and were repeatedly measured at the baseline , post invention ( 4 weeks after baseline ) , and follow-up ( 8 weeks after baseline ) . RESULTS Subjects in the IG increased their changes of GH scores from baseline to post-intervention and follow-up , which were significantly more than those of subjects in the CG ( p=0.011 and 0.005 , respectively ) . Significant difference of changes was also found at follow-up for the mental component scale between the groups ( p=0.013 ) . There was no change in disability level . CONCLUSIONS The arthritis self-management program improved the psychological outcomes among the participants , but it had no significant effect on a self-reported disability level Background Osteoarthritis ( OA ) of the knee is one of the leading causes of disability in the United States . One relatively new strategy that could be helpful in the management of OA is the use of mHealth technologies , as they can be used to increase physical activity and promote exercise , which are key components of knee OA management . Objective Currently , no published data on the use of a mHealth approach to comprehensively monitor physical activity in patients with OA are available , and similarly , no data on whether mHealth technologies can impact outcomes are available . Our objective is to evaluate the effectiveness of mHealth technology as part of a tailored , comprehensive management strategy for patients with knee OA . Methods The study will assess the impact of a smartphone app that integrates data from a wearable activity monitor ( thereby both encouraging changes in mobility as well as tracking them ) combined with education about the benefits of walking on patient mobility . The results from the intervention group will be compared with data from a control group of individuals who are given the same Arthritis Foundation literature regarding the benefits of walking and wearable activity monitors but who do not have access to the data from those monitors . Activity monitors will capture step count estimates and will compare those with patients ’ step goals , calories burned , and distance walked . Patients using the novel smartphone app will be able to enter information on their daily pain , mood , and sleep quality . The relationships among activity and pain , activity and mood , and sleep will be assessed , as will patient satisfaction with and adherence to the mobile app . Results We present information on an upcoming trial that will prospect ively assess the ability of a mobile app to improve mobility for knee OA patients who are treated with intra-articular hyaluronic acid . Conclusions We anticipate the results of this study will support the concept that mHealth technologies provide continuous , real-time feedback to patients with OA on their overall level of activity for a more proactive , personalized approach to treatment that may help modify behavior and assist with self-management through treatment support in the form of motivational messages and reminders OBJECTIVE To examine the effects of aerobic and resistance exercise on self-efficacy beliefs in older adults with knee osteoarthritis ( OA ) and to determine whether self-efficacy and knee pain mediated the effects of the treatments on stair time performance and health perceptions . METHODS Measures of self-efficacy , knee pain , stair climbing performance , and health perceptions were collected prior to r and omization and again at an 18-month followup in older adults with knee OA who were assigned to 1 of 3 treatment conditions : aerobic exercise , resistance training , or health education control .  All analyses were conducted on the intention-to-treat principle . RESULTS Both exercise treatments increased self-efficacy for stair climbing in comparison to the health education control group . Both knee pain and self-efficacy mediated the effect of the treatments on stair climb time , whereas only knee pain mediated health perceptions . CONCLUSIONS The findings suggest that control beliefs and changes in physical symptoms such as knee pain are important outcomes in physical activity programs with patients who have OA of the knee . Moreover , these variables mediate the effects that such programs have on disability and health perceptions OBJECTIVE To investigate the therapeutic effects of different muscle-strengthening exercises on the functional status of patients with knee osteoarthritis ( OA ) . METHODS One hundred thirty-two patients with bilateral knee OA ( Altman Grade II ) were sequentially divided into 4 r and om groups ( GI to GIV ) . The patients in group I received isokinetic muscle-strengthening exercise , group II received isotonic muscle-strengthening exercise , group III received isometric muscle-strengthening exercise , and group IV acted as controls . The changes of muscle power of leg flexion and extension were measured with a Kinetic Communicator dynamometer , and patients ' functional status was evaluated by visual analogue scale , ambulation speed , and Lequesne index before and after treatment , and at the follow-up 1 year later . RESULTS The results showed that the patients with OA in each treated group had significant improvement in pain reduction , disability reduction , and in walking speed after treatment and at follow-up when compared with their initial status . Isotonic exercise had the greatest effect on pain reduction after treatment , and fewer participants discontinued the treatment because of exercise knee pain . Isokinetic exercise caused the greatest increase of walking speed and decrease of disability after treatment and at follow-up . The greatest muscle-strength gain in 60 degrees /second angular velocity peak torques was found in the isokinetic and isotonic exercise groups . A significant muscle-strength gain in 180 degrees /second angular velocity peak torques was found only in the isokinetic group after treatment . CONCLUSION AND RELEVANCE Isotonic exercise is suggested for initial strengthening in patients with OA with exercise knee pain , and isokinetic exercise is suggested for improving joint stability or walking endurance at a later time OBJECTIVE To investigate the effects of integrated therapy on the functional status of patients with knee osteoarthritis ( OA ) . METHODS A total of 140 subjects with bilateral knee OA ( Altman grade II ) were r and omized sequentially into 4 groups ( groups I-IV ) . Group I received isokinetic exercises ; group II received isokinetic exercise and pulse ultrasound for periarticular soft tissue pain ; group III received isokinetic exercise , pulse ultrasound , and intraarticular hyaluronan therapy ; and group IV acted as the control group . The therapeutic effects of the interventions were evaluated by changes in Lequesne 's index , knee range of motion , peak muscle torques of knee flexion and extension , and ambulation speed after 8 weeks of treatment and at followup 1 year later . In addition , changes in visual analog scale pain and rates of attrition in each group were also recorded . RESULTS Patients in groups I-III exhibited increased muscle peak torques and significantly reduced pain and disability after treatment and at followup . Groups II and III showed significant improvements in range of motion and ambulation speed after treatment . Group III also showed the greatest increase in walking speed and decrease in disability after treatment and at followup . Both group II and group III had significant gains in muscular strength after treatment and at followup ; group III showed the greatest gains . CONCLUSION An integrated therapy deals with the extra- and intraarticular progressive pathologic changes , and kinesiologic management of OA is suggested for the management of knee OA The aims of this study were to evaluate whether balneotherapy with mineral sulphate – bicarbonate – calcium water could determine substantial symptomatic improvement , and to detect any changes in the quality of life ( QoL ) of patients with symptomatic knee osteoarthritis ( OA ) . This was a prospect i ve r and omized , single blind controlled trial . Sixty out patients with primary bilateral knee OA , according to ACR criteria , were included in the study and r and omized to one of two groups : group I ( 30 patients ) was treated with a daily sulphate – bicarbonate – calcium mineral water bath ; group II ( 30 patients ) , the control group , continued their regular outpatient care routine . At baseline , after 15 days and after 12 weeks , patients were evaluated by Visual Analogue Scale ( VAS ) for spontaneous pain , Lequesne and Womac Index for gonarthrosis , SF-36 , Arthritis Impact Measurement Scale ( AIMS ) and symptomatic drugs consumption . We observed a significant improvement of all parameters at the end of the cycle of balneotherapy which persisted throughout the follow-up period , whereas in the control group no significant differences were noted . This symptomatic effect was confirmed by the significant reduction of symptomatic drugs consumption . The differences between the two groups were significant for all considered parameters already from the 15th day and persisted during follow-up . Tolerability of balneotherapy  seemed to be good , with light and transitory side effects . Our results confirm that the beneficial effects of balneotherapy in patients with knee OA last over time , with positive effects on the painful symptomatology , a significant improvement on functional capacities and QoL.  Balneotherapy can represent a useful backup to pharmacological treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments OBJECTIVE To study the natural history of peripheral joint osteoarthritis ( OA ) and assess its impact over eight years in a prospect i ve study of 500 patients . METHODS 500 consecutive patients with peripheral joint OA were recruited from a hospital-based rheumatology clinic . All were invited for review 3 and 8 years after entry . Joint sites involved , pain severity , change in index joints , global change in the condition , use of medication , surgery and walking aids were all recorded at each visit , and after eight years disability was assessed by the  health assessment question naire ( HAQ ) and  anxiety and depression by the Hospital anxiety and depression scale ( HAD ) . RESULTS At eight-year review , 349 patients were seen : 90 % of those remaining alive . Outcome was heterogeneous . Sixty patients ( 17.2 % ) reported worsening in all three subjective parameters ( pain , index joint and global change ) compared with 22 ( 6.3 % ) who improved in all three parameters . Using this definition of worsening or improvement , strong baseline predictors of clinical outcome did not emerge . For further description , the group was split according to the index joint sites involved at entry to the study , there being 111 with knee OA alone , 87 with h and and knee OA , 72 with h and disease alone , and 29 with hip disease alone . Forty-four percent of those with lone h and disease at entry had acquired significant knee or hip OA 8 years later . The mean HAQ and HAD scores at 8 years were high , especially in those with knee disease , indicating significant disability as a result of the disease . Those with knee or knee and h and disease had the worst outcome in all parameters recorded . The data showed a general decrease in use of NSAIDs over the eight years , but an increase in utilization of analgesics , surgery ( especially for hip disease ) and walking aids . CONCLUSIONS Patients with peripheral joint OA of sufficient severity to lead to hospital referral have a heterogeneous , but generally bad outcome over 8 years , the disease result ing in high levels of physical disability , anxiety and depression , with a high level of utilization of healthcare re sources , including joint replacement , drugs and walking aids . The results were consistent with previous suggestions that peripheral joint OA in older people is characterized by the slow acquisition of new joint sites . Progression and outcome may depend on a complex set of psychosocial factors , as well as biological ones OBJECTIVE Patients with unilateral hip or knee replacements for end-stage osteoarthritis ( OA ) are at high risk for future progression of OA in other joints of the lower extremities , often requiring additional joint replacements . Although the risks of future surgery in the contralateral cognate joints ( i.e. , contralateral hip replacement after an initial hip replacement ) have been evaluated , the evolution of end-stage hip OA to OA involving the knee joints , and vice versa ( i.e. , noncognate progression ) has not been investigated . Because characterization of OA progression in noncognate joints may shed light on the pathogenesis of multijoint OA , we investigated the pattern of evolution of end-stage lower extremity OA in a large , clinical cohort . METHODS Total joint replacement ( TJR ) was selected as a marker of end-stage OA , and a data base comprising all lower extremity TJRs performed at a large referral center between 1981 and 2001 was accessed . Of the 5,894 patients identified , 486 patients with idiopathic OA who underwent hip replacement and 414 who underwent initial knee replacement  were analyzed to determine the relative likelihood of subsequent TJRs .  Patients with the systemic inflammatory arthropathy , rheumatoid arthritis ( RA ) , were evaluated as a control population because RA progression is not considered to be a primarily mechanically mediated process . RESULTS The contralateral cognate joint was the most common second joint to undergo replacement in both the OA and the RA groups . However , in OA patients for whom the second TJR was in a noncognate joint , that joint was > 2-fold more likely to be on the contralateral limb than on the ipsilateral limb ( hip to knee P < 0.001 ; knee to hip P = 0.013 ) . In contrast , among the RA cohort , the evolution was r and om and no laterality for noncognate TJR was observed at either the hip or the knee ( P = 0.782 ) . CONCLUSION This characterization of end-stage lower extremity OA demonstrates that the disease evolves nonr and omly ; after 1 joint is replaced , the contralateral limb is significantly more likely to show progression of OA than is the ipsilateral limb . Thus , OA in 1 weight-bearing joint appears to influence the evolution of OA in other joints . The absence of such laterality in RA suggests that OA progression may be mediated by extrinsic factors such as altered joint loading OBJECTIVE We previously reported that monthly telephone contact by lay personnel , to promote self-care for patients with osteoarthritis ( OA ) , was associated with improved joint pain and physical function after 1 year of followup . The present study was a secondary analysis to determine whether improvement was contingent on intensified medical treatment . METHODS We reanalyzed control/treatment group differences in all 40 subjects with radiographically confirmed knee OA who had had no changes in antirheumatic drug therapy or institution of physical therapy during the period of observation . RESULTS Group differences in measured pain remained significant ( effect size [ ES ] = 0.65 SD , P less than 0.01 ) . The same trend was observed for physical function ( ES = 0.53 SD , P not significant ) . CONCLUSION The findings in this re analysis suggest that periodic telephone support interventions are effective enough to be regarded as an adjunctive treatment for OA Osteoarthritis ( OA ) of the knee leads to restrictions of physical activity and ability to perform activities of daily living . Obesity is a risk factor for knee OA and it appears to exacerbate knee pain and disability . The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was developed to test the efficacy of lifestyle behavioral changes on physical function , pain , and disability in obese , sedentary older adults with knee OA . This controlled trial r and omized 316 sedentary overweight and obese older adults in a two-by-two factorial design into one of four 18-month duration intervention groups : Healthy Lifestyle Control ; Dietary Weight Loss ; Structured Exercise ; or Combined Exercise and Dietary Weight Loss . The weight-loss goal for the diet groups was a 5 % loss at 18 months . The intervention was modeled from principles derived from the group dynamics literature and social cognitive theory . Exercise training consisted of aerobic and strength training for 60 minutes , three times per week in a group and home-based setting . The primary outcome measure was self-report of physical function using the Western Ontario and McMaster University Osteoarthritis Index . Other measurements included timed stair climb , distance walked in 6 minutes , strength , gait , knee pain , health-related quality of life , knee radiographs , body weight , dietary intake , and cost-effectiveness of the interventions . We report baseline data stratified by level of overweight and obesity focusing on self-reported physical function and physical performance tasks . The results from ADAPT will provide approaches clinicians should recommend for behavioral therapies that effectively reduce the incidence of disability associated with knee OA OBJECTIVE To assess the effectiveness of physical therapy , given either as an individually attended treatment or in a small group format , in terms of pain , physical function , and health related quality of life for patients with osteoarthritis ( OA ) of the knee . METHODS After 2 baseline assessment s , 126 patients were r and omized into one of 3 allocation arms : individual treatments ( n = 43 ) , small group format program ( n = 40 ) , and waiting list control ( n = 43 ) . After re assessment at 8 weeks , patients allocated to waiting list control were r and omized into one of the 2 active treatment arms . Assessment s included both self-report measures ( WOMAC , SF-36 ) and objective measures of physical performance ( gait analysis and muscle strength ) . RESULTS Both physical therapy treatment allocations result ed in significant improvements in pain , physical function , and health related quality of life above the control group ( st and ardized response mean 0.36 to 0.65 ) . Improvements in the self-report measures were substantiated by significant correlated improvements in knee extensor strength and fast walking speed ( rho 0.36 - 0.42 ) . There were no significant differences in effectiveness between the 2 physical therapy allocations for any of the measured outcomes . Improvements gained were maintained for at least 2 months . Responsiveness to treatment was modified by loss of medial joint space width , the interaction being significant for physical function , gait , and knee extensor strength . CONCLUSION Physical therapy , either as an individually delivered treatment or in a small group format , is an effective intervention for patients with knee OA . Responsiveness to this 8 week intervention was modified by loss of medial joint space width OBJECTIVE To evaluate the risk of future hip or knee osteoarthritis ( OA ) in subjects with h and OA at baseline and to evaluate whether the concurrent presence of h and OA , other risk factors for OA , or an OA biomarker ( type II collagen C-telopeptide degradation product [ CTX-II ] ) further increases the risk . METHODS Radiographs of the h and s ( baseline ) and the hips and knees ( baseline and 6.6 years later ) were obtained in a r and omly selected subset of participants in the Rotterdam Study who were ages 55 years and older . Radiographs were scored for the presence of OA using the Kellgren/Lawrence ( K/L ) system . A total of 1,235 subjects without OA of the hip/knee ( K/L score 0 - 1 ) at baseline were included in the study . CTX-II levels were measured at baseline . The independent risk of future hip/knee OA in subjects with h and OA at baseline was assessed by logistic regression , as stratified for age , sex , body mass index , family history of OA , and heavy workload . RESULTS Overall 12.1 % of the participants ( 19.7 % of those with h and OA versus 10.0 % of those without ) developed hip or knee OA ( odds ratio [ OR ] 2.1 [ 95 % confidence interval ( 95 % CI ) 1.3 - 3.1 ] ) . Subjects with h and OA had an increased risk of future hip OA ( OR 3.0 [ 95 % CI 1.6 - 5.4 ] ) , which was further increased in those with a family history of OA . Subjects with h and OA had an OR of 1.6 [ 95 % CI 1.0 - 2.8 ) for the future development of knee OA , which was further increased in those who were overweight . Concurrent h and OA and high levels of CTX-II further increased the risk of having hip or knee OA at followup ( OR 4.2 [ 95 % CI 2.3 - 7.8 ] ) . CONCLUSION The presence of h and OA at baseline showed an increased risk of future hip/knee OA ( higher for hip OA than for knee OA ) . The concurrent presence of h and OA and other OA risk factors or high CTX-II levels further increased the risk of future hip/knee OA Osteoarthritis ( OA ) is a common and often disabling condition that predominately affects older adults . It is the commonest cause of locomotor disability and forms a major element of the workload in primary care . Previous studies suggest that there are both deficits in the knowledge patients have about their disease and extensive ' unmet ' information needs . This paper explores the patients ' perspective on the meaning and significance of living with arthritis , identified through quantitative and qualitative approaches undertaken during a trial that evaluated the effectiveness of a primary care-based patient education programme . This paper draws on qualitative and quantitative data from : the baseline interview ( knowledge of arthritis , satisfaction with services and support received in primary care ) ; patient diaries ( individual goals and reflections on treatment ) ; and group teaching sessions ( themes describing the patient 's experience ) . The different data sources were interrogated for common and divergent themes . One hundred and ninety-four participants were identified and 170 completed baseline interviews . Participants were predominantly female ( 73 % ) , with a mean age of 63 and arthritis of long-st and ing ; 55 % reported that they had had it for 5 years or more .  Use of primary care services was high , with 41 % consulting their GP in the 2 weeks before interview . Levels of information were low , with less than 25 % receiving support/advice about the disease , pain management or its impact upon daily life . Set against negative perceptions of the quality of services , patients ' personal priorities were for improved pain management and enhanced mobility/functional ability . The combined quantitative and qualitative data provide insight into the patients ' perspective on the causes and impact of knee OA , individual goals desired from treatment and the quality of care . There is consistent evidence of unmet needs for information and support and the priority placed by patients on finding strategies to cope with OA and maintaining independence . Even within a tightly defined study sample participating in the intervention , a diversity of experience and goals were revealed , which highlights the importance of taking account of context ual factors and individual differences when evaluating complex interventions The objective of this study was to test if spa therapy can play a role in the management of severe knee osteoarthritis ( OA ) . Twenty patients with radiologically and clinical ly severe knee OA were r and omly assigned into spa and drug therapy groups . Spa group ( n = 10 ) traveled to a spa town and stayed at a hotel for a 10-day spa therapy course . They followed a balneotherapy regimen including thermal pool baths at 37 ° C for 20 min two times daily . Drug therapy group ( n = 10 ) stayed at home and followed their individually prescribed drug therapy ( NSAIDs and paracetamol ) . Patients were assessed at baseline ( week 0 ) , after spa therapy at 2 weeks ( week 2 ) and during follow-up period at 12 ( week 12 ) and 24 ( week 24 ) weeks by a blinded investigator . Patients assessed with Lequesne algofunctional index ( LAFI ) , pain ( visual analogue scale , VAS ) , patient ’s and investigator ’s global evaluation ( VAS ) , ten-stairs stepping up and down time , 15 m walking time and three times squatting up and down time . Significant improvement in pain and LAFI scores were found at week 2 , week 12 and week 24 in the spa therapy group compared to baseline . Comparing the two group differences , spa therapy was superior to drug therapy in pain reduction and in physician ’s global assessment at all time points . This superiority was also found in LAFI scores and patients ’ global assessment s at week 12 and week 24 . A 10-day course of spa therapy may be beneficial in short- and medium-term up to 24 weeks by reducing pain and improving functional status and overall well-being in patients with severe knee OA and may be considered as an effective therapeutic tool for such patients in countries like Turkey where it is widely available and ( at least partly ) reimbursed OBJECTIVE To determine the effectiveness of exercise therapy in patients with osteoarthritis ( OA ) of the hip or knee . METHODS A r and omized single blind , clinical trial was conducted in a primary care setting . Patients with hip or knee OA by American College of Rheumatology criteria were selected . Two intervention groups were compared . Both groups received treatment from the patients ' general practitioner , including patient education and medication if necessary . The experimental group also received exercise therapy from a physiotherapist in primary care . The treatment period was 12 weeks . The main outcome measures were pain , medication use ( nonsteroidal antiinflammatory drugs , NSAID ) and observed disability . RESULTS A total of 201 patients were r and omized .  Exercise therapy was associated with a reduction of pain in the past week ( difference in change -17.0 ; 95 % CI -23.6 , -10.4 ) and observed disability ( -0.19 ; 95 % CI -0.38 ; -0.01 ) . Effect sizes were medium ( 0.58 ) and small ( 0.28 ) , respectively . No effect of  exercise therapy  was found for the use of NSAID . Additional beneficial effects ( p = 0.05 ) were found for the use of  paracetamol  ( effect size 0.33 ) , global effect as perceived by the patient ( effect size 0.68 ) , and muscle strength of the hip ( effect size 0.34 ) . CONCLUSION After 12 weeks , exercise therapy is effective in reducing pain and disability . The size of the effects is medium and small , respectively
In conclusion , even though limitations must be considered , evidence shows that BT and spa therapy can significantly improve QoL of patients with knee OA .
Moreover , reduction of drug consumption and improvement of algofunctional indexes may be other beneficial effects .
Knee osteoarthritis ( OA ) is a degenerative disease which is expected to become one of the leading causes of disability by the next years .
This work aims to assess if balneotherapy and spa therapy can significantly improve Quality of Life ( QoL ) of patients with knee OA .