McKnight and coworkers assessed the relative effectiveness of combining self-management and strength training for improving functional outcomes in patients with early knee osteoarthritis. They conducted a randomized intervention trial lasting 24 months at an academic medical center. Community-dwelling middle-aged adults (n = 273) ages 35-64 years with knee osteoarthritis, pain, and self-reported physical disability completed a strength-training program, a self-management program, or a combined program. Outcomes included five physical function tests (leg press, range of motion, work capacity, balance, and stair climbing) and two self-reported measures of pain and disability. A total of 201 participants (73.6%) completed the 2-year trial. Overall, compliance was modest for the strength training (55.8%), self-management (69.1%), and combined (59.6%) programs. The three groups showed a significant and large increase from pre- to post treatment in all of the physical functioning measures, including leg press (d = 0.85), range of motion (d = 1.00), work capacity (d = 0.60), balance (d = 0.59), and stair climbing (d = 0.59). In addition, all three groups showed decreased self-reported pain (d = -0.51) and disability (d = -0.55). There were no significant differences among the groups.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: Middle-aged, sedentary persons with mild early knee osteoarthritis benefited from strength training, self-management, and the combination program. The results suggest that both strength training and self-management are suitable treatments for the early onset of knee osteoarthritis in middle-aged adults. Self-management alone may offer the least burdensome treatment for early osteoarthritis.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The study enrolled a relatively large number of subjects and had a two-year follow-up. The next step for the investigators would be to ferret out which of three components contributed the most to the success of the study. In addition, a 69.1 compliance rate for self-management participants is actually quite high. The investigators should be encouraged to follow-up their results.

PE McKnight et al. A comparison of strength training, self-management, and the combination for early osteoarthritis of the knee. Arthritis Care & Research, 2010;62:45-53.