Exercise in knee osteoarthritis: do treatment outcomes relate to bone marrow lesions? A randomized trial.
Study Goal
The researchers aimed to determine whether the presence or absence of bone marrow lesions (BMLs) in knee osteoarthritis (OA) patients influenced treatment outcomes from walking or strength exercises.
Results Summary
The study found no significant difference in pain scores or global perceived effect between knee OA patients with and without BMLs after 18 weeks of walking or strength exercises. Both interventions were effective in improving pain, but BMLs did not predict treatment outcomes.
Population
Symptomatic knee osteoarthritis patients.
Effective Dosage
Not specified
Duration
18 weeks
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
strength exercise program | decrease | pain | patients with knee osteoarthritis | - | effective means of improving | #1 |
walking exercise program | decrease | pain | patients with knee osteoarthritis | - | effective means of improving | #2 |
strength exercise program | no change | pain scores | knee OA patients | - | did not differ | #3 |
walking exercise program | no change | pain scores | knee OA patients | - | did not differ | #4 |
exercise program | no change | pain scores | knee OA patients with baseline bone marrow lesions | - | was not different | #5 |
exercise program | no change | pain scores | knee OA patients without baseline bone marrow lesions | - | was not different | #6 |
exercise program | no change | global perceived effect | knee OA patients with baseline bone marrow lesions | - | was not different | #7 |
exercise program | no change | global perceived effect | knee OA patients without baseline bone marrow lesions | - | was not different | #8 |
PURPOSE: Exercise is effective for reducing knee osteoarthritis (OA) pain but effect sizes vary widely. Moreover, not all knee OA patients perceive beneficial effects. Tailoring specific exercises to subgroups of knee OA patients may increase effectivity. Bone marrow lesions (BMLs) have been suggested as a criterion to define such subgroups. This study aimed to investigate whether BMLs' presence/absence is related to treatment outcomes in a group of knee OA patients who exercised for 18 weeks. METHODS: Subjects with symptomatic knee OA started a strength or walking exercise program. BMLs' presence at baseline was assessed. Pain was assessed before and after the intervention with the intermittent and constant osteoarthritis pain (ICOAP) questionnaire. Also the global perceived effect (GPE) on the patient's complaints was rated. RESULTS: Thirty-five patients (strength (N = 17) and walking (N = 18)) were analyzed for BMLs. BMLs were present in 25 (71%) knees. Five (14%) patients dropped out and 19 (54%) improved (GPE ≥5). All dropouts had BMLs, but no difference was seen between dropouts and retainers (p > 0.05). Pain scores did not differ between intervention groups (p > 0.05) or between patients with BMLs and without BMLs (p > 0.05). CONCLUSIONS: Pain scores and GPE was not different between knee OA patients with and without baseline BMLs in this sample. Implications for Rehabilitation Both walking and strengthening exercises are effective means of improving pain in patients with knee osteoarthritis. In a relatively small sample, this study shows that the presence or absence of subchondral bone marrow lesions, as seen on magnetic resonance images, is not related to treatment outcomes.