Effects of Internet‐Based Neuromuscular Versus Quadriceps Exercise on Pain and Function in Patients With Knee Osteoarthritis: A Single‐Blind Randomized Controlled Trial

Vollständiger Abstract

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ABSTRACT Background Exercise and self‐management are first‐line for knee osteoarthritis (KOA), but evidence on internet‐based telerehabilitation comparing specific exercises is limited. We compared a 12‐week internet‐based neuromuscular exercise (NE) program and a quadriceps exercise (QE) program in community‐dwelling patients with symptomatic KOA. Methods This single‐center, single‐blind randomized trial compared 12‐week internet‐based NE versus QE in community‐dwelling adults with symptomatic KOA. The primary outcome: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain. Secondary outcomes: WOMAC function, daily activity, pressure pain threshold, self‐efficacy, Timed Up and Go, and 6‐Min Walk Test. Subjective outcomes were assessed at 0, 6, 12 weeks; objective outcomes were assessed at 0, 12 weeks. Generalized estimating equations with group, time, and group‐by‐time terms were used for intention‐to‐treat analyses, adjusted for age, sex, body mass index, and the baseline value. Results Of 74 randomized participants (NE = 37, QE = 37), 62 completed the 12‐week assessment (16.2% discontinued; 18.9% in the NE group, 13.5% in the QE group). Enrollment was below the planned 53 participants per group. At 12 weeks, the adjusted between‐group difference in WOMAC pain change was −1.0 points (95% confidence interval [CI], −2.4 to 0.4; p = 0.150; Cohen's d = −0.34); at 6 weeks, it was −0.8 points (95% CI, −1.9 to 0.4; p = 0.188; Cohen's d = −0.33). No statistically significant between‐group differences were found in secondary outcomes. Conclusions This under‐enrolled trial found no significant difference between NE and QE in WOMAC pain at 12 weeks. Both groups showed within‐group improvement, but equivalence was not established. Findings should be interpreted cautiously due to limited statistical power.