The effects of a physical training program on patients with osteoarthritis of the knees

Objective: To investigate physical function in patients with severe osteoarthritis (OA) of the knees during and after a general physical training program. Design: Randomized control trial, blinded observer, follow-up at 3 months and 1 year. Setting: Outpatient clinic. Patients: Consecutive sample of 25 patients (3 men, 22 women) with OA of the knees according to the criteria of the American College of Rheumatology (ACR). Two patients (8%) failed to complete the study. There were no withdrawals for adverse effects. Intervention: Twelve patients received training in groups of 6, twice a week for 3 months. Training focused on general fitness, balance, coordination, stretching, and lower extremity muscle strength, and included a daily home exercise program. Main Outcome Measures: Muscle strength across the knee (extension and flexion), Algofunctional Index (AFI), pain (0 to 10 point scale), walking speed, clinical findings. Results: Patients participated in 96 of 96 assessments (100%) and in 218 of 280 training sessions (77.9%). From baseline to 3 months, isokinetic quadriceps strength (30 degrees/sec) improved 20% (confidence interval [CI] (2 alpha = .05) 8% to 50%) in the least affected leg; isometric strength improved 21%. By 1 year, AFI had decreased 3.8 points (CI2 alpha = .05, 1.0 to 7.0), pain had decreased 2.0 points (CI2 alpha = .05, 0.0 to 4.0), and walking speed had increased 13% (CI2 alpha = .05, 4% to 23%). There was an increase in the frequency of palpable joint effusions (p <.01) on the most affected side. Frequency of crepitus decreased on the least affected side (p <.01). Conclusions: General physical training appears to be beneficial to patients with OA of the knee. As shown by the high compliance and low dropout frequency, such a program is feasible even in patients with severe OA of the knee. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.