DOS 2017

DOS Kongressen 2017 ·

One year effectiveness of neuromuscular exercise com-

pared with instruction in analgesic use on knee function in

patients with early knee osteoarthritis: the EXERPHARMA

randomized trial

Anders Holsgaard-Larsen, Robin Christensen, Brian Clausen, Jens Søndergaard, Thomas

P. Andriacchi, Ewa M. Roos

Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense

University Hospital, Institute of Clinical Research, University of Southern Denmark; Mus-

culoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital,

Copenhagen, Denmark.; Research Unit for Musculoskeletal Function and Physiotherapy,

Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark,

Odense, Denmark.; Research Unit for General Practice, Institute of Public Health, Univer-

sity of Southern Denmark, Odense, Denmark. ; Departments of Mechanical Engineering

and Orthopaedic Surgery, Stanford University, Stanford, California, USA. VA Joint Pres-

ervation Center, Palo Alto, California, USA.; Research Unit for Musculoskeletal Function

and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of

Southern Denmark, Odense, Denmark.

Background:

Exercise is a preferred treatment of osteoarthritis (OA) due to its antici-

pated negligible adverse effects while still having clinically relevant effect.

Purpose / Aim of Study:

To test whether long-term effectiveness of a neuromuscular

exercise (NEMEX) would be superior to instructions in optimized use of analgesics and

anti-inflammatory drug use (PHARMA) on knee joint function.

Materials and Methods:

Extended follow-up of 12 months results from a random-

ized controlled trial. Participants with mild-to-moderate medial tibiofemoral knee OA

were randomly allocated (1:1) to one of two 8-week treatments. The primary outcome

measure at 12 months follow- up was activity of daily living (ADL) subscale of the Knee

Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measures include

the other four KOOS subscales, the UCLA Activity Score and the EQ-5D. ClinicalTrials.

gov Identifier: NCT01638962 (July 3, 2012).

Findings / Results:

Ninety-three patients (57% women, 58 ± 8 years with a body

mass index of 27 ± 4) were randomized to NEMEX (n = 47) or PHARMA group (n = 46)

with data from 85% (41 and 38 patients, respectively) being available at 12 months

follow-up; 49% of the participants in NEMEX and only 7% in PHARMA demonstrated

good compliance. We found, with a reasonable precision (excluding any likely benefit),

no between-groups difference in patient-reported activities of daily living (KOOS ADL

3.6 [-2.1 to 9.2]; P = 0.216). For the secondary outcome measure KOOS Symptoms, a

statistically significant difference of 7.6 points (2.6 to 12.7; P = 0.004) was observed in

favor of NEMEX. There were no other statistically significant differences.

Conclusions:

The NEMEX group generally demonstrated a trend towards larger self-re-

ported improvements than the PHARMA group, but there was no statistically significant

difference on KOOS ADL after 12 months.

No conflicts of interest reported