title: Knee joint stabilization therapy in patients with osteoarthritis of the knee: a randomized, controlled trial.
abstract: OBJECTIVE
  To investigate whether an exercise program, initially focusing on knee stabilization and subsequently on muscle strength and performance of daily activities is more effective than an exercise program focusing on muscle strength and performance of daily activities only, in reducing activity limitations in patients with knee osteoarthritis (OA) and instability of the knee joint.
  
  
  METHODS
  A single-blind, randomized, controlled trial involving 159 knee OA patients with self-reported and/or biomechanically assessed knee instability, randomly assigned to two treatment groups. Both groups received a supervised exercise program for 12 weeks, consisting of muscle strengthening exercises and training of daily activities, but only in the experimental group specific knee joint stabilization training was provided. Outcome measures included activity limitations (Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC physical function, primary outcome), pain, global perceived effect and knee stability.
  
  
  RESULTS
  Both treatment groups demonstrated large (∼20-40%) and clinically relevant reductions in activity limitations, pain and knee instability, which were sustained 6 months post-treatment. No differences in effectiveness between experimental and control treatment were found on WOMAC physical function (B (95% confidence interval - CI) = -0.01 (-2.58 to 2.57)) or secondary outcome measures, except for a higher global perceived effect in the experimental group (P = 0.04).
  
  
  CONCLUSIONS
  Both exercise programs were highly effective in reducing activity limitations and pain and restoring knee stability in knee OA patients with instability of the knee. In knee OA patients suffering from knee instability, specific knee joint stabilization training, in addition to muscle strengthening and functional exercises, does not seem to have any additional value. Dutch Trial Register (NTR) registration number: NTR1475.
authors.affiliation: Amsterdam Rehabilitation Research Center, Reade, The Netherlands. j.knoop@reade.nl
authors.forename: J
authors.initials: J
authors.lastname: Knoop
authors.forename: J
authors.initials: J
authors.lastname: Dekker
authors.forename: M
authors.initials: M
authors.lastname: van der Leeden
authors.forename: M
authors.initials: M
authors.lastname: van der Esch
authors.forename: C A
authors.initials: CA
authors.lastname: Thorstensson
authors.forename: M
authors.initials: M
authors.lastname: Gerritsen
authors.forename: R E
authors.initials: RE
authors.lastname: Voorneman
authors.forename: W F
authors.initials: WF
authors.lastname: Peter
authors.forename: M
authors.initials: M
authors.lastname: de Rooij
authors.forename: S
authors.initials: S
authors.lastname: Romviel
authors.forename: W F
authors.initials: WF
authors.lastname: Lems
authors.forename: L D
authors.initials: LD
authors.lastname: Roorda
authors.forename: M P M
authors.initials: MP
authors.lastname: Steultjens
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D020370:Osteoarthritis, Knee / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D010147:Pain Measurement / Q000379:methods; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Exercise therapy; Knee osteoarthritis; Knee stability; Randomized trial