The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs.
OBJECTIVE
To identify effective strengthening exercise programs and provide rehabilitation teams and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis.


METHODS
A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+ or D-) was based on statistical significance ( p < 0.5) and clinical importance (⩾15% improvement).


RESULTS
The 26 high-quality studies identified demonstrated that various strengthening exercise programs with/without other types of therapeutic exercises are generally effective for improving knee osteoarthritis management within a six-month period. Strengthening exercise programs demonstrated a significant improvement for pain relief (four Grade A, ten Grade B, two Grade C+), physical function (four Grade A, eight Grade B) and quality of life (three Grade B). Strengthening in combination with other types of exercises (coordination, balance, functional) showed a significant improvement in pain relief (three Grade A, 11 Grade B, eight Grade C+), physical function (two Grade A, four Grade B, three Grade C+) and quality of life (one Grade A, one Grade C+).


CONCLUSIONS
There are a variety of choices for strengthening exercise programs with positive recommendations for healthcare professionals and knee osteoarthritis patients. There is a need to develop combined behavioral and muscle-strengthening strategies to improve long-term maintenance of regular strengthening exercise programs.
1 Physiotherapy Program, University of Ottawa, Ottawa, Ontario, Canada.
Lucie
L
Brosseau
2 Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Jade
J
Taki
3 School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.
Brigit
B
Desjardins
3 School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.
Odette
O
Thevenot
4 Faculty of Health Sciences, University of Sydney, Sydney, Australia.
Marlene
M
Fransen
5 School of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada.
George A
GA
Wells
6 UNIFESP, Internal Medicine, Brasilia, Brazil.
Aline
A
Mizusaki Imoto
7 Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Karine
K
Toupin-April
8 Physical Therapy Teaching Supervisor, University of British Columbia, Vancouver, British Columbia, Canada.
Marie
M
Westby
9 Department of Physical Education and Sport, University of Granada, Granada, Spain.
Inmaculada C
IC
Álvarez Gallardo
10 School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
Wendy
W
Gifford
11 Canadian Forces Health Services Group Headquarters, National Defense, Ottawa, Ontario, Canada.
Lucie
L
Laferrière
12 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
Prinon
P
Rahman
13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Laurianne
L
Loew
13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Gino
G
De Angelis
13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Sabrina
S
Cavallo
13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Shirin Mehdi
SM
Shallwani
13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Ala'
A
Aburub
14 Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia.
Kim L
KL
Bennell
15 Department of Rehabilitation, Reade Centre for Rehabilitation and Rheumatology, Amsterdam, Netherlands, Faculty of Health. ACHIEVE, Centre of Applied Research and School of Physiotherapy, University of Applied Sciences, Amsterdam, Netherlands.
Martin
M
Van der Esch
16 Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.
Milena
M
Simic
17 Department of Medicine, St. Joseph's Health Care Centre, Toronto, Ontario, Canada.
Sara
S
McConnell
18 Faculty of Health Sciences, Clinical and Rehabilitation Sciences Research Group, University of Sydney, Sydney, Australia.
Alison
A
Harmer
19 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Glen P
GP
Kenny
20 The Arthritis Society, Ottawa Office, Ontario Division, Ottawa, Ontario, Canada.
Gail
G
Paterson
21 Centre de recherche Epidémiologie et Biostatistique, Hôpital Hôtel-Dieu, Paris, France.
Jean-Philippe
JP
Regnaux
22 Institute of Rheumatology, Department of Medicine and Rehabilitation, Cochin Hospital, Paris, France.
Marie-Martine
MM
Lefevre-Colau
23 Full Professor, Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Linda
L
McLean
D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000379:methods / Q000592:standards; D006801:Humans; D052580:Muscle Stretching Exercises / Q000379:methods / Q000592:standards*; D020370:Osteoarthritis, Knee / Q000534:rehabilitation*; D059408:Pain Management / Q000379:methods*; D017410:Practice Guidelines as Topic; D055070:Resistance Training / Q000379:methods / Q000592:standards*
Therapeutic exercise; clinical practice guideline; knee osteoarthritis; strengthening exercises; systematic review