Improvement in upper leg muscle strength underlies beneficial effects of exercise therapy in knee osteoarthritis

While exercise therapy is effective for decreasing pain and activity limitations in patients with knee osteoarthritis (OA), the underlying mechanisms are unclear. This study sought to evaluate if improvements in neuromuscular factors (i.e. upper leg muscle strength and knee proprioception) underlie the beneficial effects of exercise therapy in patients with knee OA. Changes in pain [numeric rating scale (NRS)] and activity limitations [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale and get-up-and-go test] during the study period. Independent variables were changes in upper leg muscle strength and knee joint proprioception (i.e. motion sense) during the study period. Longitudinal regression analyses (generalised estimating equation) were performed to analyse associations between changes in upper leg muscle strength and knee proprioception with changes in pain and activity limitations. Improved muscle strength was significantly related to decreases in NRS pain {B coefficient -2.5 [95% confidence interval (CI) -3.7 to -1.4], meaning that every change of 1 unit of strength was linked to a change of -2.5 units of pain}, WOMAC physical function (-8.8, 95% CI -13.4 to -4.2) and get-up-and-go test (-1.7, 95% CI -2.4 to -1.0). Improved proprioception was not significantly associated with superior outcomes of exercise therapy (P>0.05).

Upper leg muscle strengthening is one of the mechanisms underlying the beneficial effects of exercise therapy in individuals with knee OA.

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