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Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial

BMJ 2002; 325 doi: (Published 05 October 2002) Cite this as: BMJ 2002;325:752
  1. K S Thomas, research associatea,
  2. K R Muir, readerb,
  3. M Doherty, professor of rheumatology (michael.doherty{at},
  4. A C Jones, consultant rheumatologista,
  5. S C O'Reilly, specialist registrara,
  6. E J Bassey, senior lecturer on behalf of the Community Osteoarthritis Research Groupc
  1. aAcademic Rheumatology, City Hospital, Nottingham NG5 1PB
  2. bDepartment of Public Health Medicine and Epidemiology, Queen's Medical Centre, Nottingham NG7 2UH
  3. cSchool of Biomedical Sciences, Queen's Medical Centre
  1. Correspondence to: M Doherty
  • Accepted 20 June 2002


Objectives: To determine whether a home based exercise programme can improve outcomes in patients with knee pain.

Design: Pragmatic, factorial randomised controlled trial of two years' duration.

Setting: Two general practices in Nottingham.

Participants: 786 men and women aged—45 years with self reported knee pain.

Interventions: Participants were randomised to four groups to receive exercise therapy, monthly telephone contact, exercise therapy plus telephone contact, or no intervention. Patients in the no intervention and combined exercise and telephone groups were randomised to receive or not receive a placebo health food tablet.

Main outcome measures: Primary outcome was self reported score for knee pain on the Western Ontario and McMaster universities (WOMAC) osteoarthritis index at two years. Secondary outcomes included knee specific physical function and stiffness (scored on WOMAC index), general physical function (scored on SF-36 questionnaire), psychological outlook (scored on hospital anxiety and depression scale), and isometric muscle strength.

Results: 600 (76.3%) participants completed the study. At 24 months, highly significant reductions in knee pain were apparent for the pooled exercise groups compared with the non-exercise groups (mean difference -0.82, 95% confidence interval -1.3 to -0.3). Similar improvements were observed at 6, 12, and 18 months. Regular telephone contact alone did not reduce pain. The reduction in pain was greater the closer patients adhered to the exercise plan.

Conclusions: A simple home based exercise programme can significantly reduce knee pain. The lack of improvement in patients who received only telephone contact suggests that improvements are not just due to psychosocial effects because of contact with the therapist.


  • Funding Department of Health

  • Competing interests None declared

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