Home exercise reduces knee pain

People with meniscus tear and osteoarthritis those prescribed home exercise, with or without physical therapy, reported substantial improvements in knee painaccording to a new study led by researchers from the Massachusetts General Hospital (Mass General Brigham) of the United States.

Participants who regularly saw a physical therapist for three months, in addition to the home exercise program, reported slightly greater pain relief at the six- and twelve-month follow-ups than those who only exercised at home.

This additional improvement could be due to the interpersonal aspects of working with the therapist, rather than his or her exercise instructions. The results are published in the New England Journal of Medicine.

The study Treatment of Meniscal Problems in Osteoarthritis (TeMPO) was carried out in the Brigham and Women’s Hospital (BWH), the University at Buffalo, the Cleveland Clinic and the University of Pittsburgh, all in the United States. The trial included 879 participants with an average age of 59 years. Participants were randomly assigned to receive exercise at home; home exercise and standard in-clinic physical therapy (PT); or exercise at home and simulated FT in the clinic.

The home exercise program consisted of 25 minutes of stretching and strengthening exercises of the lower extremities four times a week. Participants received a video and handouts to guide them through the exercises at home. In the standard and sham physical therapy groups, participants also saw a physical therapist twice a week for the first month, once a week for the second month, and every two weeks for the third month.

Standard physiotherapy consisted of muscle stretching and strengthening, manual therapy and neuromuscular trainingwhile simulated physical therapy consisted of simulated manual therapy and simulated ultrasound.

The researchers observed no clinically important or statistically significant differences in pain reduction between the groups at three months. However, participants in the standard physical therapy and sham physical therapy groups experienced slight improvement greater pain at six and twelve monthscompared to those who did not see a therapist.

“On average, participants in all groups reported moderately severe pain at the start of the study and much milder pain three, six, and 12 months later,” says lead author Dr. Jeffrey Katz, clinical director of the Orthopedics and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital, a founding member of the Mass General Brigham health system.

“We observe a similar improvement in the standard and sham physical therapy groups, suggesting that personal interactions with a physical therapist may have been more influential than physical therapy itself,” he adds.

Katz explains that the study was designed to mimic the typical half-hour individual physical therapy sessions offered in the US. The findings should be cautiously generalized to settings that employ longer sessions, group sessions, or a different frequency of visits.