Exercise and education vs intra-articular saline for knee osteoarthritis: a 1-year follow-up of a randomized trial

Review written by Dr Anthony Teoli info

Key Points

  1. The GLAD program does not appear to provide longer-term beneficial effects that exceed those of intra-articular saline injections at 1-year follow-up in patients with knee osteoarthritis.
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Knee osteoarthritis (OA) is a very common musculoskeletal condition which affects the older population, causing pain, physical disability and reduced quality of life (1). Patient education and exercise have been recommended as a primary treatment strategy for those who suffer from knee osteoarthritis (2-4).

A recent randomized controlled trial (RCT) compared the effects of the Good Life with osteoarthritis in Denmark (GLAD) program (8 weeks of exercise and education) with an open-label placebo given as intra-articular (IA) saline injections in patients with knee osteoarthritis (OA) (5). Both interventions provided the same efficacy for pain and function after 9 and 12 weeks from baseline (5).

The authors of this study extended their trial to assess whether the GLAD program was superior to open-label placebo (IA saline) at 1-year follow-up. The secondary objective was to determine which subgroups of patients would most likely benefit from the GLAD program over the open-label placebo.

Patient education and exercise has been recommended as a primary treatment strategy for those who suffer from knee osteoarthritis.
A significant portion of the improvements in pain following exercise and education can be explained by placebo response phenomena, contextual factors, natural course of the disease and regression to the mean.


  • Patients with symptomatic knee OA were assessed at 1 year from baseline after being randomized to the 8-week GLAD program or an open-label placebo given as four IA saline injections over 8 weeks (week 1, 3, 5 and 7).
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