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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BACKGROUND & OBJECTIVE

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.
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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.

METHODS

  • 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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