Effects of Internet‐Based Neuromuscular Versus Quadriceps Exercise on Pain and Function in Patients With Knee Osteoarthritis: A Single‐Blind Randomized Controlled Trial

BACKGROUND: Exercise and self-management are first-line for knee osteoarthritis (KOA), but evidence on internet-based telerehabilitation comparing specific exercises is limited. We compared a 12-week internet-based neuromuscular exercise (NE) program and a quadriceps exercise (QE) program in community-dwelling patients with symptomatic KOA. METHODS: This single-center, single-blind randomized trial compared 12-week internet-based NE versus QE in community-dwelling adults with symptomatic KOA. The primary outcome: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain. SECONDARY OUTCOMES: WOMAC function, daily activity, pressure pain threshold, self-efficacy, Timed Up and Go, and 6-Min Walk Test. Subjective outcomes were assessed at 0, 6, 12 weeks; objective outcomes were assessed at 0, 12 weeks. Generalized estimating equations with group, time, and group-by-time terms were used for intention-to-treat analyses, adjusted for age, sex, body mass index, and the baseline value. RESULTS: Of 74 randomized participants (NE = 37, QE = 37), 62 completed the 12-week assessment (16.2% discontinued; 18.9% in the NE group, 13.5% in the QE group). Enrollment was below the planned 53 participants per group. At 12 weeks, the adjusted between-group difference in WOMAC pain change was -1.0 points (95% confidence interval [CI], -2.4 to 0.4; p = 0.150; Cohen's d = -0.34); at 6 weeks, it was -0.8 points (95% CI, -1.9 to 0.4; p = 0.188; Cohen's d = -0.33). No statistically significant between-group differences were found in secondary outcomes. CONCLUSIONS: This under-enrolled trial found no significant difference between NE and QE in WOMAC pain at 12 weeks. Both groups showed within-group improvement, but equivalence was not established. Findings should be interpreted cautiously due to limited statistical power.