A Standardized Rescue Exercise Program for Symptomatic Flare-up of Knee Osteoarthritis: Description and Safety Considerations

STUDY DESIGN: Secondary analysis of clinical trial data. BACKGROUND: Knee osteoarthritis (OA) management has changed significantly over recent decades toward nonpharmacological treatments, particularly exercise. However, the optimal exercise program remains to be established. OBJECTIVE: To describe the implementation of standardized rescue exercises for patients with pain exacerbations and to assess whether performing these benefit or further worsen symptoms in patients with exacerbated symptoms of knee OA. METHODS: The data from 2 randomized controlled studies of exercise in patients with knee OA were used. A supervised, standard exercise program that included standardized rescue exercises to be performed in the event of symptomatic exacerbation, defined as knee pain of greater than 5 on a 0-to-10 numeric pain-rating scale, was conducted for 12 weeks at 3 sessions per week. Pain ratings were obtained before and after each exercise session. RESULTS: Of 131 participants included, 2 never commenced the exercise program, leaving 129 to be included in the analysis. The analysis was observational and thus had no comparison group. During the program, 36 participants (28%) were referred to the rescue exercises. In 63% of the rescue sessions, the participants experienced decreased pain intensity (average +/- SD, -2.6 +/- 2.3), 27% reported no change in pain, and 10% reported increased pain intensity (average +/- SD, 1.3 +/- 0.5). CONCLUSION: Having a predefined and standardized rescue exercise option appears beneficial, and did not result in further worsening of exacerbated knee OA symptoms. The intervention may be particularly relevant for patients with knee OA who have more severe symptoms. LEVEL OF EVIDENCE: Therapy, level 2b. Registered at www.clinicaltrials.gov (NCT01545258 and NCT01945749).