Major NEJM Study Confirms that Exercise and PT Help Ease Knee Pain

Published on Oct. 30 in the New England Journal of Medicine, the clinical trial was designed to investigate the efficacy of physical therapy and exercise in adults with knee osteoarthritis and meniscal tear; about a quarter of adults suffer from these issues. The meniscus is the tough, rubbery cartilage that absorbs shock to the knee.

The Treatment of Meniscal Problems in Osteoarthritis (TeMPO) study was conducted at Brigham and Women’s Hospital, the University at Buffalo, Cleveland Clinic, and the University of Pittsburgh.

“We know that physical therapy is effective for meniscal tears, but we don’t know which factors are most important,” says Leslie J. Bisson, MD, June A. and Eugene R. Mindell, MD, Professor and Chair, Department of Orthopaedics in the Jacobs School of Medicine and Biomedical Sciences and president of UBMD Ortho. “This trial tried to separate out the effect of exercise versus interaction with a physical therapist.”

The research showed that all trial participants with knee osteoarthritis, meniscal tear, and knee pain improved. Participants who received a home exercise program as well as standard or sham physical therapy (PT) had a small additional improvement compared with those who received the home exercise program without PT. Outcomes in those receiving standard and sham PT were similar. (A sham intervention acts as a control arm in a research study, similar to a placebo in a trial testing a new drug.)

“This critical study and the enthusiastic participation of so many Western New Yorkers underscores the powerful connection between clinical care and our research mission,” says Allison Brashear, MD, MBA, UB's vice president for health sciences, dean of the Jacobs School and president and CEO of UBMD Physicians’ Group. “We are deeply grateful to the patients of UBMD Orthopaedics and Sports Medicine and to all who participated in this study and in the research our faculty pursue in collaboration with our community.”

The trial involved a total of 879 participants with an average age of 59. More than half — 51.5% — were enrolled through the physical therapy divisions of UBMD Ortho’s sites in Orchard Park and Williamsville, 30.6% were enrolled at the Boston site, 9.9% at the Pittsburgh site, and 8.3% at the Cleveland site.

“We are proud of the contribution UB made to this important study,” says Bisson. “Patients were enrolled from UBMD Orthopaedics, and our providers and patients were very engaged.”

Participants were randomized to receive home exercise, home exercise and standard in-clinic PT, or home exercise and in-clinic sham PT.

The home exercise program consisted of 25 minutes of lower extremity stretching and strengthening exercises four times per week. Participants received a video and pamphlets to guide them through the home exercises. In the standard and sham PT arms, participants also saw a physical therapist two times a week in the first month, weekly in the second month and every other week in the third month. Standard PT consisted of muscle stretching and strengthening, manual therapy and neuromuscular training, while sham PT consisted of sham manual therapy and sham ultrasound.

Participants who had regular visits with a physical therapist over three months, in addition to the home exercise program, reported slightly greater pain relief at the six- and 12-month follow-up timepoints than those who had home exercise alone.

“All patients were treated with an exercise program and all improved substantially,” says Bisson. He adds that there seemed to be a small additional effect that was obtained by the patients interacting with a physical therapist.

“The study shows that treatment can be individualized and even just home exercises can lead to substantial improvement,” Bisson concludes.

The study was designed to mimic typical one-on-one, half-hour PT sessions offered in the U.S. The researchers note that findings should be generalized cautiously to settings that employ longer sessions, group sessions or different visit frequency. 

Corresponding author on the study is Jeffrey N. Katz, MD, professor at Harvard Medical School and clinical director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital—Mass General Brigham. 

In addition to Bisson, faculty co-authors from UB are Michael Freitas, MD, of the Department of Family Medicine, and William Wind Jr., MD, and John J. Leddy, MD, of the Department of Orthopaedics. Kelly Jordan, Melissa A. Kluczynski and Peter Tonsoline, all UBMD Ortho providers, were also co-authors.

The research was supported primarily by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.