Optimizing Clinical and Functional Outcomes in Knee Osteoarthritis Patients: The Role of Pneumatic Unloading Braces and Resistance Exercises

To assess the impact of a pneumatic unloader brace and/or specific hip and knee strengthening exercises over a twelve week intervention period on pain reduction, quality of life, and functional outcomes in patients with knee osteoarthritis with varus deformity.

Participants were selected based on pain and disability assessments, along with radiographic confirmation of grade 3 knee osteoarthritis according to the Kellgren-Lawrence scale.  48 participants were randomly assigned to two groups: Group A (n=22), which wore a pneumatic unloading brace for three hours daily in addition to performing hip and knee strengthening exercises for 12 weeks, and Group B (n=26), which performed  the same strengthening exercises for the same duration without the use of the brace.

 Outcome Measures:

• Pain: Visual Analogue Scale (VAS)
• Disability: WOMAC Index
• Function and mobility: 6-Minute Walk Test (6MWT)
• Quality of Life: Short Form 36: Subscales: Physical function (PF), Role limitation of Physical function (RP), Body pain (BP), General health (GH), Vitality (VT), Social function (SF), Role limitation of emotional function (RE), Mental health (MH)
• Lower extremity strength: 5 Times Sit-to-Stand Test (5 x STS)

Both groups showed significant improvements within their interventions. Group A achieved better results in the 6-Minute Walk Test (6MWT) with a mean distance of 841.45 ± 267 feet, compared to 806.32 ± 255 feet in Group B. Additionally, Group A outperformed Group B in the 5 Times Sit-to-Stand (5x STS) test, recording a mean time of 14.06 ± 4.76 seconds versus 16.67 ± 5.77 seconds. Group A also had lower WOMAC Index scores (29.64 ± 11.26) compared to Group B (34.46 ± 12.68). While these differences did not achieve statistical significance, significant improvements were noted in the Role Limitation (RP) and General Health (GH) subscales of the SF-36 in Group A, indicating enhanced physical activity and overall health outcomes.

Comparing effects of both interventions, the combination of exercises and  pneumatic unloader brace demonstrated superior outcomes for physical activity limitations and general health. 

The favorable response to exercise and bracing has significant implications, as it may delay or potentially eliminate the need for surgical intervention in the future.