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Neuromuscular training (i.e. balance, agility, coordination) programs in combination with traditional exercise could be used to improve performance-based function and walking speed for treatment of knee osteoarthritis.
Strength of Recommendation: Moderate (downgrade): Evidence from two or more “Moderate” quality studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention. Also requires no or only minor concerns addressed in the EtD framework.
Rationale: Three high quality studies (Fitzgerald 2011, Gomiero 2018, Apparao 2017) and two moderate quality studies (Bennell 2014 and Diracoglu 2005) comparing neuromuscular training combined with traditional strength and joint mobility exercise programs to strength and joint mobility exercise alone were reviewed. There were no differences in knee pain reported between groups in any of the studies. There were mixed results on function measures with two studies reporting greater improvements in self-reported function (Apparao 2017, Diracoglu 2005) and two studies reporting greater improvements in walking speed (Bennell 2014, Diracoglu 2005) for the neuromuscular training group.
The Neuromuscular training recommendation has been downgraded one level because of inconsistent evidence.
Benefits/Harms of Implementation: Some patients can expect an improvement in function and walking speed with neuromuscular training. Some patients may experience a temporary increase in knee pain or muscle soreness when engaging in the exercise program.
Feasibility: Neuromuscular exercise programs would be considered feasible. However, some patients may have difficulty with access to supervised exercise due to travel or co-pay concerns.
Future Research: Given the mixed results between exercise programs with and without neuromuscular exercise programs, it would be beneficial for future research to identify factors that would discriminate between patients who would have better success with a neuromuscular exercise program versus those who would have better success with a traditional strength and joint mobility exercise program.
