This recommendation is rated strong because of seven highstrength studies of which five showed beneficial outcomes. The exercise interventions were predominantly conducted under supervision, most often by a physical therapist. The selfmanagement interventions were led by various healthcare providers including rheumatologists, nurses, physical and occupational therapists, and health educators. The evidence supports the use of selfmanagement programs in primary care patients with knee osteoarthritis. One of the studies used an existing evidencebased program, the Arthritis SelfManagement Program (ASMP), which was modified to include an exercise component. In a highstrength study by Coleman et al., patients in a 6week self-management program demonstrated statistically significant and possibly minimum clinically important improvements in WOMAC Pain, Stiffness, Function, and Total scores at eight weeks as compared to waitlisted controls. The program in that study was based on the same theoretical framework as the ASMP, but included content that was specifically tailored to patients with knee osteoarthritis.
Studies in this review reported improvements in 29 of 37 outcomes favoring strength training over a control (usual care, education, or no treatment). Statistically significant and clinically important improvements were reported for VAS Pain, WOMAC Pain, and WOMAC Function scores.