***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Impairment-based exercise programs have yielded only small to moderate benefits in reducing pain and improving function in people with knee osteoarthritis ( OA ) . It has previously been proposed that adding agility and perturbation training to exercise programs for people with knee OA may improve treatment effects for pain and function . Objective The purpose of this study was to examine the effectiveness of adding agility and perturbation techniques to st and ard exercise therapy compared with the st and ard exercise program alone for people with knee OA . Design This was a single-blinded r and omized controlled trial . Setting The study was conducted in the outpatient physical therapy clinic of a large , university-based health center . Participants One hundred eighty-three people with knee OA ( 122 women , 61 men ) participated . Interventions Participants were r and omly assigned to either a group that received agility and perturbation training with st and ard exercise therapy or a group that received only the st and ard exercise program . Measurements The outcome measures were self-reported knee pain and function , self-reported knee instability , a performance-based measure of function , and global rating of change . Results Although both groups exhibited improvement in self-reported function and in the global rating of change at the 2- , 6- , and 12-month follow-up periods , there were no differences between groups on these outcomes . There was no reduction in knee pain or improvement in performance-based function in either group . Limitations It is possible that more-intense application of the interventions or application of the interventions to participants with knee OA who were at greater risk for falling may have yielded additive effects of the agility and perturbation training approach . Conclusions Both intervention groups exhibited improvement in self-reported function and the global rating of change . Our results , however , did not support an additive effect of agility and perturbation training with st and ard exercise therapy in our sample of individuals with knee OA . Further study is needed to determine whether there are subgroups of individuals who might achieve an added benefit with this approach STUDY OBJECTIVES To underst and reasons for compliance and non-compliance with a home based exercise regimen by patients with osteoarthritis of the knee . DESIGN A qualitative study , nested within a r and omised controlled trial , examining the effectiveness of physiotherapy in reducing pain and increasing mobility in knee osteoarthritis . In the intervention arm , participants undertook a series of simple exercises and repositioning of the kneecap using tape . In depth interviews were conducted with a subset of participants in the intervention arm using open ended questions , guided by a topic schedule , to encourage patients to describe their experiences and reflect on why they did or did not comply with the physiotherapy . Interviews were audiotaped , fully transcribed and analysed thematically according to the method of constant comparison . A model explaining factors influencing compliance was developed . SETTING Patients were interviewed at home . The study was nested within a pragmatic r and omised controlled trial . PARTICIPANTS Twenty participants in the intervention arm of the r and omised trial were interviewed three months after they had completed the physiotherapy programme . Eight were interviewed again one year later . MAIN RESULTS Initial compliance was high because of loyalty to the physiotherapist . Reasoning underpinning continued compliance was more complex , involving willingness and ability to accommo date exercises within everyday life , the perceived severity of symptoms , attitudes towards arthritis and comorbidity and previous experiences of osteoarthritis . A necessary precondition for continued compliance was the perception that the physiotherapy was effective in ameliorating unpleasant symptoms . CONCLUSIONS Non-compliance with physiotherapy , as with drug therapies , is common . From the patient 's perspective , decisions about whether or not to comply are rational but often can not be predicted by therapists or research ers . Ultimately , this study suggests that health professionals need to underst and reasons for non-compliance if they are to provide supportive care and trialists should include qualitative research within trials whenever levels of compliance may have an impact on the effectiveness of the intervention In recent years quality of life instruments have been featured as primary outcomes in many r and omized trials . One of the challenges facing the investigator using such measures is determining the significance of any differences observed , and communicating that significance to clinicians who will be applying the trial results . We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change . Using this approach we have established a plausible range within which the minimal clinical ly important difference ( MCID ) falls . In three studies in which instruments measuring  dyspnea , fatigue , and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item , when responses were presented on a seven point Likert scale . Furthermore , we have established ranges for changes in question naire scores that correspond to moderate and large changes in the domains of interest . This information will be useful in interpreting question naire scores , both in individuals and in groups of patients participating in controlled trials , and in the planning of new trials Background : In patients with knee osteoarthritis ( OA ) , there is a prominent loss in proprioception and kinesthesia sensation compared with control subjects of the same age and gender . Objectives : The aim of this study is the investigation of short-term clinical effects of kinesthesia and balance exercises in patients with knee OA . Methods : This 8-week study was conducted on 66 female patients with knee OA who were r and omized into 2 groups . The first group received kinesthesia and balance exercises ( such as retrowalking , walking on their toes , leaning to the sides , balance board exercises , minitrampoline exercises , plyometric exercises , and so on ) in addition to strengthening exercises . The second group received only strengthening exercises . Results : Statistically significant improvements were observed postexercise for both groups with respect to baseline for WOMAC , SF-36 Form , times for performing activities of daily living , isokinetic quadriceps muscle strength , and proprioceptive sensation levels . In the first group with kinesthesia training , compared with the second group , significantly greater improvements were obtained in all the subparameters that measure functional status ( WOMAC – physical function value , SF-36 Form [ physical function , role limitations –physical and vitality – energy or fatigue variables ] , 10 stairs climbing , and 10-m walking times ) and in isokinetic muscle strength at high angular velocities ( P < 0.05 ) . The absolute angular error percentage ( to assess proprioceptive accuracy ) was significantly improved postexercise in both groups . There were no differences between the groups . Conclusions : Additive positive effects of kinesthesia and balance exercises in knee OA have been demonstrated . Used in clinical applications , they should be able to increase the functional capacities of patients . Long-term studies about efficacy and cost-effectivity of these exercises are needed QUESTION Is four weeks of home-based balance training more effective than four weeks of home-based strength training at decreasing pain in patients with knee osteoarthritis ? DESIGN R and omised trial with concealed allocation and assessor blinding . PARTICIPANTS 48 community volunteers with knee osteoarthritis . INTERVENTION Two groups undertook home-based exercise programs : one group performed balance training and the other performed strength training . Participants performed 30 repetitions/leg/day , 5 days/week for four weeks . OUTCOME MEASURES The Knee injury and Osteoarthritis Outcome Score was used to evaluate pain , which was the primary outcome . Secondary outcomes were the other subscales of the Knee injury and Osteoarthritis Outcome Score ( other symptoms , function in daily living , function in sport and recreation , knee-related quality of life ) , strength , and mobility . RESULTS There was no significant difference between groups for pain ( mean difference -3 points out of 100 , 95 % CI -10 to 5 ) . The only between-group difference in the Knee injury and Osteoarthritis Outcome Score was in knee-related quality of life , where the strength group improved 17 points out of 100 ( 95 % CI 5 to 28 ) more than the balance group . There was no significant difference between groups for strength . The only between-group difference in mobility was in the time taken to walk downstairs , where the strength group improved by 2 s ( 95 % CI 0 to 3 ) more than the balance group . CONCLUSION There was no difference in pain between home-based strength training and home-based balance training in patients with knee osteoarthritis . TRIAL REGISTRATION NCT 00687726 Abstract Background Self-management has become increasingly popular in the management of chronic diseases . There are many different self-management models . Meta analyses of arthritis self-management have concluded that it is difficult to recommend any one program in preference to another due to inconsistencies in the study design s used to evaluate different programs . The Stanford Arthritis Self-Management Program ( ASMP ) , most commonly delivered by trained lay leaders , is a generic program widely used for people with rheumatological disorders . We have developed a more specific program expressly for people with osteoarthritis of the knee ( OAKP ) . It includes information design ed to be delivered by health professionals and results in improvements in pain , function and quality of life . Aim : To determine whether , for people with osteoarthritis ( OA ) of the knee , the OAKP implemented in a primary health care setting can achieve and maintain clinical ly meaningful improvements in more participants than ASMP delivered in the same environment . Methods / Design The effectiveness of the programs will be compared in a single-blind r and omized study . Participants : 146 participants with established OA knee will be recruited . Volunteers with coexistent inflammatory joint disease or serious co-morbidities will be excluded . Interventions : Participants will be r and omised into either  OAKP or ASMP groups and followed for 6 months . Measurements : Assessment s will be immediately before and after the intervention and at 6 months . Primary outcome measures will be WOMAC and SF-36 question naires and a VAS for pain . Secondary outcomes will include balance , tested using a timed single leg balance test and a timed step test and self-efficacy . Data will be analysed using repeated measures ANOVA . Discussion With an aging population the health care costs for people with arthritis are ever increasing . Although cost analysis is beyond the scope of this study , it is reasonable to expect that costs will be greater when health professionals deliver self-management programs as opposed to lay leaders . Consequently it is critical to examine the relative effectiveness of the primary care management strategies available for OA.Trial Registration This study is registered with the Australian New Zeal and Clinical Trials Registry : Objective : To investigate whether alleviation of knee pain influences quadriceps function , proprioceptive acuity , and postural stability in patients with knee osteoarthritis ( OA ) . Methods : A crossover , within-subject , double blind study design involving 68 subjects with painful knee OA . Each subject received an intra-articular injection into one or both knees ( both if symptomatic ) of either 5 ml 0.5 % bupivacaine or 5 ml 0.9 % saline . Two weeks later they received an injection of the alternative agent . Subjects and observer were unaware of the order of injection , which was r and omly assigned . Knee pain ( 100 mm visual analogue scale ) , static postural sway , knee proprioceptive acuity , maximum voluntary contraction ( MVC ) , and percentage activation of the quadriceps were assessed immediately before and one hour after each injection . Results : Significant pain reduction was achieved one hour post-bupivacaine ( mean difference as a percentage change 56.85 , 95 % CI 31.01 to 73.65 ; p<0.001 ) and post-saline ( mean difference as a percentage change 41.94 , 95 % CI 11.57 to 76.66 ; p < 0.001 ) , with no significant difference between the two . Both MVC and activation increased significantly post-bupivacaine ( mean percentage differences 18.83 , 95 % CI −31.79 to −0.26 , and −11.90 , 95 % CI −39.53 to 2.97 , respectively ; both p<0.001 ) and post-saline ( mean percentage differences −7.64 , 95 % CI −21.96 to 4.73 , and −10.71 , 95 % CI −25.19 to 2.60 respectively ; both p<0.001 ) . Proprioception worsened after bupivacaine ( mean percentage difference −28.15 % , 95 % CI −83.47 to 19.74 ; p=0.009 ) , but there was no effect on postural sway ; saline injection had no effects . There was no order effect , and comparison of median percentage changes showed no significant differences between injections for change in MVC , activation , proprioception , or sway . Conclusion : Reduction in knee pain through either peripheral ( local anaesthetic ) or central ( placebo ) mechanisms result ed in increased MVC . This increase , however , did not result in improvements in proprioception or static postural stability , suggesting that other mechanisms play a part in these functions , at least in this acute model INTRODUCTION Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee . The objective of this prospect i ve case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain , range of movement , muscle strength and function , active goniometry , manual strength test and function . METHODS Thirty-eight adults with osteoarthritis of the knee ( > or= 45 years old ) who were referred to the physiotherapy service at the university hospital ( Santa Casa de Misericórdia de São Paulo ) were studied . Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home . They were evaluated for 
    Output:
    
Proprioceptive exercises are efficacious in the treatment of knee OA .
There is some evidence to indicate the effectiveness of proprioceptive exercises compared to general strengthening exercises in functional outcomes