People with painful knee osteoarthritis find that using a knee brace helps them to manage their symptoms, according to the results of a study led by two researchers with a background in physiotherapy.

They are Melanie Holden, who is a professor of musculoskeletal rehabilitation at Keele University, and Professor George Peat, a professor of clinical epidemiology at Sheffield Hallam University.  

Professors Holden and Peat are the first and last authors of a study, known as PROP OA, the results of which were published in the British Medical Journal last week (26 January). The study was conducted was carried out in the NHS in collaboration with researchers based in universities in the UK, USA and Australia. It was funded by the National Institute for Health and Care Research (NIHR). 

In the randomised controlled trial, some participants with osteoarthritis received a tailored knee brace intervention from their physiotherapist together with self-management advice and an exercise plan. Compared to their counterparts who received the advice and exercise plan alone, they reported a greater improvement in their symptoms. 

Scale of problem

About one adult in five aged over 45 is affected by painful knee osteoarthritis, which often causes significant long-term pain, lost time and productivity at work, and problems with daily activities. The researchers in this study wanted to investigate whether a knee brace might provide lasting benefit. 

‘Our study is the world’s largest independent trial of knee bracing for knee osteoarthritis, and shows that a tailored knee brace, alongside advice and exercise, is a low-risk option that patients may find worthwhile’ [Melanie Holden]

In this clinical trial, 466 people with knee osteoarthritis were assessed by a physiotherapist and then randomly assigned to one of two groups; one group received advice, written information, and an exercise plan; the other group received the same support but with the addition of a knee brace. 

The type of brace was chosen to match an individual’s pattern of knee osteoarthritis. Participants were shown how to fit the brace, had a follow-up appointment, and received text messages over the next six months to encourage ongoing knee brace use. 

The participants were asked to complete questionnaires at three months, six months and one year later to see how their symptoms had changed. 

Key findings

The findings showed that those randomised to the knee brace group had less pain, better physical function, and higher quality of life outcomes compared to the group who received the advice and exercise plan alone. There were no serious harms, but skin rubbing or irritation from knee braces was common. 

Although the benefits were small, and reduced over 12 months, the participants who used their brace as often as they were advised were the ones who saw the greatest improvement. 

Overall, these findings show that while the extra benefits from a knee brace are typically small and reduce over time, people with osteoarthritis may still find them worthwhile for self-managing their condition. 

Professor Holden said: ‘There has been little high-quality evidence on whether knee braces help people with knee osteoarthritis. Our study is the world’s largest independent trial of knee bracing for knee osteoarthritis, and shows that a tailored knee brace, alongside advice and exercise, is a low-risk option that patients may find worthwhile.’

She added: ‘This NIHR-funded research was only made possible through close collaboration between universities, the NHS, physiotherapists and the patients who took part, and we are incredibly grateful to everyone involved.’ 

Professor Peat noted: ‘We know that millions of people spend years living with painful knee osteoarthritis. Many really want to find effective treatment options that do not rely on long-term medication or surgery. Self-management, maintaining a healthy weight, and exercise are the cornerstone of management.’

He added: ‘This trial provides the clearest and most rigorous evidence yet that knee braces, tailored to the type of knee osteoarthritis and provided by trained professionals, provide some additional benefits for pain control and daily activities, particularly if they are used consistently over time.’

To access the full version of the paper – titled Provision of knee bracing for knee osteoarthritis (PROP OA): multicentre, parallel group, superiority, statistician blinded, randomised controlled trial – click

Image: Shutterstock