{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T02:04:04Z","timestamp":1778119444405,"version":"3.51.4"},"reference-count":40,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T00:00:00Z","timestamp":1669334400000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004928","name":"Danske Fysioterapeuter","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100004928","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Union\u2019s Horizon 2020 Research and Innovation program","award":["No 801790"],"award-info":[{"award-number":["No 801790"]}]},{"name":"European Union\u2019s Horizon 2020 Research and Innovation program","award":["No 945377"],"award-info":[{"award-number":["No 945377"]}]},{"DOI":"10.13039\/100008368","name":"Gigtforeningen","doi-asserted-by":"publisher","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/100008368","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The main objective was to investigate 5-year outcomes in patients with knee osteoarthritis, randomised to one of two non-surgical treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Two outpatient clinics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>At baseline, 100 patients with radiographic and symptomatic knee osteoarthritis not found eligible for knee replacement (KR) were included. Main exclusion criteria were average score above 75 of the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, function of daily living and quality of life; KOOS<jats:sub>4<\/jats:sub>and average knee pain the previous week greater than 60\u2009mm on a 100\u2009mm visual analogue scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Patients were randomised to supervised non-surgical treatment consisting of patient education, supervised exercise, weight loss, insoles, and pain medication (the MEDIC treatment) or written advice. The 12-week MEDIC treatment included patient education, neuromuscular exercise, insoles and a dietary weight loss programme and\/or pain medication if needed and written advice consisted of two leaflets.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary and secondary outcome measures<\/jats:title><jats:p>Primary outcome was 5-year mean change for KOOS<jats:sub>4<\/jats:sub>. Secondary outcomes included KOOS subscales, self-reported health, usage of pain medication and self-reported physical activity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty-nine (78%) and 36 (72%) from the MEDIC and written advice groups responded at 5\u2009years. There were no between-group differences in KOOS<jats:sub>4<\/jats:sub>(difference 5.3 (95% CI \u22121.5 to 12.1) or any secondary outcomes. However, the 95%\u2009CI included the minimal clinically important difference for the main outcome.<\/jats:p><jats:p>Seventy-six percent of the MEDIC group and 66% of the written advice group experienced clinically important improvements in KOOS<jats:sub>4<\/jats:sub>.<\/jats:p><jats:p>Fifteen patients (30%) from the MEDIC group and 17 (34%) from the written advice group received KR in the index knee. Undergoing KR did not result in a statistically significant greater improvement in KOOS<jats:sub>4<\/jats:sub>(difference 6.1 (95% CI \u22121.1 to 13.4).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>No statistically significant differences between supervised non-surgical treatment and written advice were demonstrated at 5\u2009years. Most patients experienced clinically important improvements, irrespective of initial treatment strategy or KR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT01535001\">NCT01535001<\/jats:ext-link>; ClinicalTrials.gov.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2021-060169","type":"journal-article","created":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T14:32:34Z","timestamp":1669386754000},"page":"e060169","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Five-year follow-up of patients with knee osteoarthritis not eligible for total knee replacement: results from a randomised trial"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct01535001","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01535001","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3077-7913","authenticated-orcid":false,"given":"Jesper Bie","family":"Larsen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5425-2199","authenticated-orcid":false,"given":"Ewa M","family":"Roos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mogens","family":"Laursen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7314-2152","authenticated-orcid":false,"given":"Sinead","family":"Holden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9790-0985","authenticated-orcid":false,"given":"Martin Nygaard","family":"Johansen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael Skovdal","family":"Rathleff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"Arendt-Nielsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8664-352X","authenticated-orcid":false,"given":"Sten","family":"Rasmussen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4336-7059","authenticated-orcid":false,"given":"S\u00f8ren T","family":"Skou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,11,25]]},"reference":[{"key":"2022120903405308000_12.11.e060169.1","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2014.44"},{"key":"2022120903405308000_12.11.e060169.2","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.joca.2016.09.011","article-title":"Productivity costs of work loss associated with osteoarthritis in Canada from 2010 to 2031","volume":"25","author":"Sharif","year":"2017","journal-title":"Osteoarthritis Cartilage"},{"key":"2022120903405308000_12.11.e060169.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"2022120903405308000_12.11.e060169.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1505467"},{"key":"2022120903405308000_12.11.e060169.5","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1016\/j.joca.2019.06.004","article-title":"Lifetime risk of knee and hip replacement following a GP diagnosis of osteoarthritis: a real-world cohort study","volume":"27","author":"Burn","year":"2019","journal-title":"Osteoarthritis Cartilage"},{"key":"2022120903405308000_12.11.e060169.6","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.joca.2016.11.005","article-title":"Substantial rise in the lifetime risk of primary total knee replacement surgery for osteoarthritis from 2003 to 2013: an international, population-level analysis","volume":"25","author":"Ackerman","year":"2017","journal-title":"Osteoarthritis Cartilage"},{"key":"2022120903405308000_12.11.e060169.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2019.06.011"},{"key":"2022120903405308000_12.11.e060169.8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-212662"},{"key":"2022120903405308000_12.11.e060169.9","doi-asserted-by":"crossref","unstructured":"Kolasinski SL , Neogi T , Hochberg MC . 2019 American College of Rheumatology\/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. 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