Long-Term Effects of High-Volume Resistance Training Combined with Pain Neuroscience Education on Pain, Physical Function, Muscle Strength, Pain Modulation, and Quality of Life in Individuals with Knee Osteoarthritis: A Randomized Controlled Trial
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Background: The optimal resistance-training volume and additional value of Pain Neuroscience Education in knee osteoarthritis rehabilitation remain uncertain. Objective: To compare high-volume resistance training combined with Pain Neuroscience Education, moderate-volume resistance training, and standard physiotherapy for symptomatic knee osteoarthritis. Methods: This multicentre, assessor-blinded, three-arm randomized controlled trial included 210 participants allocated equally among the three programmes. Supervised treatment was delivered three times weekly for 12 weeks. Pain, WOMAC, quadriceps strength, functional performance, psychosocial outcomes, pain modulation, biomarkers, and health-related quality of life were assessed at the specified intervention and follow-up time points. Longitudinal outcomes were analysed using linear mixed-effects models under the intention-to-treat principle. Results: At 12 months, NPRS scores were 2.1 ± 0.8, 3.8 ± 1.0, and 5.2 ± 1.3 in the combined, moderate-volume, and standard-physiotherapy groups, respectively ((F=28.64), (p<0.001)). Corresponding WOMAC scores were 26.2 ± 6.1, 39.6 ± 7.4, and 49.8 ± 8.5 ((F=31.27), (p<0.001)), while quadriceps strength was 26.9 ± 4.6, 23.8 ± 4.4, and 20.5 ± 4.1 kg ((F=24.83), (p<0.001)). Week 12 functional, psychosocial, pain-modulation, biomarker, and SF-36 findings also favoured the combined programme. Conclusion: HVRT + PNE was associated with greater and more sustained improvement in pain, WOMAC, and quadriceps strength, although its individual treatment components could not be separated
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