Bennell 2016

Methods	Assessor‐blinded, 3‐arm randomised controlled trial.
Participants	Inclusion criteria: aged > 50 years, knee OA fulfilling ACR criteria, and at least moderate difficulty with daily activities (WOMAC). Exclusion criteria: "systemic arthritic conditions such as rheumatoid arthritis; medical condition precluding safe exercise such as uncontrolled hypertension or heart condition; self‐reported history of serious mental illness, such as schizophrenia, or self‐reported diagnosis of current clinical depression; neurological condition such as Parkinson's disease, multiple sclerosis or stroke; knee surgery including arthroscopy within the past 6 months or total joint replacement; awaiting or planning any back or lower limb surgery within the next 12 months; current or past (within 3 months) oral or intra‐articular corticosteroid use; physiotherapy, chiropractic or acupuncture treatment or exercises specifically for the knee within the past 6 months; walking exercise for >30 minutes continuously daily; participating in a regular (more than twice a week) structured or supervised (or both) exercise programme such as attending exercise classes in a gym or use of a personal trainer; participating in or previous participation in a formal PCST programme; inability to walk unaided; inadequate written and spoken English; inability to comply with the study protocol such as inability to attend physical therapy sessions or attend assessment appointments at the University." Sample size: 222. Exercise group: 75; mean age: 62.7 years (SD 7.9); 44 women; median symptom duration 6 years. Education group: 74; mean age: 63.0 years (SD 7.9); 45 women; median symptom duration 5.5 years. Combined intervention: 73; mean age 64.6 years (SD 8.3); 44 women; median symptom duration 5.5 years. Country: Australia.
Interventions	Providers: physical therapists, with 11 therapists delivering education and education/exercise treatments and 11 therapists delivering exercise treatments. Training: yes. Setting: private practice. Content: CG: education only (pain education and cognitive and behavioural pain coping skills; exercise only group: 6 exercises to strengthen quadriceps, hamstrings, and hip abductor muscles; exercise + education group. Length/intensity: 10 treatments over 12 weeks + home programme.
Outcomes	Outcomes at 12, 32 and 52 weeks: Primary outcomes: mean knee pain intensity over the last week (VAS). physical function (WOMAC). Secondary outcomes: mean knee pain on walking in the past week (VAS); WOMAC pain subscale; Assessment of quality of life (AQoL‐6D); Physical Activity Scale for the Elderly; Arthritis Self‐Efficacy Scale; Pain Catastrophizing Scale; coping attempts (score of the Coping Strategies Questionnaire); Depression, Anxiety, Stress Scales in 21 items; global rating of change overall, in pain and in function; maximum isometric quadriceps strength; performance measures (30 second sit to stand test, 20‐m fast‐paced walking velocity); dynamic standing balance (step test).
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated random numbers table used for allocations, which were sealed in an envelope by an independent person.
Allocation concealment (selection bias)	Low risk	Envelopes opened by another independent person who emailed the therapist shortly before the next participant attended.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Therapists not blinded. Participants blinded to study hypotheses but not to intervention.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcome assessors blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Loss to follow‐up from 222 participants: 21 at 12 weeks (9.5%), 41 (27.9%) at 32 weeks and 36 (44.1%) at 52 weeks.
Selective reporting (reporting bias)	Low risk	Results reported for all variables.
Other bias	Low risk