Mikesky 2006

Methods	Randomised controlled trial.
Participants	Inclusion criteria: adults aged > 55 years with knee OA, considered to be present if 1 or both knees exhibited grade 2 or higher OA by Kellgren and Lawrence (K/L) criteria. Knee pain was considered to be present if participants reported moderate or greater knee pain in the past month (i.e. a rating of ≥3 on a 5‐point Likert scale) for any of the 5 items of the WOMAC pain scale. Exclusion criteria: inability to walk without assistance; amputation of either lower extremity; knee or hip replacement; history of stroke, myocardial infarction, congestive heart failure, uncontrollable hypertension, fibromyalgia, rheumatoid arthritis or other systemic connective tissue disease; lower‐extremity neuropathy; severe cognitive impairment. Country: US. Sample number: IG: 82; CG: 80. Mean age: 69 years. Progress Plus: 84% women.
Interventions	Provider(s): fitness trainer. Training: yes. Setting: National Institute for Fitness and Sport and home based. Content: strength training. Length/intensity: exercise 3 times a week (twice at a fitness facility, once at home) for 12 weeks, followed by transition to home‐based exercise after 12 months. Comparator: attention placebo/alternative intervention; range of motion exercises.
Outcomes	At 30 months: pain (WOMAC); function (WOMAC); depression (CES‐D).
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Stratified randomisation scheme allocated participants into 8 groups on the basis of sex and the presence of radiographic evidence of knee OA and knee pain.
Allocation concealment (selection bias)	High risk	No information provided.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and providers not blind to treatment allocation.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Blinded outcome assessor.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Breakdown of attrition by group for each follow‐up period not provided. Attrition: entire sample: 30% (66/221); IG: 36%; CG: 24%. Reasons for dropout not reported in full. However, authors described that primary reason was time and travel involved in participating. ITT analysis.
Selective reporting (reporting bias)	Low risk	Selective outcome not apparent.
Other bias	Low risk	No other bias detected.