Open Access Highly Accessed Research article

Web-based therapeutic exercise resource center as a treatment for knee osteoarthritis: a prospective cohort pilot study

M Alison Brooks1*, John E Beaulieu2, Herbert H Severson3, Christa M Wille4, David Cooper2, Jeff M Gau3 and Bryan C Heiderscheit5

Author Affiliations

1 University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI 53705, USA

2 Visual Health Information, Inc., 11003 A St. South, Tacoma, WA 98444, USA

3 Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA

4 University of Wisconsin-Madison, 4195 Medical Sciences Center, 1300 University Ave, Madison, WI 53706, USA

5 University of Wisconsin-Madison, 4120 Medical Sciences Center, 1300 University Ave, Madison, WI 53706, USA

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BMC Musculoskeletal Disorders 2014, 15:158  doi:10.1186/1471-2474-15-158

Published: 17 May 2014



Although beneficial effects of exercise in the management of knee osteoarthritis (OA) have been established, only 14 -18% of patients with knee OA receive an exercise from their primary care provider. Patients with knee OA cite lack of physician exercise advice as a major reason why they do not exercise to improve their condition. The purpose of this pilot study was to investigate use of a web-based Therapeutic Exercise Resource Center (TERC) as a tool to prescribe strength, flexibility and aerobic exercise as part of knee OA treatment. It was hypothesized that significant change in clinical outcome scores would result from patients’ use of the TERC.


Sixty five individuals diagnosed with mild/moderate knee OA based on symptoms and radiographs were enrolled through outpatient physician clinics. Using exercise animations to facilitate proper technique, the TERC assigned and progressed patients through multiple levels of exercise intensity based on exercise history, co-morbidities and a validated measure of pain and function. Subjects completed a modified short form WOMAC (mSF-WOMAC), World Health Organization Quality of Life (WHO-QOL) and Knee Self-Efficacy Scale (K-SES) at baseline and completion of the 8 week program, and a user satisfaction survey. Outcomes were compared over time using paired t-tests and effect sizes calculated using partial point biserial (pr).


Fifty two participants completed the 8 week program with average duration of knee pain 8.0 ± 11.0 yrs (25 females; 61.0 ± 9.4 yrs; body mass index, 28.8 ± 6.3 kg/m2). During the study period, all outcome measures improved: mSF-WOMAC scores decreased (better pain and function) (p < .001; large effect, pr = 0.70); WHO-QOL physical scores increased (p = .015; medium effect, pr = 0.33); and K-SES scores increased (p < .001; large effect, pr = 0.54). No significant differences were found in study outcomes as a function of gender, age, BMI or symptom duration. Patients reported very positive evaluation of the TERC (94% indicated the website was easy to use; 90% specified the exercise animations were especially helpful).


This pilot study demonstrated the web-based TERC to be feasible and efficacious in improving clinical outcomes for patients with mild/moderate knee OA and supports future studies to compare TERC to current standard of care, such as educational brochures.

Knee osteoarthritis; Internet; Home exercise program