Knee Bracing Adds Modest Pain Relief in Osteoarthritis, BMJ Trial Find
UK: Adding compartment-specific knee bracing to standard non-surgical care offers a small but meaningful benefit for adults with knee osteoarthritis, according to findings from a large randomised controlled trial published in The BMJ. The study, led by Professor Melanie A Holden from Keele University, suggests that knee bracing, when combined with advice, education, exercise, and adherence support, can modestly improve patient-reported outcomes, particularly pain, over the short to medium term.
Knee osteoarthritis is a highly prevalent condition worldwide and remains a major contributor to pain, disability, and reduced quality of life. While education, exercise, and weight management form the cornerstone of conservative management, the role of knee bracing has remained uncertain due to inconsistent guideline recommendations and limited high-quality evidence. The Provision of Knee Bracing for Knee Osteoarthritis (PROP OA) trial was designed to address this gap.
The multicentre, parallel-group, superiority trial enrolled 466 adults aged 45 years or older with symptomatic knee osteoarthritis across four regions in England between 2019 and 2022. Participants were randomly assigned to receive either standard care—consisting of advice, written information, and exercise instruction delivered by a physiotherapist—or the same care supplemented with a compartment-specific knee brace and structured adherence support.
Patients in the bracing group were fitted with patellofemoral, tibiofemoral unloading, or neutral stabilising braces based on their predominant pattern of knee involvement. To encourage consistent use, the intervention also included brief motivational interviewing, follow-up consultations, and targeted text message reminders over six months.
The primary outcome was the change in the Knee Osteoarthritis Outcomes Score (KOOS-5) at six months.
The study led to the following findings:
- Participants who received knee bracing in addition to standard care showed greater improvement in KOOS-5 scores than those receiving standard care alone.
- The improvement with knee bracing was modest but statistically significant at three and six months.
- By 12 months, the difference between the two groups was no longer statistically significant.
- Pain relief was the most pronounced benefit of adding knee bracing to standard care.
- Improvements in pain and activities of daily living were consistently greater in the bracing group, with the largest benefits seen at six months.
- Better adherence to brace use was associated with greater clinical improvement, underscoring the importance of consistent use.
- Adverse events were generally mild, predictable, and similar between groups, mainly involving temporary skin irritation or discomfort.
- No serious or unexpected safety concerns related to knee bracing were reported.
The authors concluded that while knee bracing does not lead to dramatic improvements, it provides a safe and acceptable adjunct to standard conservative care for knee osteoarthritis. They emphasized that treatment decisions should consider patient preferences, symptom severity, and the likelihood of adherence, rather than relying solely on average effect sizes.
Overall, the PROP OA trial offers robust evidence supporting the selective use of compartment-specific knee bracing as part of a broader, individualized management strategy for knee osteoarthritis.
Reference: BMJ 2026;392:e086005
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