Additional Benefits of Creatine Supplementation with Physical Therapy and Resistance Exercise in Knee Osteoarthritis: A Randomized Controlled Trial

<b>Background</b>: Knee osteoarthritis (KOA) is a progressive joint disorder that leads to pain, functional limitations, and reduced quality of life. While physical therapy (PT) and resistance exercise are effective in managing KOA, creatine supplementation (CS) may provide additional benefits. <b>Aims/Objectives</b>: To determine the additive effects of creatine supplementation alongside physical therapy (PT) and resistance exercise training in individuals with KOA. <b>Methods</b>: A parallel-design, double-blind, randomized controlled trial was conducted on 40 patients with KOA (≤grade III on Kellgren classification), aged 40-70 years. Participants were randomly allocated to either a placebo control group, which received placebo supplementation (maltodextrin) along with PT, including heat therapy, electrotherapy, manual therapy, and resistance exercises, for four weeks, or an experimental group, which received CS instead of maltodextrin in addition to the same treatment. Outcome measures included the visual analog scale (VAS), fall risk, Knee Injury and Osteoarthritis Outcome Score (KOOS), isometric muscle strength (IMS), five-repetition sit-to-stand test (5xSST), knee range of motion (ROM), and body composition analysis. <b>Results</b>: No significant differences were observed between the two groups at baseline. After four weeks of treatment, a significant interaction effect (treatment group x time) was observed for VAS (<i>p</i> = 0.001), fall risk score (<i>p</i> < 0.001), KOOS overall score (<i>p</i> < 0.001), IMS (<i>p</i> < 0.001), and body composition parameters (<i>p</i> < 0.05) in favor of the CS group. However, no significant interaction effect was observed for knee ROM and KOOS QOL subscale. <b>Conclusions</b>: CS, when combined with PT and resistance exercise, may provide additional benefits in terms of pain, function, muscle strength, and body composition parameters in individuals with KOA. However, no supplementary benefits of CS are observed in terms of quality of life and ROM.