More than a shot: function over pain with tele-supervised resistance exercise added to hyaluronic acid injection in knee osteoarthritis, a randomized add-on trial

Exercise is central to knee osteoarthritis (KOA) care, and intra-articular hyaluronic acid (IAHA) is often used as an adjunct, yet access to supervised exercise after injection is limited. Whether adding tele-supervised resistance band exercise (TSBE) improves outcomes beyond IAHA alone is unclear. Eighty adults with Kellgren–Lawrence grade 1–3 KOA who had not responded adequately to conservative care received a single IAHA injection and were allocated to a 12-week TSBE or standard education without supervised exercise. The between-group difference in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total change favoured TSBE (−5 points, 95% CI − 9.86 to −0.13; p = .044). TSBE also favoured WOMAC physical function (−4.88, 95% CI − 8.28 to −1.47), 30-second sit-to-stand (+3.79 repetitions, 95% CI 2.80 to 4.79), and timed up-and-go (−1.87 s, 95% CI − 2.34 to −1.41), but not VAS pain (−0.38, 95% CI − 1.00 to 0.25). Adding TSBE to IAHA improved function and mobility, with no additional reduction in pain.