Knee bracing adds small short-term improvement
Adding a compartment-targeted knee brace plus adherence support modestly improved knee symptoms at 6 months compared with advice and home exercises alone.
*Randomized controlled trial; Level 1b (Oxford Centre for Evidence-Based Medicine).

Citation

Holden MA, Nicholls E, Abdali Z, et al. Provision of knee bracing for knee osteoarthritis (PROP OA): multicentre, parallel group, superiority, statistician blinded, randomised controlled trial. BMJ. 2026;392:e086005. doi:10.1136/bmj-2025-086005.

Background

Guidelines disagree on whether knee bracing helps knee osteoarthritis, partly because earlier trials were small and did not support long-term brace use. This trial tested compartment-targeted braces plus strategies to help people keep wearing them.

Patients

466 adults aged ≥45 years in England with symptomatic knee osteoarthritis and moderate-to-severe weight-bearing pain; excluded if recent knee injection/physiotherapy or current brace use, inflammatory arthritis, recent major knee surgery, or planned joint replacement within 6 months.

Intervention

Advice, written information, and home exercise instruction plus a fitted knee brace (type matched to knee compartment), a 2-week follow-up visit, brief adherence coaching, and text-message reminders for 6 months.

Control

Advice, written information, and home exercise instruction in a single visit.

Outcome

Primary: 0–100 composite patient-reported knee score at 6 months (higher is better). Secondary: pain measures and responder status.

Follow-up Period

12 months (primary endpoint: 6 months).

Results

Outcome (6 months) Effect (brace group minus control) Practical meaning
Composite knee score, 0–100 (primary) +3.39 points (95% CI 0.96 to 5.82) Small average improvement
Pain during weight-bearing activity, 0–10 −0.80 (95% CI −1.15 to −0.44) Less pain with activity
Responder status (patient-relevant improvement) 48% vs 33%; NNT ≈7 About 1 extra responder per 7 treated
CI=confidence interval; NNT=number needed to treat.
Analyses followed an intention-to-treat approach (treatment-policy estimand). Minor expected harms occurred; skin irritation was most common (up to about 1 in 5).
A commonly used meaningful-change threshold for the primary score was 8 points; the average between-group difference did not reach this level.

Limitations

Benefits were small and may not be noticeable for many patients. Participants and clinicians could not be blinded; some control participants used braces and received adherence-style counseling, which could shrink differences. The study population was mostly White, limiting generalizability.

Funding

UK National Institute for Health and Care Research; Keele University; braces donated/discounted.

Clinical Application

Offer compartment-targeted bracing as an optional add-on to education and exercises, especially for patients willing to wear it regularly; counsel about modest benefits and skin irritation.