Limited effect of a self-management exercise program added to spa therapy for increasing physical activity in patients with knee osteoarthritis: a quasi-randomized controlled trial.

•We confirm the efficacy of spa therapy in knee osteoarthritis (KOA) for pain and disability.•We show for the first time that spa therapy may help increase physical activity in patients with KOA, with limited effect of an additional self-management exercise program.•The benefits of a self-management education program were a significant alleviation of fears and beliefs about KOA and physicians (KOFBeQ) and anxiety (HAD) at 3 months after treatment.