A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol (original) (raw)
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Annals of the Rheumatic Diseases, 2005
Objective: To determine whether a multimodal physiotherapy programme including taping, exercises, and massage is effective for knee osteoarthritis, and if benefits can be maintained with self management. Methods: Randomised, double blind, placebo controlled trial; 140 community volunteers with knee osteoarthritis participated and 119 completed the trial. Physiotherapy and placebo interventions were applied by 10 physiotherapists in private practices for 12 weeks. Physiotherapy included exercise, massage, taping, and mobilisation, followed by 12 weeks of self management. Placebo was sham ultrasound and light application of a non-therapeutic gel, followed by no treatment. Primary outcomes were pain measured by visual analogue scale and patient global change. Secondary measures included WOMAC, knee pain scale, SF-36, assessment of quality of life index, quadriceps strength, and balance test. Results: Using an intention to treat analysis, physiotherapy and placebo groups showed similar pain reductions at 12 weeks: 22.2 cm (95% CI, 22.6 to 21.7) and 22.0 cm (22.5 to 21.5), respectively. At 24 weeks, pain remained reduced from baseline in both groups: 22.1 (22.6 to 21.6) and 21.6 (22.2 to 21.0), respectively. Global improvement was reported by 70% of physiotherapy participants (51/73) at 12 weeks and by 59% (43/73) at 24 weeks. Similarly, global improvement was reported by 72% of placebo participants (48/67) at 12 weeks and by 49% (33/67) at 24 weeks (all p.0.05).
2012
Knee osteoarthritis is an extremely common musculoskeletal disorder of the lower extremity that results in significant physical impairment and functional limitations. The resulting pain and disability associated with knee osteoarthritis impacts various components of physical function including treatment satisfaction and patient/client quality of life. Therefore, the need to know the efficacy of currently existing interventions in the physical rehabilitation of patients with knee osteoarthritis is essential in the clinical decision-making process involved in the implementation of plan of care for effective management and successful treatment outcomes. This paper also highlights the scientific methods involved in the search of existing literature to capture highly relevant information in the critical analysis of physical therapy treatment for knee osteoarthritis.
Arthritis Research & Therapy, 2012
Introduction: Our aim in the present study was to determine whether a disease-specific self-management program for primary care patients with osteoarthritis (OA) of the knee (the Osteoarthritis of the Knee Self-Management Program (OAK)) implemented by health care professionals would achieve and maintain clinically meaningful improvements in health-related outcomes compared with a control group. Methods: Medical practitioners referred 146 primary care patients with OA of the knee. Volunteers with coexistent inflammatory joint disease or serious comorbidities were excluded. Randomisation was to either a control group or the OAK group. The OAK group completed a 6-week self-management program. The control group had a 6-month waiting period before entering the OAK program. Assessments were taken at baseline, 8 weeks and 6 months. The primary outcomes were the results measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Function subscales on the Short Form 36 version 1 questionnaire (SF-36) Secondary outcomes were Visual Analogue Scale (VAS) pain, Timed Up & Go Test (TUG), knee range of motion and quadriceps and hamstring strength-isometric contraction. Responses to treatment (responders) and minimal clinically important improvements (MCIIs) were determined. Results: In the OAK group, VAS pain improved from baseline to week 8 from mean (SEM) 5.21 (0.30) to 3.65 (0.29) (P ≤ 0.001). During this period, improvements in the OAK group compared with the control group and responses to treatment were demonstrated according to the following outcomes: WOMAC Pain, Physical Function and Total dimensions, as well as SF-36 Physical Function, Role Physical, Body Pain, Vitality and Social Functioning domains. In addition, from baseline to week 8, the proportion of MCIIs was greater among the OAK group than the control group for all outcomes. For the period between baseline and month 6, WOMAC Pain, Physical Function and Total dimensions significantly improved in the OAK group compared to the control group, as did the SF-36 Physical Function, Role Physical, Body Pain, Vitality and Social Functioning domains, as well as hamstring strength in both legs. During the same period, the TUG Test, range of motion extension and left-knee flexion improved compared with the control group, although these improvements had little clinical relevance. Conclusions: We recorded statistically significant improvements compared with a control group with regard to pain, quality of life and function for participants in the OAK program on the basis of WOMAC and SF-36 measures taken 8 weeks and 6 months from baseline.
Background: To increase the uptake of key clinical recommendations for non-surgical management of knee osteoarthritis (OA) and improve patient outcomes, we developed a new model of service delivery (PARTNER model) and an intervention to implement the model in the Australian primary care setting. We will evaluate the effectiveness and cost-effectiveness of this model compared to usual general practice care. Methods: We will conduct a mixed-methods study, including a two-arm, cluster randomised controlled trial, with quantitative, qualitative and economic evaluations. We will recruit 44 general practices and 572 patients with knee OA in urban and regional practices in Victoria and New South Wales. The interventions will target both general practitioners (GPs) and their patients at the practice level. Practices will be randomised at a 1:1 ratio. Patients will be recruited if they are aged ≥45 years and have experienced knee pain ≥4/10 on a numerical rating scale for more than three months. Outcomes are self-reported, patient-level validated measures with the primary outcomes being change in pain and function at 12 months. Secondary outcomes will be assessed at 6 and 12 months. The implementation intervention will support and provide education to intervention group GPs to deliver effective management for patients with knee OA using tailored online training and electronic medical record support. Participants with knee OA will have an initial GP visit to confirm their diagnosis and receive management according to GP intervention or control group allocation. As part of the intervention group GP management, participants with knee OA will be referred to a centralised multidisciplinary service: the PARTNER Care Support Team (CST). The CST will be trained in behaviour change support and evidence-based knee OA management. They will work with patients to develop a collaborative action plan focussed on key self-management behaviours, and communicate with the patients' GPs. Patients receiving care by intervention group GPs will receive tailored OA educational materials, a leg muscle strengthening program, and access to a weight-loss program as appropriate and agreed. GPs in the control group will receive no additional training and their patients will receive usual care.
Journal of Physical Therapy Science
To investigate the effectiveness of cognitive-behavioural therapy (CBT) and pain coping skills training (PCST) on pain level in adults with osteoarthritis of the knee (KOA) in comparison with usual care. [Subjects and Methods] Five databases were systematically searched for relevant randomised controlled trials (RCTs) according to the selected eligibility criteria (inception to June 7, 2016). PEDro scale was used to assess the validity of included studies. [Results] Four studies met the inclusion criteria and all studies had high methodological quality. The total number of participants was 665 across the four included studies. All participants had been diagnosed with KOA (clinical and radiographic evaluation). The majority of the population were female (71.13%). The interventions utilised were: CBT, CBT for insomnia (CBT-I), PCST, and PCST combined with behavioral weight management (BWM) in one study and with exercise in another study. The outcome measure for pain in KOA was the WOMAC scale. Overall, three studies have reported clinical improvement in KOA pain perception after 12-month follow-up time point. [Conclusion] This review has recognised the need for future studies that have rigorous methodological quality, and investigate the effect of mutual CBT and PCST protocols on KOA pain and pain-related functional and psychological abilities.
Human Movement, 2018
Purpose. To investigate and compare the effects of 6-week self-management education (SME) and quadriceps strengthening exercises (QSE) on pain and disability in individuals with knee osteoarthritis (OA). Methods. A total of 79 (13 males, 66 females) consecutive patients with knee OA were randomised into SME and QSE groups. The SME group were taught modules of self-management once a week for 6 weeks, while the QSE group had supervised QSE thrice a week for 6 weeks. Pain intensity and physical function were assessed with the Visual Analogue Scale and Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) at baseline, week 6, and at the follow-up time points of the 1 st , 2 nd and 3 rd months. Results. The effects of both interventions were comparable (p > 0.005) during intervention and follow-up. During intervention, in both groups, pain intensity significantly decreased (p < 0.001, effect size = 0.603) and IKHOAM scores improved (p < 0.001, effect size = 0.540). There were significant time by group interaction effects during follow-up as pain intensity (p < 0.001, effect size = 0.085) did not change in the QSE group but further decreased in the SME group, IKHOAM scores (p = 0.005, effect size = 0.053) remained the same in the SME group while it decreased in the QSE group with respect to the end of intervention (6 th week). Conclusions. Supervised QSE and SME are both effective in reducing pain and disability in knee OA but improvements in the outcomes are better sustained with SME.
Physical Therapy, 2005
Background and Purpose Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteo-arthritis (OA) of the knee. The purpose of this study was tocompare outcomes between a home-based physical therapy program and a clinically based physical therapy program. Subjects. One hundred thirty-four subjects with OA of the knee were randomly assigned to a clinictreatment group (n=66; 61% female, 39% male; mean age [±SD]=64±10 years) or a home exercise group (n=68, 71% female, 29% male; mean age [±SD]=62±9 years). Methods. Subjects in the clinic treatment group received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. Subjects in the home exercise group received thesame home exercise program initially, reinforced at a clinic visit 2 weeks later. Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. B...