Objective. To evaluate the efficacy on physical functioning and safety of tailored exercise therapy in patients with knee osteoarthritis (OA) and comorbidities. Methods. In a randomized controlled trial, 126 participants were included with a clinical diagnosis of knee OA and at least 1 of the following target comorbidities: coronary disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, or obesity (body mass index ‡30 kg/m 2 ), with severity score ‡2 on the Cumulative Illness Rating Scale. The intervention group received a 20-week, individualized, comorbidity-adapted exercise program consisting of aerobic and strength training and training of daily activities. The control group received their current medical care for knee OA and were placed on a waiting list for exercise therapy. Primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index, subscale physical functioning (WOMAC-pf), and the 6-minute walk test (6MWT). Measurements were performed at baseline, after 20 weeks (directly posttreatment), and at 3 months posttreatment. Results. Statistically significant physical functioning differences over time were found between the intervention and control group (WOMAC: B 5 27.43 [95% confidence interval (95% CI) 29.99, 24.87], P < 0.001; and 6MWT: B 5 34.16 [95% CI 17.68, 50.64], P < 0.001) in favor of the intervention group. At 3 months followup, the mean improvements in the intervention group were 33% on the WOMAC scale and 15% on the 6MWT. These improvements are of clinical relevance. No serious adverse events occurred during the intervention. Conclusion. This is the first study showing that tailored exercise therapy is efficacious in improving physical functioning and safe in patients with knee OA and severe comorbidities.

This first trial evaluating cognitive treatment of illness perceptions concerning CLBP showed statistically significant and clinically relevant improvements in patient-relevant physical activities at 18 weeks.

AimsTo determine whether preclinical medical students are able to learn therapeutic problem solving simultaneously with gaining knowledge of pharmacolog y. MethodsA randomized controlled pre/post-test study among 85 3rd year preclinical medical students from two medical faculties in Amsterdam. In addition to the normal curriculum, the study group followed a course, which was a copy of the obligatory training in cognitive therapeutic skills for 5th year students who had gained knowledge first, followed by applying the knowledge. Before, immediately after and 9 months after the training both the study group and a control group took a test (T0, T1, T2). The level of knowledge and cognitive therapeutic skills were assessed. As a reference, 38 5th year students also took the tests. ResultsOn T0 the levels of cognitive therapeutic skills of the study and control g roups were similar (26.7% and 27.4% of the required level for graduation, respectively). On T1 and T2, the study group scored significantly higher compared with the control group: 46.0/36.7% and 41.3/36.3%, respectively ( P < 0.05). In comparison with T0, the scores of the study group on T1 increased significantly and showed no significant decline on T2. There were no differences between the groups with respect to the level of knowledge in any of the three tests. The level of cognitive therapeutic skills in the 5th year reference group increased slightly but not significantly from 40.3% to 44.5% after the training; the level of knowledge increased significantly from 48.8% to 68.0%. ConclusionsPreclinical medical students are able to learn cognitive therapeutic skills simultaneously with gaining knowledge of pharmacology.

What is already known about this subject• Context-learning in medicine is mainly based on theories explaining how medical expertise is achieved, particularly with regard to diagnostic problem solving.• By frequently solving diagnostic clinical problems doctors generate so-called networks of organized knowledge in their memory.• Preclinical medical students are well able to learn to choose and prescribe drugs. What this study adds• Preclinical pharmacotherapy context learning for medical students has a modest but positive effect on learning cognitive pharmacotherapeutic skills, i.e. choosing a drug treatment and determining patient information.• The effect can be obtained with role-play sessions, a suboptimal form of context learning, with a minimal study load and a high appreciation by students. AimTo evaluate a context-learning pharmacotherapy programme for approximately 750 2nd, 3rd and 4th year preclinical medical students with respect to mastering cognitive pharmacotherapeutic skills, i.e. choosing a (drug) treatment and determining patient information. MethodsThe context-learning pharmacotherapy programme consists of weekly organized role play sessions in the form of consulting hours. Fourth year students sit for a therapeutic Objective Structured Clinical Examination (OSCE) in the form of consulting hours at the outpatient clinic. Sixty-one 2nd, 74 3rd and 49 4th year medical students who attended the role play sessions and the OSCE were randomly selected. Their performances were assessed by clinical examiners and clinical exper ts and compared with a reference group of 6th year graduated students. Additionally, the scores of a questionnaire on study load and appreciation were collected. ResultsThe level of the pharmacotherapeutic skills of the 4th year students who followed the pharmacotherapy context-learning programme was not far below that of 6th year graduates who had finished their clinical clerkships, but had not followed the pharmacotherapy programme. The time spent on the programme was about 1% of the total study load per year. The students appreciated the role play sessions and OSCE by around 80% and 99% of the maximum possible scores. ConclusionsPreclinical pharmacotherapy context learning has a modest but positive effect on learning cognitive pharmacotherapeutic skills, i.e. choosing a drug treatment and determining patient information. This effect has been obtained with role play sessions, a suboptimal form of context learning, with a minimal study load and a high appreciation by students.