Clinical effectiveness of a rehabilitation program integrating exercise, self‐management, and active coping strategies for chronic knee pain: A cluster randomized trial

Abstract

Objective. Chronic knee pain is a major cause of disability and health care expenditure, but there are concerns about efficacy, cost, and side effects associated with usual primary care. Conservative rehabilitation may offer a safe, effective, affordable alternative. We compared the effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies (Enabling Self-management and Coping with Arthritic Knee Pain through Exercise [ESCAPEknee pain]) with usual primary care in improving functioning in persons with chronic knee pain. Methods. We conducted a single-blind, pragmatic, cluster randomized controlled trial. Participants age >50 years, reporting knee pain for >6 months, were recruited from 54 inner-city primary care practices. Primary care practices were randomized to continued usual primary care (i.e., whatever intervention a participant's primary care physician deemed appropriate), usual primary care plus the rehabilitation program delivered to individual participants, or usual primary care plus the rehabilitation program delivered to groups of 8 participants. The primary outcome was self-reported functioning (Western Ontario and McMaster Universities Osteoarthritis Index physical functioning [WOMAC-func]) 6 months after completing rehabilitation. Results. A total of 418 participants were recruited; 76 (18%) withdrew, only 5 (1%) due to adverse events. Rehabilitated participants had better functioning than participants continuing usual primary care (؊3.33 difference in WOMAC-func score; 95% confidence interval [95% CI] ؊5.88, ؊0.78; P ‫؍‬ 0.01). Improvements were similar whether participants received individual rehabilitation (؊3.53; 95% CI ؊6.52, ؊0.55) or group rehabilitation (؊3.16; 95% CI ؊6.55, ؊0.12). Conclusion. ESCAPE-knee pain provides a safe, relatively brief intervention for chronic knee pain that is equally effective whether delivered to individuals or groups of participants.

Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

“…In comparison to other exercise trials in patients with knee OA and comorbidity, we included patients with more severe comorbidity (10,12,13,49). Our study population had more activity limitations at baseline, had on average more pain, and had lower muscle strength in comparison to the baseline characteristics of patients in other exercise trials (10,12,13,49).…”

“…Our study population had more activity limitations at baseline, had on average more pain, and had lower muscle strength in comparison to the baseline characteristics of patients in other exercise trials (10,12,13,49). We selected patients if they had a severity score $2 for the comorbidity on the Cumulative Illness Rating Scale (23), indicating that the comorbidity had an impact on daily activities, and the patient was receiving regular care for the comorbid disease.…”

Efficacy of simple integrated group rehabilitation program for patients with knee osteoarthritis: Single-blind randomized controlled trial

“…This program included educational aspects about KOA (15 min) followed by several physical activities (45 min). The education sessions were adapted from Hurley et al [13] and consisted of seminars and discussion groups, which had the following themes: aims and objectives of the program; identification of personal objectives and recognition of individual functional capabilities; weight control and constituents of a healthy diet, including possible benefits of omega-3; explanation of pain perceptions and biopsychosocial model of pain; nonpharmacological procedures of pain management and use of ice and heat when appropriate; and home exercise and home relaxation techniques. Physical activities included the following: warm-up for 10 min with a stationary bike and stretching; exercises for the strength of the lower and upper limbs; body mobility, functional, and balance exercises; and relaxation ( Table 1).…”

“…Group rehabilitation programs have become more popular in recent years, and a typical program consists of stretching, strengthening resistance, and/or aerobic exercises [11][12]. Despite a considerable amount of rehabilitation programs, few works report the efficacy of an integrated group rehabilitation program for subjects with KOA [13][14]. Moreover, the exercise protocols are commonly established by the therapist's personal preferences and availability, which hinders the elucidation of which rehabilitation techniques are actually positive for KOA rehabilitation and patient adherence.…”

“…Based on the efficacy of various intervention techniques described in previous works [7,13,15], we designed a simple and evidence-based 8 wk group rehabilitation program consisting of exercise and a self-management program for patients with moderate to very severe KOA. Thus, we hypothesized that this integrated group rehabilitation program would limit pain and improve quality of life and function in patients with KOA as compared with those receiving no exercise intervention.…”