Development of comorbidity-adapted exercise protocols for patients with knee osteoarthritis

Abstract

BackgroundExercise therapy is generally recommended for patients with osteoarthritis (OA) of the knee. Comorbidity, which is highly prevalent in OA, may interfere with exercise therapy. To date, there is no evidence-based protocol for the treatment of patients with knee OA and comorbidity. Special protocols adapted to the comorbidity may facilitate the application of exercise therapy in patients with knee OA and one or more comorbidities.PurposeThe purpose of this study was to develop comorbidity-adapted exercise protocols for patients with knee OA and comorbidity.MethodSeveral steps were undertaken to develop comorbidity-adapted protocols: selection of highly prevalent comorbidities in OA, a literature search to identify restrictions and contraindications for exercise therapy for the various comorbid diseases, consultation of experts on each comorbid disease, and field testing of the protocol in eleven patients with knee OA and comorbidity.ResultsBased on literature and expert opinion, comorbidity-adapted protocols were developed for highly prevalent comorbidities in OA. Field testing showed that the protocols provided guidance in clinical decision making in both the diagnostic and the treatment phase. Because of overlap, the number of exercise protocols could be reduced to three: one for physiological adaptations (coronary disease, heart failure, hypertension, diabetes type 2, chronic obstructive pulmonary diseases, obesity), one for behavioral adaptations (chronic a-specific pain, nonspecific low back pain, depression), and one for environmental adaptations (visual or hearing impairments). Evaluation of patient outcome after treatment showed significant (P<0.05) and clinically relevant improvements in activity limitations and pain.ConclusionComorbidity-adapted exercise protocols for patients with knee OA were developed, providing guidance in clinical reasoning with regard to diagnostics and treatment. To evaluate the effectiveness of treatment in line with our protocols, a randomized clinical trial should be performed.

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

“…More research is needed to evaluate the effectiveness of the protocol in primary care. In addition, the effect of tailored exercise in other highly prevalent comorbid diseases in knee OA (e.g., chronic pain or depression) (9,20,50) should be investigated. Fourth, a limitation of the present study is that we did not investigate the costeffectiveness of the developed protocols to get insight as to whether the costs outweigh the benefits on health-related outcomes, medication use, hospital care, and outpatient care.…”

“…We have previously developed a treatment protocol to tailor exercise therapy for knee OA to comorbid diseases (20). The purpose of the present study was to evaluate the efficacy on physical functioning and safety of tailored exercise therapy in patients with knee OA and comorbidity.…”

Evaluation of an educational course for primary care physiotherapists on comorbidity‐adapted exercise therapy in knee osteoarthritis: an observational study

“…The strategy, as developed in a secondary care setting, consists of diagnostic and intervention phases and supports the PT in making clinical decisions and designing a customized treatment plan. The specific options for adaptations to the diagnostic phase and intervention phase are listed in the protocol, as described previously (de Rooij et al, ; de Rooij et al, ). In the randomized controlled trial in which the strategy was evaluated patients received a 20‐week individualized (tailored) knee OA exercise program, with two sessions of 30 to 60 min a week under supervision of a PT.…”

“…For example, in patients with knee OA and chronic heart failure (HF), breathlessness and fatigue disproportional to the level of exertion should be avoided because of the risk of cardiac decompensation (Coats, ). Therefore, we have recently developed and evaluated a strategy to adapt knee OA exercises to the comorbid disease in patients with knee OA and severe comorbidity (de Rooij et al, ; de Rooij et al, ). Targeted comorbidities were coronary disease, heart failure, type 2 diabetes, chronic obstructive pulmonary disease, and obesity.…”

Physical Activity Intervention in Primary Care and Rheumatology for the Management of Knee Osteoarthritis: A Review

“…For example, a brief written prescription for a walking program, easily accessible from an EHR system, may be an effective way to simplify the recommendation for both physicians and patients while also being time efficient. Walking has been shown to be effective in decreasing pain and improving quality of life in patients with OA and suitable for most patients including those with cardiovascular disease and diabetes, which are common comorbid conditions . However, a specific protocol that can be individualized for OA patients has not been developed and is a necessary next step.…”