The impact of physical activity level on the short- and long-term pain relief from supervised exercise therapy and education: a study of 12,796 Danish patients with knee osteoarthritis

Skou, Søren Thorgaard; Roos, Ewa M.

doi:10.1016/j.joca.2018.07.010

Cited by 39 publications

(41 citation statements)

References 16 publications

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“…Increasing the number of nonresponders may potentially alter the results. However, our findings are consistent with those of a recent noncontrolled exercise intervention study for persons with knee pain, suggesting that similar pain relief was observed regardless of the initial self‐reported PA levels . It is important to note that, following the recently published 2018 PA guideline , the MV activity minutes we reported here are total MV time, not “bouted” (MV intensity PA accumulated in bouts lasting 10 minutes or more).…”

Section: Discussionsupporting

confidence: 90%

Association between Pre‐intervention Physical Activity Level and Treatment Response to Exercise Therapy in Persons with Knee Osteoarthritis—An Exploratory Study

Chang

Lee

Song

et al. 2019

ACR Open Rheumatology

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Objective. Examine whether pre-intervention physical activity (PA) level is associated with achieving a positive treatment response of pain and/or function improvement after a 12-week exercise intervention in participants with knee osteoarthritis (OA).Methods. We performed a secondary analysis of a randomized, single-blind comparative effectiveness trial showing similar treatment effects between Tai Chi mind-body exercise and standard physical therapy intervention for knee OA. Baseline PA was assessed by a Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire and, in a subsample, by tri-axial accelerometers. The Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) dichotomous responder criteria was used for clinically meaningful improvement at follow-up. Associations between baseline self-reported PA by the CHAMPS questionnaire and outcomes of responders vs. nonresponders (reference group) were assessed using logistic regressions, adjusting for demographic covariates. We compared objectively measured PA by accelerometry between responders vs. nonresponders using Wilcoxon tests.Results. Our sample consisted of 166 participants with knee OA who completed both baseline and 12-week postintervention evaluations: mean age 60.7 year (SD 10.5), body mass index 32.4 kg/m 2 (6.9), 119 (72%) women, and 138 (83%) OMERACT-OARSI responders. Neither time spent in total PA [odds ratio (OR) 1.00; 95% confidence interval (CI) 0.96, 1.03] nor time in moderate-to-vigorous PA (OR 1.01; 95% CI 0.93, 1.09) at pre-intervention were associated with being a responder. Similar findings were observed in 42 accelerometry sub-cohort participants.Conclusion. Pre-intervention PA levels (subjective report or objective measurement) were not associated with individuals achieving favorable treatment outcomes after a 12-week exercise intervention, which suggests that regardless of pre-intervention PA level, individuals will likely benefit from structured exercise interventions.

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Section: Discussionsupporting

confidence: 90%

Association between Pre‐intervention Physical Activity Level and Treatment Response to Exercise Therapy in Persons with Knee Osteoarthritis—An Exploratory Study

Chang

Lee

Song

et al. 2019

ACR Open Rheumatology

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“…This result confirms previous findings from similar first-line interventions suggesting that people with OA may benefit from education and exercise regardless of their initial level of physical activity. 14 …”

Section: Discussionmentioning

confidence: 99%

Factors Associated With the Outcome of a First-Line Intervention for Patients With Hip or Knee Osteoarthritis or Both: Data From the BOA Register

et al. 2020

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Objective This study explored the association of patients’ demographics, health status, symptom severity, previous osteoarthritis (OA) care, and psychological status with the change in pain severity following a first-line intervention including education and exercise for OA provided nationwide in Swedish primary care. Methods This register-based cohort study included 23,309 people with knee or hip OA from the Better management of patients with OA (BOA) register. Linear regression models were used to assess the association of independent variables with the change in pain from baseline to 3 and 12 months. All the analyses were stratified based on the affected joint (hip vs knee). Results In people with hip and people with knee OA, high levels of baseline pain were associated with decreased pain at both follow-ups (3 months: knee β = −0.67; hip β = −0.64; 12 months: knee β = −0.70; hip β = −0.66), whereas being older, overweight, or female had weak or no association. Finally, at both follow-ups, bilateral OA was associated with increased pain only in people with knee OA, whereas comorbidities and the willingness to undergo surgery were associated with increased pain regardless of the affected joint. Conclusions Baseline pain showed the strongest association among the analyzed variables, whereas sex, age, and body mass index appear to be weakly associated with the pain change after a first-line intervention. Comorbidities and willingness to undergo surgery showed a potentially important association and may have a negative impact on the pain change following a first-line intervention. Impact. In people with hip or knee OA, age, sex, BMI and previous surgery are only weakly associated with the change in pain after a first-line intervention supporting the evidence recommending exercise and education as a foundation for all OA therapy. Having comorbidities and being willing to undergo surgery is associated with a worse outcome from a first-line intervention, including exercise and education. Individualized treatments addressing the disease perception and the specific comorbidity profile may improve the outcomes.

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“…Both models include three main parts: 1. a certification course for health care professionals, 2. a patient education and supervised exercise program and 3. a nationwide quality register. Both programs have shown promising results—participation decreases pain, increases quality of life and self-efficacy [ 16 ] and has a significant impact on the intake of painkillers and sick leave up to 1 year after inclusion [ 17 , 18 ]. In 2016, a similar implementation model, the AktivA (Active with osteoArthritis), was initiated in Norway.…”

Section: Introductionmentioning

confidence: 99%

The Active with OsteoArthritis (AktivA) Physiotherapy Implementation Model: A Patient Education, Supervised Exercise and Self-Management Program for Patients with Mild to Moderate Osteoarthritis of the Knee or Hip Joint. A National Register Study with a Two-Year Follow-Up

Holm

Pripp

Risberg

2020

JCM

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Background: Recent systematic reviews and international guidelines recommend patient education, exercises, and weight control (if overweight) as first-line treatment for patients with hip or knee osteoarthritis (OA). The Active with osteoArthritis (AktivA) program is a physiotherapy model for the implementation of these guidelines into clinical primary care practice. The purpose of the present study was to evaluate the long-term effects of and adherence to the AktivA program for patients with mild to moderate knee or hip OA. Methods: The AktivA program includes three modules: a physiotherapy certification course, a patient education and exercise program and an electronic quality register. An electronic questionnaire including questions about, pain, quality of life, physical activity, self-efficacy and satisfaction with the AktivA program are sent to the participants at inclusion and after 3, 12 and 24 months. A linear mixed model for repeated measurements was used to assess the difference between the follow-up times. Results: Until January 2020, 6245 patients were included in the register. The response rates were 98%, 86% and 63% at 3, 12 and 24 months, respectively. After participating in the AktivA program, the patients reported decreased pain and increased health-related and disease-specific quality of life at three months and the positive effect was maintained up to two years after inclusion. The proportion of patients reporting to be inactive or having a low physical activity level was reduced from 43% to 22%. After two years, more than 80% of the participants reported to use what they have learned from the AktivA program at least once a week. Conclusions: Two years after inclusion in the AktivA physiotherapy program, the patients still report reduced pain, increased quality of life and higher activity levels.

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The impact of physical activity level on the short- and long-term pain relief from supervised exercise therapy and education: a study of 12,796 Danish patients with knee osteoarthritis

Cited by 39 publications

References 16 publications

Association between Pre‐intervention Physical Activity Level and Treatment Response to Exercise Therapy in Persons with Knee Osteoarthritis—An Exploratory Study

Association between Pre‐intervention Physical Activity Level and Treatment Response to Exercise Therapy in Persons with Knee Osteoarthritis—An Exploratory Study

Factors Associated With the Outcome of a First-Line Intervention for Patients With Hip or Knee Osteoarthritis or Both: Data From the BOA Register

The Active with OsteoArthritis (AktivA) Physiotherapy Implementation Model: A Patient Education, Supervised Exercise and Self-Management Program for Patients with Mild to Moderate Osteoarthritis of the Knee or Hip Joint. A National Register Study with a Two-Year Follow-Up

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