Effects of Self-Management, Education and Specific Exercises, Delivered By Health Professionals, Using Behaviour Modification In Patients With Osteoarthritis Of The Knee


Background: Results from a disease-specific, community based self-management programme for people with OA of the knee was previously found to improve in SF36, WOMAC, VAS, and physical measures, in an uncontrolled trial. To further test this programme we undertook a randomised, controlled trial of patients with OA of the knee offering specific self-administered exercises and education, in accordance with the principles of self-management.

Objectives: To examine the efficacy of this programme for patients with OA knee by a randomised controlled trial.

Methods: Participants:145 participants (40 male, 105 female): mean age of 67, referred from primary practice settings with radiologically confirmed OA knee, were randomised to control or intervention groups. Coexistent inflammatory joint disease or serious co-morbidities excluded participation.

Interventions: The intervention group completed the 8-week self-management behaviour modification programme that included specific exercises tailored for knee OA, in addition to their usual medical management. The control group continued usual management for 6 months.

Measurements: Participants were assessed at baseline, 8weeks and 6months. Isometric quadriceps and hamstring strength and knee range of movement were measured using a dynamometer and goniometer; and dynamic knee function was assessed using a modified "get up and go" timed test. VAS, WOMAC and SF36 questionnaires were completed. Data were analysed using repeated measures ANOVA.

Results: In the intervention group, VAS for pain improved during the 8-week clinic phase (5.1±2.5 to 3.5±2.4 p=<0.001). The WOMAC questionnaire, specific to OA knee, was as expected, more sensitive to change. Pain, physical function and total WOMAC scores improved. Vitality and social function domains improved in the SF36, as did right hamstring strength, compared to the control group. In other outcome measures, changes were comparable between groups.




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