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STepped exercise program for patients with knee OsteoArthritis (STEP-KOA): protocol for a randomized controlled

Kelli D Allen1,2, Dennis Bongiorni3, Kevin Caves4

  • 1Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System HSRD (152), 508 Fulton Street, Durham, NC, 27705, USA. kdallen@email.unc.edu.

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Summary

The STepped Exercise Program for Knee OsteoArthritis (STEP-KOA) offers a patient-centered approach to managing knee OA. This stepped care model efficiently delivers exercise interventions, reserving in-person physical therapy for those needing it most.

Keywords:
ExerciseKneeOsteoarthritisPhysical therapy

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Area of Science:

  • Orthopedics
  • Rehabilitation Medicine
  • Health Services Research

Background:

  • Knee osteoarthritis (OA) management relies on exercise, yet access and utilization are suboptimal.
  • The STepped Exercise Program for Knee OsteoArthritis (STEP-KOA) trial addresses these limitations.
  • STEP-KOA aims to personalize exercise interventions and optimize resource allocation.

Purpose of the Study:

  • To evaluate the effectiveness of the STEP-KOA model for knee OA.
  • To compare STEP-KOA against an Arthritis Education (AE) control group.
  • To identify patient characteristics associated with treatment response and assess cost-effectiveness.

Main Methods:

  • A randomized trial involving 345 patients with symptomatic knee OA.
  • Participants were assigned 2:1 to STEP-KOA or AE control.
  • STEP-KOA involves a 3-month internet program, followed by optional coaching calls and then in-person physical therapy (PT) if needed.

Main Results:

  • Primary outcome: Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) at 9 months.
  • Secondary outcomes: Objective measures of physical function.
  • Analysis using linear mixed models to compare groups and identify predictors of response.

Conclusions:

  • STEP-KOA represents a novel, efficient, and patient-centered care model for knee OA.
  • The trial will elucidate the effectiveness of this stepped intervention approach.
  • Findings will inform potential new models for managing prevalent and disabling knee OA.