Related Experiment Video
Updated: Jan 24, 2026
Author Spotlight: Investigating the Mechanism of Action of Acupotomy in Treating Knee Osteoarthritis
Published on: October 20, 2023
STepped exercise program for patients with knee OsteoArthritis (STEP-KOA): protocol for a randomized controlled trial
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.
Background:
Physical therapy (PT) and other exercise-based interventions are core components of care for knee osteoarthritis (OA), but both are underutilized, and some patients have limited access to PT services. This clinical trial is examining a STepped Exercise Program for patients with Knee OsteoArthritis (STEP-KOA). This model of care can help to tailor exercise-based interventions to patient needs and also conserve higher resource services (such as PT) for patients who do not make clinically relevant improvements after receiving less costly interventions.
Methods / Design:
Step-KOA is a randomized trial of 345 patients with symptomatic knee OA from two Department of Veterans Affairs sites. Participants are randomized to STEP-KOA and Arthritis Education (AE) Control groups with a 2:1 ratio, respectively. STEP-KOA begins with 3 months of access to an internet-based exercise program (Step 1). Participants not meeting response criteria for clinically meaningful improvement in pain and function after Step 1 progress to Step 2, which involves bi-weekly physical activity coaching calls for 3 months. Participants not meeting response criteria after Step 2 progress to in-person PT visits (Step 3). Outcomes will be assessed at baseline, 3, 6 and 9 months (primary outcome time point). The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and secondary outcomes are objective measures of physical function. Linear mixed models will compare outcomes between the STEP-KOA and AE control groups at follow-up. We will also evaluate patient characteristics associated with treatment response and conduct a cost-effectiveness analysis of STEP-KOA.
Discussion:
STEP-KOA is a novel, efficient and patient-centered approach to delivering exercise-based interventions to patients with knee OA, one of the most prevalent and disabling health conditions. This trial will provide information on the effectiveness of STEP-KOA as a novel potential model of care for treatment of OA.
Trial Registration:
Clinicaltrials.gov, NCT02653768 (STepped Exercise Program for Knee OsteoArthritis (STEP-KOA)), Registered January 12, 2016.
Related Concept Videos
03:08Rate-Determining Steps
In a multistep reaction mechanism, one of the elementary steps progresses significantly slower than the others. This slowest step is called the rate-limiting step (or rate-determining step). A reaction cannot proceed faster than its slowest step, and hence, the rate-determining step limits the overall reaction rate.
The concept of rate-determining step can be understood from the analogy of a 4-lane freeway with a short-stretch of traffic-bottleneck caused due to...
01:18Steps in Outbreak Investigation
01:14Steps in the Modeling Process
Attention is the first necessary component for observational learning. It involves focusing on what the model is doing and saying. For example, if you decide to take a drawing class to enhance your skills, you need to pay close attention to the instructor's words and hand movements. The characteristics of the model significantly...
02:31Multi-Step Reactions
01:22Steps for Free-Body Diagram
To find the acceleration of the system, it is first necessary to calculate the net force on the system. In order to accomplish this, a free-body diagram can be created to...
02:24Regulation of Expression Occurs at Multiple Steps
Transcription results in the generation of precursor (pre-mRNA) that consists of both exons and introns, which needs further processing before being translated to a...