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Published on: July 22, 2019
Stepped Exercise Program for Patients With Knee Osteoarthritis : A Randomized Controlled Trial
Kelli D Allen1, Sandra Woolson2, Helen M Hoenig3
1Durham VA Health Care System, Durham, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (K.D.A.).
Background:
Evidence-based models are needed to deliver exercise-related services for knee osteoarthritis efficiently and according to patient needs.
Objective:
To examine a stepped exercise program for patients with knee osteoarthritis (STEP-KOA).
Design:
Randomized controlled trial. (ClinicalTrials.gov: NCT02653768).
Setting:
2 U.S. Department of Veterans Affairs sites.
Participants:
345 patients (mean age, 60 years; 15% female; 67% people of color) with symptomatic knee osteoarthritis.
Intervention:
Participants were randomly assigned in a 2:1 ratio to STEP-KOA or an arthritis education (AE) control group, respectively. The STEP-KOA intervention began with 3 months of an internet-based exercise program (step 1). Participants who did not meet response criteria for improvement in pain and function after step 1 progressed to step 2, which involved 3 months of biweekly physical activity coaching calls. Participants who did not meet response criteria after step 2 went on to in-person physical therapy visits (step 3). The AE group received educational materials via mail every 2 weeks.
Measurements:
Primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Scores for the STEP-KOA and AE groups at 9 months were compared by using linear mixed models.
Results:
In the STEP-KOA group, 65% of participants (150 of 230) progressed to step 2 and 35% (81 of 230) to step 3. The estimated baseline WOMAC score for the full sample was 47.5 (95% CI, 45.7 to 49.2). At 9-month follow-up, the estimated mean WOMAC score was 6.8 points (CI, -10.5 to -3.2 points) lower in the STEP-KOA than the AE group, indicating greater improvement.
Limitation:
Participants were mostly male veterans, and follow-up was limited.
Conclusion:
Veterans in STEP-KOA reported modest improvements in knee osteoarthritis symptoms compared with the control group. The STEP-KOA strategy may be efficient for delivering exercise therapies for knee osteoarthritis.
Primary Funding Source:
Department of Veterans Affairs, Health Services Research and Development Service.
