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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.).
Annals of Internal Medicine
|December 28, 2020
Summary
The stepped exercise program for knee osteoarthritis (STEP-KOA) showed modest improvements in symptoms for veterans compared to an education group. This strategy may efficiently deliver exercise therapies for knee osteoarthritis.
Area of Science:
- Orthopedics
- Rehabilitation Medicine
- Geriatric Medicine
Background:
- Effective models for delivering exercise interventions for knee osteoarthritis (KOA) are essential for patient-centered care.
- Current treatment approaches require efficient and adaptable strategies to meet diverse patient needs.
Purpose of the Study:
- To evaluate the efficacy of a stepped exercise program (STEP-KOA) for managing symptomatic knee osteoarthritis.
- To compare the outcomes of the STEP-KOA intervention against a standard arthritis education control group.
Main Methods:
- A randomized controlled trial involving 345 participants with symptomatic knee osteoarthritis was conducted at two U.S. Department of Veterans Affairs sites.
- Participants were randomized to either the STEP-KOA program or an arthritis education (AE) control group.
- The STEP-KOA intervention involved a tiered approach: internet-based exercises, followed by physical activity coaching calls, and then in-person physical therapy if needed.
Main Results:
- At 9-month follow-up, the STEP-KOA group demonstrated a statistically significant reduction in knee osteoarthritis symptoms, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, compared to the AE group.
- A substantial proportion of participants in the STEP-KOA group progressed through the stepped intervention, with 65% advancing to step 2 and 35% to step 3.
- The estimated mean WOMAC score was 6.8 points lower in the STEP-KOA group than in the AE group.
Conclusions:
- The STEP-KOA program resulted in modest improvements in knee osteoarthritis symptoms among predominantly male veterans.
- The stepped, adaptive nature of the STEP-KOA intervention suggests it may be an efficient method for delivering exercise-based treatments for knee osteoarthritis.
- Further research should explore broader applicability and address limitations such as participant demographics and follow-up duration.
