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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
PubMed
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.

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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.