Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial)
Objective: To investigate whether knee osteoarthritis (OA) related pain and function can be improved by offering enhanced physical therapist-led exercise interventions. Design: Three-arm prospectively designed pragmatic randomized controlled trial. Setting: General practices and National Health Serv...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-06-01
|
| Series: | Archives of Rehabilitation Research and Clinical Translation |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590109523000186 |
| _version_ | 1827934664248000512 |
|---|---|
| author | Nadine E. Foster, DPhil Elaine Nicholls, PhD Melanie A. Holden, PhD Emma L. Healey, PhD Elaine M. Hay, MD |
| author_facet | Nadine E. Foster, DPhil Elaine Nicholls, PhD Melanie A. Holden, PhD Emma L. Healey, PhD Elaine M. Hay, MD |
| author_sort | Nadine E. Foster, DPhil |
| collection | DOAJ |
| description | Objective: To investigate whether knee osteoarthritis (OA) related pain and function can be improved by offering enhanced physical therapist-led exercise interventions. Design: Three-arm prospectively designed pragmatic randomized controlled trial. Setting: General practices and National Health Service physical therapy services in England. Participants: 514 adults (252 men, 262 women) aged ≥45 years with a clinical diagnosis of knee osteoarthritis (N=514). Mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline were 8.4 for pain and 28.1 for function. Interventions: Participants were individually randomized (1:1:1 allocation) to usual physical therapy care (UC control: up to 4 sessions of advice and exercise over 12 weeks), individually tailored exercise (ITE: individualized, supervised, and progressed lower limb exercises, 6-8 sessions over 12 weeks), or targeted exercise adherence (TEA: transitioning from lower limb exercise to general physical activity, 8-10 contacts over 6 months). Main Outcome Measures: Primary outcomes were pain and physical function measured by the WOMAC at 6 months. Secondary outcomes were measured at 3, 6, 9, 18, and 36 months. Results: Participants receiving UC, ITE, and TEA all experienced moderate improvement in pain and function. There were no significant differences between groups at 6 months (adjusted mean differences (95% confidence intervals): pain UC vs ITE, -0.3 (-1.0 to 0.4), UC vs TEA, -0.3 (-1.0 to 0.4); function UC vs ITE, 0.5 (-1.9 to 2.9), UC vs TEA, -0.9 (-3.3 to 1.5)), or any other time-point. Conclusions: Patients receiving UC experienced moderate improvement in pain and function; however, ITE and TEA did not lead to superior outcomes. Other strategies for patients with knee osteoarthritis to enhance the benefits of exercise-based physical therapy are needed. |
| first_indexed | 2024-03-13T07:42:56Z |
| format | Article |
| id | doaj.art-88b99aeefeed4ff1869e3824fe79a3d4 |
| institution | Directory Open Access Journal |
| issn | 2590-1095 |
| language | English |
| last_indexed | 2024-03-13T07:42:56Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Archives of Rehabilitation Research and Clinical Translation |
| spelling | doaj.art-88b99aeefeed4ff1869e3824fe79a3d42023-06-03T04:22:39ZengElsevierArchives of Rehabilitation Research and Clinical Translation2590-10952023-06-0152100266Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial)Nadine E. Foster, DPhil0Elaine Nicholls, PhD1Melanie A. Holden, PhD2Emma L. Healey, PhD3Elaine M. Hay, MD4STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UKPrimary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK; Keele Clinical Trials Unit, Keele University, Keele, UK.Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UKPrimary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK; Corresponding author Emma L. Healey, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UKObjective: To investigate whether knee osteoarthritis (OA) related pain and function can be improved by offering enhanced physical therapist-led exercise interventions. Design: Three-arm prospectively designed pragmatic randomized controlled trial. Setting: General practices and National Health Service physical therapy services in England. Participants: 514 adults (252 men, 262 women) aged ≥45 years with a clinical diagnosis of knee osteoarthritis (N=514). Mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline were 8.4 for pain and 28.1 for function. Interventions: Participants were individually randomized (1:1:1 allocation) to usual physical therapy care (UC control: up to 4 sessions of advice and exercise over 12 weeks), individually tailored exercise (ITE: individualized, supervised, and progressed lower limb exercises, 6-8 sessions over 12 weeks), or targeted exercise adherence (TEA: transitioning from lower limb exercise to general physical activity, 8-10 contacts over 6 months). Main Outcome Measures: Primary outcomes were pain and physical function measured by the WOMAC at 6 months. Secondary outcomes were measured at 3, 6, 9, 18, and 36 months. Results: Participants receiving UC, ITE, and TEA all experienced moderate improvement in pain and function. There were no significant differences between groups at 6 months (adjusted mean differences (95% confidence intervals): pain UC vs ITE, -0.3 (-1.0 to 0.4), UC vs TEA, -0.3 (-1.0 to 0.4); function UC vs ITE, 0.5 (-1.9 to 2.9), UC vs TEA, -0.9 (-3.3 to 1.5)), or any other time-point. Conclusions: Patients receiving UC experienced moderate improvement in pain and function; however, ITE and TEA did not lead to superior outcomes. Other strategies for patients with knee osteoarthritis to enhance the benefits of exercise-based physical therapy are needed.http://www.sciencedirect.com/science/article/pii/S2590109523000186ExerciseFunctionKneeOsteoarthritisPainRandomized controlled trial |
| spellingShingle | Nadine E. Foster, DPhil Elaine Nicholls, PhD Melanie A. Holden, PhD Emma L. Healey, PhD Elaine M. Hay, MD Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial) Archives of Rehabilitation Research and Clinical Translation Exercise Function Knee Osteoarthritis Pain Randomized controlled trial |
| title | Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial) |
| title_full | Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial) |
| title_fullStr | Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial) |
| title_full_unstemmed | Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial) |
| title_short | Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial) |
| title_sort | improving the effectiveness of exercise therapy for adults with knee osteoarthritis a pragmatic randomized controlled trial beep trial |
| topic | Exercise Function Knee Osteoarthritis Pain Randomized controlled trial |
| url | http://www.sciencedirect.com/science/article/pii/S2590109523000186 |
| work_keys_str_mv | AT nadineefosterdphil improvingtheeffectivenessofexercisetherapyforadultswithkneeosteoarthritisapragmaticrandomizedcontrolledtrialbeeptrial AT elainenichollsphd improvingtheeffectivenessofexercisetherapyforadultswithkneeosteoarthritisapragmaticrandomizedcontrolledtrialbeeptrial AT melanieaholdenphd improvingtheeffectivenessofexercisetherapyforadultswithkneeosteoarthritisapragmaticrandomizedcontrolledtrialbeeptrial AT emmalhealeyphd improvingtheeffectivenessofexercisetherapyforadultswithkneeosteoarthritisapragmaticrandomizedcontrolledtrialbeeptrial AT elainemhaymd improvingtheeffectivenessofexercisetherapyforadultswithkneeosteoarthritisapragmaticrandomizedcontrolledtrialbeeptrial |