Comparing physical therapy, internet-based exercise training, and no therapy for knee osteoarthritis / Kelli D. Allen.

Format:

• Book

Author/Creator:

• Allen, Kelli D., author.

Language:

English

Subjects (All):

• Physical therapy.

Physical Description:

1 online resource (1 PDF file (83 pages)) : illustrations

Place of Publication:

Washington (DC) : Patient-Centered Outcomes Research Institute (PCORI), 2019.

Summary:

BACKGROUND: Most adults with knee osteoarthritis (OA) are inactive, highlighting the need for continued efforts to promote regular engagement in exercise. Few studies have directly compared different strategies, ranging in intensity of resources required, for improving exercise and related outcomes among patients with OA. OBJECTIVE: The objective of this 3-arm study was to compare the effectiveness of physical therapy (PT; with an emphasis on a home exercise program) and internet-based exercise training (IBET), both compared with a wait list (WL) control arm, among individuals with knee OA. METHODS: This study was a randomized controlled trial of 350 participants with symptomatic knee OA, allocated to standard PT, IBET, and WL control group in a 2:2:1 ratio, respectively. The PT group received up to 8 individual visits within 4 months. The IBET program provided tailored exercises, video demonstrations, and guidance on exercise progression. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, range 0-96), assessed at baseline, 4 months (primary time point), and 12 months. General linear mixed effects modeling compared changes in WOMAC among study groups, with superiority hypotheses testing differences between intervention groups and WL and noninferiority hypotheses comparing IBET with PT (noninferiority margin = 5 points on WOMAC). Higher WOMAC scores indicate worse symptoms; therefore, negative scores for comparisons at follow-up indicate more improvement for PT and IBET at groups compared with the WL group. RESULTS: Baseline mean WOMAC scores for PT, IBET, and WL groups were 32.0, 31.3, and 33.6, respectively. At 4 months, improvements in WOMAC score did not differ significantly for either the PT group or IBET group compared with WL (PT: −3.36, 95% CI, −6.84 to 0.12, P = .06; IBET: - 2.70, 95% CI, −6.24 to 0.85, P = .14). Similarly, at 12 months, mean differences compared with WL were not statistically significant for either group (PT: −1.59, 95% CI, −5.26 to 2.08, P = .39; IBET: −2.63, 95% CI, −6.37 to 1.11, P = .17). IBET was noninferior to PT at both time points. CONCLUSIONS: Improvements in WOMAC score following IBET and PT did not differ significantly or clinically from the WL group. This contrasts with prior studies showing that PT improves pain and function for people with knee OA. Additional research is needed regarding strategies to maximize the effects of exercise-based interventions for individuals with knee OA. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: This study was conducted in 1 geographic region and included only participants who had regular internet access. More than half of participants had a college education. These factors could affect generalizability to other subpopulations.

Notes:

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