Nearly all available international guidelines for the management of knee osteoarthritis recommend exercise as a core treatment, ideal for primary care delivery, with effect sizes in the region of 0.3 to 0.4 (moderate effects). This presentation will briefly review best evidence for exercise including recent primary care randomised trials that highlight the benefits of exercise on pain, function and proportions of treatment responders. In addition data on current practice will be presented that highlights the ‘know-do’ gap between best evidence and current primary care management of patients. These data highlight the challenges in supporting evidence-based exercise practice and provide the underpinning rationale for a current large trial, the BEEP study (Best Evidence for Exercise in knee Pain) in the UK.
The objective of the BEEP study is to test ways to improve outcomes for patients with knee osteoarthritis from exercise and physical activity, helping people find the right exercise routine and maintain it over time. BEEP is a multicentre randomised controlled trial, funded by the National Institute for Health Research (NIHR) involving adults aged 45 years and over in primary care with a clinical diagnosis of knee osteoarthritis. 526 patients who are eligible and consent to take part are randomised to receive 1 of 3 exercise based interventions delivered by physiotherapists, who have each participated in a BEEP study training programme:
- UK usual care: up to 4 treatment sessions over 12 weeks
- Individualised, supervised and progressed exercise: between 6 to 8 treatment sessions over 12 weeks and focused on lower limb strengthening, stretching and balance
- Targeted exercise adherence: 4 treatment sessions within 12 weeks, plus between 4 to 6 additional contacts from week 12 to month 6, focused on supporting patients to make the transition from lower limb exercise to general physical activity engagement and maintenance.
All patients are followed up at 3, 6, 9, 18 and 36 months, to compare the clinical and cost-effectiveness of efforts to optimise exercise care for people with knee osteoarthritis. The study completed recruitment in 2012 and is in follow-up. This presentation will provide a key example of testing approaches to optimise primary care for patients with knee osteoarthritis.
Acknowledgements NE Foster is supported through an NIHR Research Professorship. This abstract presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0407-10386). The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health.
Disclosure of Interest None Declared