Background Symptoms in patients with knee osteoarthritis (KOA) reflect many factors including lifestyle, fitness, weight, extent of damage and altered biomechanics etc. Our patients with KOA attend an education session followed by 4 weekly exercise sessions. The aim of the program is to improve knowledge and understanding and self-management techniques. Activity modification and exercises help symptoms in the short term and provide motivation in the long term. A new user-friendly patient reported outcome measure has been developed to easily and reliably assess patient perspectives of well-being and symptoms in musculoskeletal conditions. The application of this tool in KOA is explored
Objectives To use a new patient reported outcome tool to assess the value of the components of a specific package of physiotherapy for KOA
Methods 49 consecutive patients referred from rheumatology clinics with a diagnosis of KOA completed the assessment tool at their first physiotherapy session.
The tool consists of 12 statements each defining a separate domain - communication, relationships, knowledge, anxiety, fatigue, pain, movement, strength, independence, mobility, work and social aspects. These are domains assessed independently or in three clusters broadly addressing emotional, physical and functional status of the patient at a time point.
The patients score each of the 12 statements on a visual analogue scale (0–10) reflecting their perceived status in that domain at the time of assessment. The measure is repeated with the patient blinded to original scores after their final exercise session in the KOA program.
The change in domain scores is documented on a database allowing multi-variate analysis within individual domains and the three composite clusters
Results Overall improvement with the treatment program was reported by 41 (84%) of patients with improvement ranging from 30% in 9 (18%) to 10% in 27 (55%) of patients. Thus only 8 patients reported a decline after the treatment program. In patients with decline in average scores, this is domain specific and not global. Overall cohort analysis shows on average all 12 domains improved but to varying degrees with the largest VAS change (≥2.0) in two domains, ability to communicate and knowledge of their condition. In three domains (relationships, independence and social activities) change was marginal with average VAS improvement score less than 1.0. In the other 7 domains improvement was moderate ranging between 1.0 and 2.0 on the VAS.
Conclusions The new tool is effective and efficient in a time limited, busy clinical setting. It is easily understood and quickly completed by patients allowing for accurate reflection of their domain specific perspective at a specific time.
Through the successful application of this assessment tool the value of this specific physiotherapy package of care has been demonstrated. This validation of practice is of value to patients, the clinical team involved and managers. The tool allows the assessment of positive and negative response to the treatment package to be analysed within domains. KOA patients improve in physical and functional clusters but show only marginal change in the emotional cluster of domains. Our new patient assessment tool will allow for appropriate and informed modifications of the treatment package to further improve patient outcome.
Disclosure of Interest None declared