Background Persistent Knee Pain (PKP) is a common cause of disability in Europe1. Therapeutic exercise, education and weight loss are central to the management of PKP2. Aquatic therapy (AT), (therapeutic exercise in water) is recommended but the optimal effective dosage is unknown.
Objectives To investigate the acceptability and efficacy of six sessions of AT and self-management advice compared to self-management advice only on self-reported pain, function and general health in adults with PKP.
Methods This two arm, single blinded, pilot, randomised controlled trial received ethical approval from the Joint UCL/UCLH Research Ethics Committee (08/H0715). A convenience sample of adults ≥50 years old with self reported knee pain of >12 weeks were recruited from an inner city physiotherapy department. They were randomly assigned to receive either 6 weekly sessions of group AT consisting of 30–40 minutes strengthening, stretching and balance exercises facilitated by a physiotherapist or a comparison group. All participants attended a single session of self-management advice and prescribed home exercises by a physiotherapist. Process outcomes: number of people willing to enter the study and adverse events were recorded by the researcher, attendance at AT sessions was recorded by treating physiotherapists. Clinical outcomes: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Pain visual analogue scale (0 -10cm VAS), SF12 and six minute walk distance (6MWD) were assessed at baseline and 6 weeks by a researcher blind to participant group allocation.
Process outcomes were evaluated using descriptive statistics. Clinical data were analysed on an intention to treat basis and between group differences in mean change were investigated using Analysis of Covariance adjusted for baseline differences. Significance was accepted at P<0.05 level.
Results 34 eligible patients were invited to participate in the study. 14 (41%) women (mean age 63 (7.46) years) were enrolled into the trial and 13 (93%) people completed the 6 week assessment. Compliance was 98% in the AT group. No adverse effects were reported. All clinical outcomes improved in the AT group in pre-post scores (mean change (95% CI)): WOMAC -17.7 (3.9, 31.6), VAS -3.4 (-.2, 7.0) SF12-Physical 4.3 (-16.2, 7.5), SF12-Mental 8.2 (-16.7, 0.4), 6WMD 48.6m (-102.3, 5.2) but not the comparison group: WOMAC 2.6 (-11.4, 6.3), VAS 0.5 (-1.5, 0.5), SF12-Physical 0.009 (-3.8, 3.7) and SF12-Mental 1.2 (-6.0, 3.7), 6MWD 22.9m (-62.6, 16.6). There were between group differences in change in WOMAC over 6 weeks (20.3 (-33.9, -1.0) p=0.039), the WOMAC pain subscale (5.4 (-8.6, -0.8) p=0.022) and SF12 mental subscale (6.982 (0.4, 13.2) p=0.04), but not other outcomes, favouring the AT group.
Conclusions Whilst our study had a good recruitment rate, only women agreed to participate. Attendance at AT was high and no adverse events were reported. This study suggests that 6 sessions of AT improves PKP and function but not walking distance compared to self management only in women. Understanding the reasons why men did not wish to participate in the study warrants further investigation.
Eumusc.net. (2012). Musculoskeletal Health in Europe Report v5.0. http://www.eumusc.net/publications.cfm/p>
Fernandes L., Hagen B., Bijlsma J. et al Ann Rheum Dis. doi: 10.1136/annrheumdis-2012-202745
Disclosure of Interest None declared