Elsevier

Physiotherapy

Volume 96, Issue 2, June 2010, Pages 137-143
Physiotherapy

The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: A parallel randomised single-blind clinical trial

https://doi.org/10.1016/j.physio.2009.09.009Get rights and content

Abstract

Objectives

To assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme.

Design

A parallel randomised single-blind clinical trial.

Participants

Fifty patients aged 65 years or over with knee osteoarthritis.

Interventions

The study group (n = 25) was given a group education programme once a week for 4 weeks, followed by a self-executed home-based exercise programme. The controls (n = 25) were given a brief course in short-wave diathermy treatment.

Main outcome measures

Patients were assessed before the intervention, after the intervention (4 weeks) and again 8 weeks later (follow-up) using the Western Ontario McMaster Osteoarthritis Index (WOMAC), the repeated sit-to-stand test and the get-up-and-go test.

Results

At 4 weeks, there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score; for example, the WOMAC total score was reduced by a mean of 9.5 points [95% confidence interval (CI) −12.3 to −6.7]. However, at follow-up, patients in the study group demonstrated continued improvement in the get-up-and-go test and the WOMAC total, pain and disability scores, but no such improvement was noted among the controls. This difference was significant; for example, the difference in mean WOMAC total score between the groups was −9.0 points (95%CI −14.5 to −3.4).

Conclusion

A simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction. Further study is required to determine if this positive effect can be maintained over a longer period.

Introduction

Osteoarthritis is the primary cause of disability in elderly people [1]. The knee is the most commonly affected weight-bearing joint [2], and remains a common cause of disability in the community [3]. One-third of people aged 63 to 94 years are affected by knee osteoarthritis, which often causes knee pain and limited ability in rising from a chair, walking comfortably and using stairs [4], [5].

The primary goals for osteoarthritis therapy are pain relief, maintenance of joint integrity, improvement in functional status, and lessening deformity and instability [6]. Physical agents such as short-wave diathermy, transcutaneous electrical nerve stimulation, ultrasound and hot packs are passive, non-invasive modalities commonly used to control both acute and chronic pain [7]. Short-wave diathermy is widely applied to alleviate the symptoms associated with knee osteoarthritis. A review by Marks et al. (1999) noted that although strong theoretical arguments can be made for the potential benefit of short-wave diathermy on the underlying pathological processes found in knee osteoarthritis, the prevailing clinical studies concerning its application are inconclusive [8]. Moffett et al. (1996) concluded that short-wave diathermy may have no more than a placebo effect when applied for 3 weeks [9].

Active modalities such as muscle strength exercises were found to be effective in reducing pain and disability, as well as improving quality of life [10], [11]. Exercises to improve muscle strength and joint mobility often require considerable commitment by patients over long periods of time. Home programmes are typically prescribed by a physician or physical therapist, but non-compliance is common. McCarthy et al. (2004) assessed the efficacy of a home-based exercise programme compared with a home-based exercise programme supplemented with class-based exercises, and found that 30% of subjects were lost to follow-up [12]. Campbell et al. (2001) found that continued compliance depends on a person's perception of the effectiveness of the intervention, their ability to incorporate it into their everyday life, and support from physiotherapists [13].

Enlightening the patient about the importance of regular exercise could be the key element for patient adherence to a home-based exercise programme. Existing knowledge regarding the benefit of such programmes has increased in recent years [10]. Controlled studies reported that a simple programme of home quadriceps exercises was not only effective for pain, but also decreased disability [10], [11]. It is important to inform patients that some authors have suggested that pain occurs secondarily to the loss of strength [14], and that pain reduction is associated with a reduction in disability, as well as with an increase in functional capacity after a home-based exercise programme [11], [15]. There is some evidence that teaching self-care skills and modifying risk factors have a beneficial influence on patients’ symptoms and disease progression [16], [17], [18]. A study that assessed the effects of a health educational and exercise programme for older adults with hip or knee osteoarthritis found that such a programme has an immediate positive effect [19].

The aim of this study was to assess the effect of a group education programme through knowledge acquisition followed by an individual non-supervised home exercise programme on pain and function. The programme included exercises which may be incorporated into daily life and applied by the patient at home. The control group received a short-wave diathermy course (i.e. passive intervention) with equal clinical treatment time for the symptoms of knee osteoarthritis.

Section snippets

Methods

A single-blind randomised controlled trial was performed. Patients were assigned at random to an educational group (study group) or a short-wave diathermy control group. A computer random number generator determined group allocation. Ethical approval was obtained through the Human Research Ethics Committee of Asuta Hospital, Tel-Aviv, Israel and the Institutional Review Board at Tel-Aviv University. All patients gave informed consent before participation.

The calculations for adequate sample

Results

Descriptive data for the study and control groups are shown in Table 1. Thirty-seven women and 13 men were enrolled in the study, with a mean age of 75 years (SD 5). There were no statistically significant baseline differences in demographic or clinical parameters between the study groups, except for the WOMAC pain section which was higher in the control group. Six patients from the study group and three patients from the control group withdrew from the study (Fig. 1). Baseline characteristics

Discussion

Both groups obtained significant reductions in all outcome parameters, excluding the WOMAC stiffness score, at 4 weeks. However, at follow-up, the WOMAC scores and get-up-and-go performance continued to improve in the study group, while no change was noted among the controls. The reductions in WOMAC total score in the study group subjects exceeded the 20% to 25% levels suggested as minimally meaningful by Barr et al. [20].

The initial improvement seen in both groups could be attributed to a

References (34)

  • J.A. Moffett et al.

    A placebo controlled double blind trial to evaluate the effectiveness of pulsed short wave therapy for osteoarthritic hip and knee pain

    Pain

    (1996)
  • L.J. Petrella et al.

    Home based exercise therapy for older patients with knee osteoarthritis: a randomized clinical trial

    J Rheumatol

    (2000)
  • S.C. O’Reilly et al.

    Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomized controlled trial

    Ann Rheum Dis

    (1999)
  • C.J. McCarthy et al.

    Supplementing a home exercise programme with a class-based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis

    Rheumatology (Oxford)

    (2004)
  • R. Campbell et al.

    Why don’t patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee

    J Epidemiol Community Health

    (2001)
  • T.E. McAlindon et al.

    Determinants of disability in osteoarthritis of the knee

    Ann Rheum Dis

    (1993)
  • W.H. Ettinger et al.

    A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis

    JAMA

    (1997)
  • Cited by (56)

    • The effectiveness of group education in people over 50 years old with knee pain: A systematic review and meta-analysis of randomized control trials

      2022, Musculoskeletal Science and Practice
      Citation Excerpt :

      The control groups could be broadly categorized as exercise only (Alfieri et al., 2020), short-wave diathermy therapy (Bezalel et al., 2010), usual care (Hurley et al., 2012; Yip et al., 2008), usual care by physiotherapists (Jessep et al., 2009), and “wait and see” (Ganji et al., 2018; Kwok et al., 2016). Pain was assessed using a VAS in four RCTs (Alfieri et al., 2020; Ganji et al., 2018; Kwok et al., 2016; Yip et al., 2008) and the WOMAC pain scale in four RCTs (Alfieri et al., 2020; Bezalel et al., 2010; Hurley et al., 2012; Jessep et al., 2009). A meta-analysis of four RCTs (Alfieri et al., 2020; Hurley et al., 2012; Jessep et al., 2009; Yip et al., 2008) was performed after excluding two RCTs lacking post-treatment data for the intervention and control groups (Bezalel et al., 2010; Kwok et al., 2016).

    View all citing articles on Scopus
    View full text