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
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
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2022, Musculoskeletal Science and PracticeCitation 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).
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