PICO
Patient/Population
Adults with knee OA, aged ≥ 45 years (n=514).
Intervention
- Individually Tailored Exercise (ITE) + information about the value of exercise and physical activity.
- Targeted Exercise Adherence (TEA) + information about the value of exercise and physical activity.
Comparison
- Usual physical therapy Care (UC) + information about the value of exercise and physical activity.
Outcomes
- Pain (WOMAC)
Physical function (WOMAC)
Translatability: (3/3) Easy
Comments: “Patients receiving UC experienced moderate improvement in pain and function, however ITE and TEA did not lead to superior outcomes. Other strategies for patients with knee OA to enhance the benefits of exercise-based physical therapy are needed.”
Limitations: “…potential lack of sufficient difference between interventions, and intervention fidelity (particularly in TEA), we did not adjust for multiple testing in our analyses of the two primary outcomes and comparisons (UC versus ITE, UC versus TEA).”
Appraisals:
Trustworthiness – The study contains no serious weaknesses. Based on this result you should conclude that the trustworthiness of the study is high (90%). This means there is a 10% chance that alternative explanations for the effect found are possible. The effect size was large and 95% CI was OK. (by CAT)
BTB
Intervention – 1
Individually Tailored Exercise (ITE)
Dose
- Based on physical therapist assessment findings
Periodicity
- 6 to 8 one-to-one treatment sessions over 12 weeks
Local/Technic:
The program focuses on lower limb exercise “… strengthening, stretching and balance exercise, and functional task training. Agreed and defined functional and exercise goals were reviewed and progressed. Individualisation was based on physical therapist assessment findings, including biomechanical and physiological observations, pain responses to specific exercises and starting levels of strength, range of movement and balance. Participants were given a print-out of their specific exercise prescription (using PhysioTools computer software), which changed over time as the exercise programme progressed. Physical therapists encouraged exercise behaviour change using self-monitoring via a lower limb exercise diary to record adherence.” – Details.
Intervention – 2
- Targeted Exercise Adherence (TEA)
Dose
- Based on physical therapist assessment findings
Periodicity
- 8 to 10 sessions, up to 6 months
Local/Technic:
The program focuses on lower limb exercise “… aimed to support a transition to increasing general physical activity adherence over 6 months. It included 4 individual face-to-face treatments up to week 12, and a further 4 to 6 follow-up contacts (face-to-face or over the telephone) from week 12 through to 6 months (a total of 8 to 10 treatment contacts). The target by the end of 6 months was that participants would be engaged in physical activity opportunities within their community, having had support from their physical therapist to overcome initial problems or barriers in engaging in these activities. The emphasis was therefore on maintenance of physical activity beyond the period of support from the physical therapist.” – Details.
Intervention – 3
Usual Physical Therapy Care (UC)
Dose
- Based on physical therapist assessment findings
Periodicity
- 4 individual, one-to-one treatment sessions over 12 weeks
Local/Technic:
“ Exercises were selected from an agreed template of commonly prescribed lower limb exercises (available from the authors on request), including muscle strengthening (non-weight-bearing and weight-bearing), range of movement or stretching exercises. UC matched usual physical therapy practice in the NHS.“
Citation: Nadine E. Foster, Elaine Nicholls, Melanie A. Holden, Emma L. Healey, Elaine M. Hay, Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial), Archives of Rehabilitation Research and Clinical Translation, 2023, 100266, ISSN 2590-1095, https://doi.org/10.1016/j.arrct.2023.100266.