12-wk multimodal non-surgical program effective in improving knee osteoarthritis symptoms

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Dr. S.T. Skou discusses the efficacy of a 12 week multimodal non-surgical intervention for patients with knee OA not eligible for TKR.
100 patients with knee osteoarthritis not eligible for total knee replacement were randomly assigned to either a 12-week non-surgical program (MEDIC treatment), consisting of neuromuscular exercise, educational sessions, insoles, diet changes, and pain medication, or to usual care with educational pamphlets. The purpose of this study was to determine the effects of a multi-modal non-surgical treatment on patient pain, function, and quality of life. Patients enrolled in Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: The Danish Rheumatism Association and The Association of Danish Physiotherapists Research Fund.
Conflicts: None disclosed
Why was this study needed now?
Osteoarthritis (OA) is the most prevalent form of arthritis, and commonly affects the knee joint. While total knee replacement (TKR) is an effective treatment for severe OA, a multi-modal, individualized non-surgical treatment program is preferable as the first line of treatment. These programs typically consist of exercises, weight management, and education, with pharmaceuticals and biomechanical interventions (such as insoles) used as needed. However, at the outset of the present study, the research base supporting the efficacy of this combined treatment was inadequate. This study investigates the efficacy of a 12 week program incorporating exercise, diet, education, insoles, and pain medication.
What was the principal research question?
How did a 12-week non-surgical program consisting of exercise, diet, education, insoles and pain medication for treatment of knee osteoarthritis affect pain, function and quality of life compared to usual treatment, as evaluated one year after initiation of treatment?
Population: 100 patients with symptomatic and radiographic knee osteoarthritis (Kellgran-Lawrence grade 1 or higher) not eligible for total knee replacement were selected for inclusion. Individuals who scored above a 75 on the self-reported Knee injury and Osteoarthritis Outcome Score (KOOS), presented with a history of previous ipsilateral knee replacement, or scored greater than 60/100mm on a VAS pain scale within one week prior to study enrollment were excluded. (91 completed study)
Intervention: MEDIC group: Patients were enrolled in a 12-week non-surgical program consisting of five components: education, neuromuscular exercises and insoles with weight-loss and/or pain medication as needed. Patients were prescribed with 1 g paracetamol four times, 400 mg ibuprofen three times and 20 mg pantoprazol daily for pain management if needed. Standardized treatment was delivered by a trained physiotherapist and dietitian, and patients received monthly telephone calls following treatment completion to support continuation of exercise and dietary intervention. Patients also received leaflets described in the comparison. (n=50, Completed=47, Mean age=64.8+/-8.7), 26F/24M).
Comparison: Usual care group: Patients received usual care protocol for treatment of knee osteoarthritis. Patients were given two standardized information leaflets. The first leaflet contained information regarding knee OA etiology, symptoms, functional limitations, recommended treatment and general advice. The second leaflet contained information revealing where in the region one can seek treatment and knowledge on how to live a healthy lifestyle. (n=50, Completed=44, Mean age=67.1+/-9.1, 25F/25M)
Outcomes: The primary outcome measure was change in KOOS score, defined as the average of the KOOS subscores (excluding the difficulty in sports and recreational activities subscale). Secondary outcomes included change in the 5 KOOS subscales (pain, symptoms, activities of daily living (ADL), quality of life (QOL) and difficulty in sports and recreational activities), functional performance (Timed Up and Go test & two 20-m walk tests), self-reported general health (EQ-5D index & EQ VAS), weight, analgesic intake, and incidence of adverse events. The number needed to treat (NNT) was also calculated in order to estimate the number of patients who would need to through the MEDIC treatment in order for one individual to have a 15% improvement.
Methods: RCT: prospective, assessor-blinded, single-centered
Time: Outcomes were assessed at baseline and at 3, 6, and 12 months after baseline assessment.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
January 27, 2016
Will OHIP cover it?