Multistep exercise program alleviates knee osteoarthritis pain

A stepped exercise program for patients with knee osteoarthritis called STEP-KOA improved patients’ pain, a randomized clinical trial in Annals of Internal Medicine showed.

Kelli D. Allen, PhD, an exercise physiologist at the Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham Veterans Affairs Health Care System, and colleagues assigned 345 patients with symptomatic knee osteoarthritis (mean age, 60 years) in a 2:1 ratio to either the STEP-KOA group or a control group for 9 months.

Among all participants, mean total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline was 47.5 points, mean pain range was 9.9 points and mean function score was 33.3 points.

In the STEP-KOA group, all participants began with an internet-based exercise training program with seven levels of intensity and instructions to complete the exercise three times weekly. The 150 participants whose osteoarthritis symptom scores did not show “meaningful improvement” moved on to step 2, which was biweekly telephone-based physical activity coaching sessions for 3 months. During these sessions, coaches discussed barriers to exercise, set weekly activity goals and encouraged participants to perform strengthening exercises two to three times weekly and strive for a long-term goal of 150 minutes of physical activity weekly. There were 81 patients whose osteoarthritis scores did not show “meaningful improvement,” and therefore, advanced to step 3, which consisted of three to seven physical therapy sessions ranging from 30 to 60 minutes long.

Progression to advanced steps was based on Outcome Measures in Rheumatology–Osteoarthritis Research Society International (OMERACT-OARSI) response criteria, Allen and colleagues wrote. The control group received educational materials on osteoarthritis management via mail every 2 weeks.

The researchers estimated that at the study’s end, the total WOMAC score declined 5.5 points (95% CI, –7.7 to –3.2) among participants in the STEP-KOA group and increased 1.4 points (95% CI, –1.6 to 4.3) in the control group. Overall, the WOMAC score was estimated to be 6.8 points (95% CI, –10.5 to –3.2) lower in the STEP-KOA group vs. the control group (P = .0003), “indicating greater improvement,” the researchers wrote.

Mean improvement was also greater in the STEP-KOA group vs. the control group at 9 months for the WOMAC pain subscale (mean difference = –1.4 points (95% CI, –2.3 to –0.6) and the WOMAC physical function score (mean difference = –4.6 (95% CI, –7.4 to –1.9). While both WOMAC measures followed patterns like overall WOMAC scores “over time,” there was no difference between groups on objective physical function measures and the Physical Activity Scale for the Elderly, according to the researchers.

Allen and colleagues noted that most of the patients were male veterans and follow-up was limited, but their study still provided “novel data” on the proportions of patients with knee osteoarthritis who met OMERACT-OARSI response criteria after various exercise-based interventions.

With knee osteoarthritis prevalence expected to continue rising “substantially,” Allen and colleagues recommended future studies “identify effective strategies to boost adherence to exercise-based interventions for knee osteoarthritis, as well as to maintain it.”