Patients with osteoarthritis, instability benefit more from education, exercise
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Patients with knee osteoarthritis and self-reported knee instability benefit more from education and supervised exercise compared with those without instability, according to data published in Arthritis Care & Research.
“Knee instability is common in osteoarthritis, but prior to our study, only a few studies on the effects of exercise in people with knee osteoarthritis and knee instability existed,” Søren Thorgaard Skou, PT, MSc, PhD, a professor of exercise and human health at the University of Southern Denmark, told Healio. “Neither of the prior studies described the severity of knee instability or investigated the impact of the severity on patient outcomes, although this could be perceived as important.”
To examine the impact of patient-reported knee instability on OA pain and gait speed outcomes following education and supervised exercise interventions, Skou and colleagues conducted a retrospective cohort study. The analysis included patients enrolled in the Good Life with Osteoarthritis in Denmark (GLA:D) registry, which began in 2013 and is a nationwide, ongoing program.
For this analysis, the researchers included patients enrolled in GLA:D starting on Jan. 1, 2019, and ending Nov. 10, 2019. Patients were excluded from the analysis if they had another reason for knee problems, such as a tumor or inflammatory joint disease, other, more pronounced physical problems, such as generalized pain or fibromyalgia, or if they underwent a total joint replacement in the impacted knee before the study period.
Exposure was defined as the level of knee instability as reported by the patients at baseline. Patients were asked to define how often in the past week their impacted knee “gave way” or “let them down,” from zero, meaning never, to four, meaning all the time. Three and four were categorized together as “high instability.” The primary outcome was the change in knee pain and gait speed from baseline to the conclusion of an 8-week education and exercise program. A change of 15 mm in knee pain intensity, and 0.095 meters per second in gait speed, was considered a minimal clinically important difference.
The analysis included a total of 2,466 patients with knee OA. There was no difference in gait speed between patients reporting instability or no instability. However, patients with instability reported more improvement in pain intensity compared with patients who reported no instability (4.3 mm; 95% CI, 1.2-7.5), according to the researchers.
“People with knee instability have worse pain and function at baseline but will experience similar or better outcomes after exercise and education as compared to patients with no knee instability,” Skou said. “Exercise is effective as treatment of 26 chronic conditions, as well as in people with multimorbidity, and it improves the physical and mental health of the individual.
“Furthermore, it can help prevent 35 chronic conditions and any increase in physical activity level can have a health benefit for the individual,” he added. “Therefore, it is important to talk about exercise and physical activity as a natural part of the consultations with patients.”
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