Effects of Two Physiotherapy Booster Sessions on Outcomes With Home Exercise in People With Knee Osteoarthritis: A Randomized Controlled Trial

Abstract

Objective. Enhancing exercise adherence over the longer term is an important goal in self-management of knee osteoarthritis (OA). Following an initial period of more intensive exercise supervision, this study investigated whether 2 additional physiotherapy visits improved outcomes with continued home exercise over a subsequent 24-week period. Methods. A total of 78 people with medial knee OA (mean ؎ SD age 62.1 ؎ 6.9 years, mean ؎ SD body mass index 29.4 ؎ 4.0 kg/m 2 , and radiographic disease severity 19% mild, 49% moderate, and 32% severe) who completed a 12-week physiotherapist-supervised exercise trial were randomly allocated to 2 30-minute physiotherapy booster sessions (delivered by 8 physiotherapists in private clinics) or no booster sessions for the subsequent 24 weeks. All participants were asked to continue home exercises 4 times weekly. Primary outcomes were change in pain, using a 100-mm visual analog scale, and self-reported physical function, measured using the Western Ontario McMaster Universities Osteoarthritis Index. Participants and physiotherapists were unblinded to group allocation, although participants were blinded to the study hypothesis.

Interventions to increase adherence to therapeutic exercise in older adults with low back pain and/or hip/knee osteoarthritis: a systematic review and meta-analysis

“…Three studies fulfilled all 12 requirements for complete intervention reporting 35 37 38. Less than half of included studies (n=4, 44%) adequately reported all activities and processes used in the intervention (Item 4).…”

“…Three studies recruited older adults with chronic low back pain (total n=339),33 34 41 three recruited participants with knee osteoarthritis (total n=364)36 37 40 and three recruited participants with either hip or knee osteoarthritis (total n=342) 35 38 39. Intervention duration ranged from 3 sessions over 8 weeks to 23 sessions over 55 weeks, with follow-up periods ranging from 8 to 65 weeks.…”

“…A number (n=4, 44%) of studies assessed adherence at short-term (≤3 months) time points only 36 38 39 41. Two studies reported mid-term (3–6 months) follow-up,33 37 and three studies reported long-term (≥12 months) outcome measurement 34 35 40…”

“…Two studies included behavioural graded exercise, alone36 or in combination with booster sessions supervised by a clinician 35. One study examined booster sessions supervised by a clinician in isolation,37 one evaluated action coping plans39 and one used an audio or video tape of exercises in addition to verbal instructions of the exercise programme 38…”

“…All studies had at least one domain judged as unclear risk of bias. The main weaknesses of included studies related to reporting bias, where only one study was rated as being at low risk 37. A number of studies reported prespecified outcomes incompletely, or in a way that excluded inclusion in a meta-analysis.…”