Physiotherapy delivered pain management skills in addition to strength training improves knee OA treatment outcomes

A combined intervention of specific strength training plus training in pain management skills provided by a physiotherapist is associated with better function than either treatment alone in patients with knee osteoarthritis (OA).

A multicentre trial randomised 222 patients with painful knee OA who were aged 50 years or older to receive one of the three interventions. Each intervention involved 10 supervised sessions over 12 weeks, plus a home therapy program.

  • Exercise focused on the delivery of an individualised strengthening program;
  • Pain Management training focused on pain education and cognitive and behavioral skills to manage pain more effectively and included strategies such as pacing, relaxation, goal setting, pleasant activity scheduling;
  • A combined exercise and pain management training approach.

Combining strength training with pain management skills demonstrated significantly greater improvements in functional scores compared with baseline than either of the other groups at 12, 32 and 52 weeks. It also led to significantly greater improvements in walking pain, depression, anxiety, stress and self efficacy and quality of life. Those that report better function are less likely to undergo knee joint replacement. The study found that the combined approach reduced hospital related costs at 1 year. In contrast, there is evidence that arthroscopic knee surgery is no more effective than placebo for treating OA of the knee and the Australian Orthopaedic Association states that arthroscopy is not effective for people with OA.

This opens the door to more effective physiotherapy delivered treatment for those suffering painful osteoarthritis of the knee that is impacting on daily functioning and quality of life. A recent review found that only 4.4% of those with knee OA are referred to a physiotherapist for treatment despite this research showing that this approach achieves lasting benefitsĀ of at least 1 year duration after treatment has ceased by focusing on providing effective self management skills.

References:

Bennell KL et al. Arthritis Care Res 2015.

Brand etal. Arth Care Res 2014

Moseley, JB etal. N Engl J Med 2002

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