• Arthritis care & research · Sep 2015

    Physical therapist-delivered pain coping skills training and exercise for knee osteoarthritis: Randomized controlled trial.

    • Kim L Bennell, Yasmin Ahamed, Gwendolen Jull, Christina Bryant, Michael A Hunt, Andrew B Forbes, Jessica Kasza, Muhammed Akram, Ben Metcalf, Anthony Harris, Thorlene Egerton, Justin A Kenardy, Michael K Nicholas, and Francis J Keefe.
    • Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia.
    • Arthritis Care Res (Hoboken). 2015 Sep 28.

    AbstractObjective To investigate whether a 12-week physical therapist-delivered combined pain coping skills training and exercise (PCST+EX) is more efficacious and cost-effective than either treatment alone for knee OA. Methods This was an assessor-blinded, 3-arm randomized controlled trial in 222 (73 PCST+EX, 75 EX, 74 PCST) people aged ≥50 years with knee OA. All participants received 10 treatments over 12 weeks plus a home program. PCST covered pain education and training in cognitive and behavioral pain coping skills. EX comprised strengthening exercises. PCST+EX integrated both. Primary outcomes were self-reported average knee pain (0-100mm visual analogue scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index 0-68) at week 12. Secondary outcomes included other pain measures, global change, physical performance, psychological health, physical activity, quality-of-life and cost-effectiveness. Analyses were by intention-to-treat with multiple imputation for missing data. Results 201 (91%), 181 (82%) and 186 (84%) completed week 12, 32 and 52 measurements, respectively. At week 12, there were no significant between-group differences for reductions in pain comparing PCST+EX versus EX (mean difference 5.8mm, 95%CI -1.4,13.0) and PCST+EX versus PCST (6.7mm, 95%CI -0.6,14.1). Significantly greater improvements in function were found for PCST+EX versus EX (3.7units, 95%CI 0.4,7.0) and PCST+EX versus PCST (7.9units, 95%CI 4.7,11.2). These differences persisted at weeks 32 (both) and 52 (PCST). Benefits favoring PCST+EX were seen on several secondary outcomes. Cost effectiveness of PCST+EX was not demonstrated. Conclusion This model-of-care could improve access to psychological treatment and augment patient outcomes from exercise in knee OA although it did not appear to be cost effective. This article is protected by copyright. All rights reserved.© 2015, American College of Rheumatology.

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