• P Ravaud, R-M Flipo, I Boutron, C Roy, A Mahmoudi, B Giraudeau, and T Pham.
• INSERM, U738, Paris, France. philippe.ravaud@bch.ap-hop-paris.fr
• BMJ. 2009 Jan 1; 338: b421.

ObjectiveTo evaluate the impact of standardised consultations on patients with osteoarthritis of the knee.DesignOpen pragmatic cluster randomised controlled trial.SettingPrimary care in France.Participants198 primary care rheumatologists, each of whom had to include two consecutive patients who met the American College of Rheumatology criteria for osteoarthritis of the knee.InterventionsStandardised consultation was provided during three goal oriented visits (education on osteoarthritis and treatment management; information on physical exercises; information on weight loss) or usual care.Main Outcome MeasuresChange in body weight and in time spent on physical exercises (Baecke index) at four months.Results336 patients were included (154 allocated to standardised consultation and 182 to usual care). Nine patients were excluded because of lack of baseline data (standardised consultation, n=8; usual care, n=1). At four months, taking into account the clustering effect, the decrease in weight was greater in the standardised consultation group than in the usual care group (mean -1.11 (SD 2.49) kg v -0.37 (2.39) kg; P=0.007). The physical activity score was higher for the standardised consultation group than for the usual care group (mean 0.20 (0.65) v 0.04 (0.78); P=0.013). The standardised consultation and usual care groups did not differ in secondary outcomes, except for global assessment of disease activity (0-10 numeric scale: mean -1.66 (2.26) v -0.90 (2.48); P=0.003) and pain level (0-10 numeric scale: mean -1.65 (2.32) v -1.18 (2.58); P=0.04).ConclusionsA structured consultation programme for patients with osteoarthritis of the knee resulted in short term improvement in weight loss and time spent on physical activity.Trial RegistrationClinical trials NCT00462319.

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