Group Physical Therapy for Knee Osteoarthritis
| Status: | Completed |
|---|---|
| Conditions: | Arthritis, Osteoarthritis (OA) |
| Therapuetic Areas: | Rheumatology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 1/1/2014 |
| Start Date: | February 2011 |
| End Date: | May 2014 |
| Contact: | Tessa Walker, MPH |
| Email: | Tessa.Walker@va.gov |
| Phone: | (919) 286-0411 |
Group Physical Therapy for Veterans With Knee Osteoarthritis
Pain management is a priority for the Department of Veterans Affairs (VA) health care
system, and knee osteoarthritis (OA) is a main cause of chronic pain. Veterans who receive
care within the VA health care system have higher rates and more severe OA than both the
general population of adults and veterans who receive health care elsewhere. Physical
therapy (PT) is a primary part of treatment for knee OA, but in the VA health care system PT
appointments are a limited resource, and veterans often do not receive enough visits to
promote long-term improvements in pain and physical function. New models of delivery, such
as the group-based approach examined in this study, are needed to expand PT services in a
cost-effective manner.
system, and knee osteoarthritis (OA) is a main cause of chronic pain. Veterans who receive
care within the VA health care system have higher rates and more severe OA than both the
general population of adults and veterans who receive health care elsewhere. Physical
therapy (PT) is a primary part of treatment for knee OA, but in the VA health care system PT
appointments are a limited resource, and veterans often do not receive enough visits to
promote long-term improvements in pain and physical function. New models of delivery, such
as the group-based approach examined in this study, are needed to expand PT services in a
cost-effective manner.
Knee osteoarthritis (OA) is one of the most common health problems and a leading cause of
disability among veterans. Physical therapy (PT) and ongoing exercise are associated with
reduced pain and improved physical function among patients with knee OA, yet the majority of
veterans with OA are physically inactive. Furthermore, PT services are a limited resource
in the VA health care system, with demand exceeding supply. VA patients with knee OA
generally receive only one or two PT visits. Prior research indicates this amount of
clinical contact time is not sufficient to provide patients with the assessment,
instruction, and support needed to adopt and maintain an exercise program, particularly in
the context of a chronic pain condition. Therefore development, testing, and implementation
of mechanisms to cost-effectively expand PT services for knee OA may play a key role in
improving pain and other outcomes in this large group of veterans. This research examines a
group-based approach to delivering PT for knee OA, which can extend services to more
veterans, for a greater number of sessions per veteran, at lower staffing costs. The
objective of this study is to compare the effectiveness of a group-based PT program for knee
OA with usual individual PT care for knee OA.
This study will be a randomized controlled trial of a 12-week, group-based PT program among
N=376 veterans with symptomatic knee OA at the Durham VAMC. Participants will be randomly
assigned to the group-based PT program or individual PT (usual care). The group PT arm will
include 6 1-hour visits (every other week) led by a physical therapist and exercise
physiologist or physical therapy assistant, with 8 participants per group. The individual PT
arm, modeled after typical PT care for knee OA at the Durham VAMC and other health care
settings, will include 2 1-hour visits with a physical therapist, 2-3 weeks apart. The
group PT sessions will include group instruction in joint care (activity pacing and joint
projection), group discussion of exercise successes and barriers, group exercise, and
scheduled individual consultations with the physical therapist (2 per participant, 15-20
minutes each) to address specific functional and therapeutic needs. While the individual PT
sessions will differ in structure, they will include the same informational, assessment, and
therapeutic content as the group sessions. Both groups will be given instructions for the
same home exercise program. The primary outcome for this study will be the Western Ontario
and McMasters Universities Osteoarthritis Index (WOMAC). The secondary outcome will be
objectively assessed physical function (Short Physical Performance Test Protocol). These
outcomes will be assessed at baseline and 12-week follow-up. The WOMAC will also be
assessed via telephone at 24-week follow-up to examine whether any observed intervention
effects are maintained. Mixed linear models will be used to compare outcomes for the two
study arms. We will also conduct an economic analysis of the group-based PT program.
disability among veterans. Physical therapy (PT) and ongoing exercise are associated with
reduced pain and improved physical function among patients with knee OA, yet the majority of
veterans with OA are physically inactive. Furthermore, PT services are a limited resource
in the VA health care system, with demand exceeding supply. VA patients with knee OA
generally receive only one or two PT visits. Prior research indicates this amount of
clinical contact time is not sufficient to provide patients with the assessment,
instruction, and support needed to adopt and maintain an exercise program, particularly in
the context of a chronic pain condition. Therefore development, testing, and implementation
of mechanisms to cost-effectively expand PT services for knee OA may play a key role in
improving pain and other outcomes in this large group of veterans. This research examines a
group-based approach to delivering PT for knee OA, which can extend services to more
veterans, for a greater number of sessions per veteran, at lower staffing costs. The
objective of this study is to compare the effectiveness of a group-based PT program for knee
OA with usual individual PT care for knee OA.
This study will be a randomized controlled trial of a 12-week, group-based PT program among
N=376 veterans with symptomatic knee OA at the Durham VAMC. Participants will be randomly
assigned to the group-based PT program or individual PT (usual care). The group PT arm will
include 6 1-hour visits (every other week) led by a physical therapist and exercise
physiologist or physical therapy assistant, with 8 participants per group. The individual PT
arm, modeled after typical PT care for knee OA at the Durham VAMC and other health care
settings, will include 2 1-hour visits with a physical therapist, 2-3 weeks apart. The
group PT sessions will include group instruction in joint care (activity pacing and joint
projection), group discussion of exercise successes and barriers, group exercise, and
scheduled individual consultations with the physical therapist (2 per participant, 15-20
minutes each) to address specific functional and therapeutic needs. While the individual PT
sessions will differ in structure, they will include the same informational, assessment, and
therapeutic content as the group sessions. Both groups will be given instructions for the
same home exercise program. The primary outcome for this study will be the Western Ontario
and McMasters Universities Osteoarthritis Index (WOMAC). The secondary outcome will be
objectively assessed physical function (Short Physical Performance Test Protocol). These
outcomes will be assessed at baseline and 12-week follow-up. The WOMAC will also be
assessed via telephone at 24-week follow-up to examine whether any observed intervention
effects are maintained. Mixed linear models will be used to compare outcomes for the two
study arms. We will also conduct an economic analysis of the group-based PT program.
Inclusion Criteria:
- Physician diagnosis of knee osteoarthritis in VA medical records
- Current knee symptoms
- No PT care for knee osteoarthritis in past 6 months
Exclusion Criteria:
- Diagnosis of systemic rheumatic disease
- Hospitalized for a stroke, transient ischemic attack, aneurysm, myocardial
infarction, coronary artery revascularization, or mental health condition in the past
3 months
- Diagnosis of psychosis
- Diagnosis of dementia
- Current chest pain
- On waiting list for / planning arthroplasty within study period (i.e., next 6 months)
- Resident in nursing home
- Currently participating in another OA-related or lifestyle interventional study
- Knee ligament/meniscus injury (past 1 year)
- Cancer that has spread
- Gout in knees
- Multiple Sclerosis
We found this trial at
1
site
Durham VA Medical Center Since 1953, Durham Veterans Affairs Medical Cetner has been improving the...
Click here to add this to my saved trials
