Less surgery after new physiotherapy treatment in hip osteoarthritis

The risk for joint replacement surgery is almost three times lower in patients with hip osteoarthritis who are treated with behavioural graded activity compared with usual exercise therapy, according to a publication of researchers of NIVEL (Netherlands institute for health services research) in the Osteoarthritis & Cartilage.

Osteoarthritis is a common and disabling condition that affects an increasing percentage of the population. Exercise therapy is an effective treatment by physiotherapist, which reduces pain and limitations in activities (e.g. walking, cycling). However, the positive treatment effect declines after discharge and finally disappears in the long-term. The main reason is that most people stop doing the recommended exercises and return to a less active lifestyle. To improve exercise adherence and maintenance of a more active lifestyle after discharge of a physiotherapy exercise treatment and consequently improve the long-term effectiveness of exercise therapy, researchers of NIVEL developed a new exercise program for patients with osteoarthritis, based on principles of behavioural graded activity.

Behavioural graded activity
In the behavioural graded activity treatment patients select their three most problematic activities (e.g. walking, cycling and gardening) and the physical therapist selects individually tailored exercises to improve impairments (e.g. muscle strength, stability of joints) limiting the performance of these activities. Next, patients set their individual treatment goal for the selected activities (for instance walk for 1 hour). The exercises and activities are gradually increased during the treatment period using preset time quotas (e.g. walk every day 2 minutes longer) to reach the preset goal. The physical therapist gives positive reinforcement towards healthy or active behaviour and successful completion of the quotas to enhance patients motivation. After the 12 weeks treatment period, patients return for 5 to 7 booster sessions.

A five years follow-up
The researchers followed two groups of patients for five years. One group received the conventional exercise therapy treatment following the Dutch guideline for physiotherapy in patients with knee or hip osteoarthritis, and the other group received behavioural graded activity. During the five years that patients were followed, the researcher measured several times the amount of pain and limitations in physical function and also measured the number of joint replacement surgeries. This project was funded by the Dutch Arthritis Association.

Less pain and limitations in physical function
On the long term both treatments resulted in less pain and limitations in physical function, in patients with hip osteoarthritis and knee osteoarthritis. However, in patients with hip osteoarthritis beneficial effects in favour of behavioural graded activity were found in the short- and mid-long-term on pain and physical function. Furthermore, the results show that the risk for joint replacement surgery is almost 3 times lower in patients with hip osteoarthritis who are treated with behavioural graded activity. NIVEL-researcher Martijn Pisters says:  “This is obviously a very interesting result. It means that a specific exercise program can prevent, or at least postpone joint replacement surgery. Naturally, further research is needed, because our study was not primarily focused on demonstrating changes in the number of joint replacement surgeries”.
The Dutch Arthritis Association is also very pleased with the results of the study and they hope that the treatment will be applied by physiotherapists in the future.