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Long-term effect of exercise therapy in patients with osteoarthritis: a randomized controlled trial comparing two different physiotherapy interventions.
Pisters, M., Veenhof, C., Schellevis, F., Bakker, D. de, Dekker, J. Long-term effect of exercise therapy in patients with osteoarthritis: a randomized controlled trial comparing two different physiotherapy interventions. Physiotherapy: 2011, 97(suppl. 1), p. s1005. Abstract. World Physical Therapy Congress, 22 juni 2011, Amsterdam.
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Purpose: To determine if behavioural graded activity (BGA) results in better long-term effectiveness (5 years after inclusion) than usual exercise therapy (UC; usual care) in patients with OA of the hip or knee. Relevance: The positive effects of exercise therapy in patients with osteoarthritis seem to decline over time after discharge and finally disappear in the long term. Low exercise adherence rates after discharge is seen as one of the main reasons to explain poor long-term effectiveness of exercise therapy. Because earlier research has show that BGA results in better exercise adherence and a more physically active lifestyle after discharge, it is expected that BGA results in better long-term effectiveness than UC. Participants: One hundred and forty-nine patients with osteoarthritis of the hip and/or knee were followed until 60 months follow-up. Patients were recruited by participating primary care physiotherapist and by articles about the study in local newspapers. Methods: Long-term follow-up study of a single blind cluster randomized trial comparing BGA and usual exercise therapy (UC) according to the Dutch physical therapy guideline for patients with hip and/or knee OA. To avoid contamination of interventions, cluster randomization was performed at the level of the participating physiotherapy practices. Primary outcome measures were pain, physical function, and patient global assessment. Furthermore, patient oriented physical function, physical performance, health care utilization and the number of joint replacement surgeries were assessed. Assessments took place at 3, 9, 15 and 60 months followup. All assessments were performed on a test location, in the presence of a research assistant, who was blinded for the assigned treatment. Analysis: Multiple regression analyses were performed with change scores as dependent variable and type of intervention as independent variable. Analyses were adjusted for potential confounders. Data were nalyzed according to intent-to-treat principle. Results: Both treatments showed beneficial within-groups effects in the long-term. In patients with knee OA no differences between treatments were found on the short-, mid-long and long-term. In patients with hip OA significant differences in favour of BGA were found at 3 months (pain and physical performance) and 9 months follow-up (pain, physical function, patients global assessment and patient oriented physical function). Furthermore, UC resulted in patients with hipOAin more joint replacement surgeries compared toBGA (hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.1; 7.3). Conclusions: No differences between treatment groups were found in the long-term on the primary outcome measures. Although more research is needed to confirm the study findings, the results indicate that BGA reduces the risk for joint replacement surgeries compared to UC in patients with hip OA, which probably can be explained by better outcome in favour of BGA in the short and mid-long-term. Implications: The current study shows that BGA results in better short- and mid-long-term effects and indicate thatBGA reduces the risk for joint replacement surgery compared to usual exercise therapy. Therefore, behavioural graded activity is recommended in patients with hip OA. Furthermore, for a successful implementation ofBGAa post-graduate education should be developed and BGA should be recommended in guidelines for hip OA patients. Funding acknowledgements: This study was funded by the Dutch Arthritis Association. Ethics approval: The study was approved by the medical ethics committee of the VU University Medical Center, Amsterdam. Trial Registration: ClinicalTrials.gov (NCT00522106).
Purpose: To determine if behavioural graded activity (BGA) results in better long-term effectiveness (5 years after inclusion) than usual exercise therapy (UC; usual care) in patients with OA of the hip or knee. Relevance: The positive effects of exercise therapy in patients with osteoarthritis seem to decline over time after discharge and finally disappear in the long term. Low exercise adherence rates after discharge is seen as one of the main reasons to explain poor long-term effectiveness of exercise therapy. Because earlier research has show that BGA results in better exercise adherence and a more physically active lifestyle after discharge, it is expected that BGA results in better long-term effectiveness than UC. Participants: One hundred and forty-nine patients with osteoarthritis of the hip and/or knee were followed until 60 months follow-up. Patients were recruited by participating primary care physiotherapist and by articles about the study in local newspapers. Methods: Long-term follow-up study of a single blind cluster randomized trial comparing BGA and usual exercise therapy (UC) according to the Dutch physical therapy guideline for patients with hip and/or knee OA. To avoid contamination of interventions, cluster randomization was performed at the level of the participating physiotherapy practices. Primary outcome measures were pain, physical function, and patient global assessment. Furthermore, patient oriented physical function, physical performance, health care utilization and the number of joint replacement surgeries were assessed. Assessments took place at 3, 9, 15 and 60 months followup. All assessments were performed on a test location, in the presence of a research assistant, who was blinded for the assigned treatment. Analysis: Multiple regression analyses were performed with change scores as dependent variable and type of intervention as independent variable. Analyses were adjusted for potential confounders. Data were nalyzed according to intent-to-treat principle. Results: Both treatments showed beneficial within-groups effects in the long-term. In patients with knee OA no differences between treatments were found on the short-, mid-long and long-term. In patients with hip OA significant differences in favour of BGA were found at 3 months (pain and physical performance) and 9 months follow-up (pain, physical function, patients global assessment and patient oriented physical function). Furthermore, UC resulted in patients with hipOAin more joint replacement surgeries compared toBGA (hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.1; 7.3). Conclusions: No differences between treatment groups were found in the long-term on the primary outcome measures. Although more research is needed to confirm the study findings, the results indicate that BGA reduces the risk for joint replacement surgeries compared to UC in patients with hip OA, which probably can be explained by better outcome in favour of BGA in the short and mid-long-term. Implications: The current study shows that BGA results in better short- and mid-long-term effects and indicate thatBGA reduces the risk for joint replacement surgery compared to usual exercise therapy. Therefore, behavioural graded activity is recommended in patients with hip OA. Furthermore, for a successful implementation ofBGAa post-graduate education should be developed and BGA should be recommended in guidelines for hip OA patients. Funding acknowledgements: This study was funded by the Dutch Arthritis Association. Ethics approval: The study was approved by the medical ethics committee of the VU University Medical Center, Amsterdam. Trial Registration: ClinicalTrials.gov (NCT00522106).