S. Coleman1, N. Briffa 2 , H. Burton 1 , G. Carroll 3 , C. Inderjeeth 4 , N. Cook 5 , R. Prince 6 , J. McQuade 1. 1Health and Education, Arthritis Foundation of Western Australia, 2School of Physiotherapy, Curtin University, 3Rheumatologist, Guildford Rd, Perth, 4Gerontology, QE11 Medical Centre, Nedlands WA, 5Rheumatology, Royal Perth Hospital, Perth WA, 6University Department of Medicine, QE11 Medical Centre, Nedlands WA, Australia

Background: Results from a disease-specific, community based self-management programme for people with OA of the knee was previously found to improve in SF36, WOMAC, VAS, and physical measures, in an uncontrolled trial. To further test this programme we undertook a randomised, controlled trial of patients with OA of the knee offering specific self-administered exercises and education, in accordance with the principles of self-management.
Objectives: To examine the efficacy of this programme for patients with OA knee by a randomised controlled trial.
Methods: Participants:145 participants (40 male, 105 female): mean age of 67, referred from primary practice settings with radiologically confirmed OA knee, were randomised to control or intervention groups. Coexistent inflammatory joint disease or serious co-morbidities excluded participation.
Interventions: The intervention group completed the 8-week self-management behaviour modification programme that included specific exercises tailored for knee OA, in addition to their usual medical management. The control group continued usual management for 6 months. Measurements: Participants were assessed at baseline, 8weeks and 6months. Isometric quadriceps and hamstring strength and knee range of movement were measured using a dynamometer and goniometer; and dynamic knee function was assessed using a modified "get up and go" timed test. VAS, WOMAC and SF36 questionnaires were completed. Data were analysed using repeated measures ANOVA.
Results: In the intervention group, VAS for pain improved during the 8-week clinic phase (5.1±2.5 to 3.5±2.4 p=<0.001). The WOMAC questionnaire, specific to OA knee, was as expected, more sensitive to change. Pain, physical function and total WOMAC scores improved. Vitality and social function domains improved in the SF36, as did right hamstring strength, compared to the control group. In other outcome measures, changes were comparable between groups.

Table 1. Mean±SD scores for control & intervention groups at each timepoint
Baseline ControlIntervention8 Weeks ControlIntervention6 Months ControlInterventionP Value*
WOMAC Pain*8.6±3.66.3±3.78.2±3.94.8±3.48±3.55.5±3.70.039
Physical Function*27.6±10.522.2±11.627.5±11.417.4±1027±11.618.4±11.30.004
SF36 Vitality*53.4±21.755.8±1651.5±1960±17.853.1±21.862.5±17.30.019
Social Function*72.1±24.875.5±21.969.7±26.584±18.269±24.879.5±22.90.03
Mental Health75±14.176.9±14.373.8±14.377.3±13.373.6±16.379.3±13.60.3
STRENGTH R)Flexion#6.9±5.47.5±4.78.1±7.110.1±4.97.3±6.19.6±6.20.04
R)Extension#14.6± 1315.5± 8.514.6± 14.318.3± 12.214.4± 11.717±9.50.2
*Group x time interaction # Median IQR

*Group x time interaction # Median IQR
Conclusion: Although improvements did occur in the intervention group consistent with those in the pilot study, the control group also experienced improvements in some outcomes. The WOMAC questionnaire is specific to OA knee, and was more sensitive to changes in pain and physical function. Follow up assessments will be done to both groups for a further 12months to determine any long-term benefits.
Citation: Ann Rheum Dis 2005;64(Suppl III):67

Session: Advances in osteoarthritis


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