A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program

Clare E Safran-Norton^{1

2}, James K Sullivan¹, James J Irrgang³, Hannah M Kerman¹, Kim L Bennell⁴, Gary Calabrese⁵, Leigh Dechaves², Brian Deluca⁶, Alexandra B Gil³, Madhuri Kale², Brittney Luc-Harkey¹, Faith Selzer^{1

7}, Derek Sople², Peter Tonsoline⁶, Elena Losina^{1

7

8}, Jeffrey N Katz^{9

10

11

12}

Affiliations

¹ Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA.
² Department of Rehabilitation Services - Physical and Occupational Therapy, Brigham and Women's Hospital, Boston, MA, USA.
³ Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia.
⁵ Department of Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, OH, USA.
⁶ UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
⁷ Harvard Medical School, Boston, MA, USA.
⁸ Department of Biostatistics, Boston University School of Public Health, United States of America, Boston, MA, USA.
⁹ Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA. jnkatz@bwh.harvard.edu.
¹⁰ Harvard Medical School, Boston, MA, USA. jnkatz@bwh.harvard.edu.
¹¹ Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA. jnkatz@bwh.harvard.edu.
¹² Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA. jnkatz@bwh.harvard.edu.

PMID: 31684921
PMCID: PMC6830005
DOI: 10.1186/s12891-019-2872-x

Randomized Controlled Trial

A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program

Clare E Safran-Norton et al. BMC Musculoskelet Disord. 2019.

. 2019 Nov 4;20(1):514.

doi: 10.1186/s12891-019-2872-x.

Authors

Affiliations

¹ Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA.
² Department of Rehabilitation Services - Physical and Occupational Therapy, Brigham and Women's Hospital, Boston, MA, USA.
³ Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ Centre for Health, Exercise and Sports Medicine, School of Health Sciences, University of Melbourne, Melbourne, Australia.
⁵ Department of Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, OH, USA.
⁶ UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
⁷ Harvard Medical School, Boston, MA, USA.
⁸ Department of Biostatistics, Boston University School of Public Health, United States of America, Boston, MA, USA.
⁹ Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5016, Boston, MA, 02115, USA. jnkatz@bwh.harvard.edu.
¹⁰ Harvard Medical School, Boston, MA, USA. jnkatz@bwh.harvard.edu.
¹¹ Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA. jnkatz@bwh.harvard.edu.
¹² Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA. jnkatz@bwh.harvard.edu.

PMID: 31684921
PMCID: PMC6830005
DOI: 10.1186/s12891-019-2872-x

Abstract

Background: Knee osteoarthritis (OA) is prevalent and often associated with meniscal tear. Physical therapy (PT) and exercise regimens are often used to treat OA or meniscal tear, but, to date, few programs have been designed specifically for conservative treatment of meniscal tear with concomitant knee OA. Clinical care and research would be enhanced by a standardized, evidence-based, conservative treatment program and the ability to study the effects of the contextual factors associated with interventions for patients with painful, degenerative meniscal tears in the setting of OA. This paper describes the process of developing both a PT intervention and a home exercise program for a randomized controlled clinical trial that will compare the effectiveness of these interventions for patients with knee pain, meniscal tear and concomitant OA.

Methods: This paper describes the process utilized by an interdisciplinary team of physical therapists, physicians, and researchers to develop and refine a standardized in-clinic PT intervention, and a standardized home exercise program to be carried out without PT supervision. The process was guided in part by Medical Research Council guidance on intervention development.

Results: The investigators achieved agreement on an in-clinic PT intervention that included manual therapy, stretching, strengthening, and neuromuscular functional training addressing major impairments in range of motion, musculotendinous length, muscle strength and neuromotor control in the major muscle groups associated with improving knee function. The investigators additionally achieved agreement on a progressive, protocol-based home exercise program (HEP) that addressed the same major muscle groups. The HEP was designed to allow patients to perform and progress the exercises without PT supervision, utilizing minimal equipment and a variety of methods for instruction.

Discussion: This multi-faceted in-clinic PT program and standardized HEP provide templates for in-clinic and home-based care for patients with symptomatic degenerative meniscal tear and concomitant OA. These interventions will be tested as part of the Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial.

Trial registration: The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 on February 14, 2017. TeMPO was also approved by the Institutional Review Board at Partners HealthCare/Brigham and Women's Hospital.

Keywords: Home exercise program; Meniscal tear; Osteoarthritis; Physical therapy; Randomized trial.

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Conflict of interest statement

The authors declare that they have no competing interests.

References

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A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program

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A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program

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