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. 2023 May 6;5(2):100266.
doi: 10.1016/j.arrct.2023.100266. eCollection 2023 Jun.

Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial)

Nadine E Foster  1   2 , Elaine Nicholls  2   3 , Melanie A Holden  2 , Emma L Healey  2 , Elaine M Hay  2 ; BEEP trial team
Affiliations

Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial)

Nadine E Foster et al. Arch Rehabil Res Clin Transl. .

Abstract

Objective: To investigate whether knee osteoarthritis (OA) related pain and function can be improved by offering enhanced physical therapist-led exercise interventions.

Design: Three-arm prospectively designed pragmatic randomized controlled trial.

Setting: General practices and National Health Service physical therapy services in England.

Participants: 514 adults (252 men, 262 women) aged ≥45 years with a clinical diagnosis of knee osteoarthritis (N=514). Mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline were 8.4 for pain and 28.1 for function.

Interventions: Participants were individually randomized (1:1:1 allocation) to usual physical therapy care (UC control: up to 4 sessions of advice and exercise over 12 weeks), individually tailored exercise (ITE: individualized, supervised, and progressed lower limb exercises, 6-8 sessions over 12 weeks), or targeted exercise adherence (TEA: transitioning from lower limb exercise to general physical activity, 8-10 contacts over 6 months).

Main outcome measures: Primary outcomes were pain and physical function measured by the WOMAC at 6 months. Secondary outcomes were measured at 3, 6, 9, 18, and 36 months.

Results: Participants receiving UC, ITE, and TEA all experienced moderate improvement in pain and function. There were no significant differences between groups at 6 months (adjusted mean differences (95% confidence intervals): pain UC vs ITE, -0.3 (-1.0 to 0.4), UC vs TEA, -0.3 (-1.0 to 0.4); function UC vs ITE, 0.5 (-1.9 to 2.9), UC vs TEA, -0.9 (-3.3 to 1.5)), or any other time-point.

Conclusions: Patients receiving UC experienced moderate improvement in pain and function; however, ITE and TEA did not lead to superior outcomes. Other strategies for patients with knee osteoarthritis to enhance the benefits of exercise-based physical therapy are needed.

Keywords: Exercise; Function; Knee; Osteoarthritis; Pain; Randomized controlled trial; Rehabilitation.

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Figures

Fig 1
Fig 1
BEEP recruitment flow diagram.
Fig 1
Fig 1
BEEP recruitment flow diagram.
Fig 1
Fig 1
BEEP recruitment flow diagram.
Fig 2
Fig 2
Flow chart of accelerometer allocation and return.
Fig 3
Fig 3
Means and 95% confidence intervals for the primary outcome at each time point.
See this image and copyright information in PMC

References

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    1. Juhl C, Christensen R, Roos EM, et al. Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol. 2014;66:622–636. - PubMed
    1. Uthman OA, van der Windt DA, Jordan JL, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ. 2013;347:f5555. - PMC - PubMed
    1. Larmer PJ, Reay ND, Aubert ER, et al. Systematic review of guidelines for the physical management of osteoarthritis. Arch Phys Med Rehabil. 2014;95:375–389. - PubMed

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