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. 2024 Jan 20;16(1):24.
doi: 10.1186/s13102-023-00779-0.

Effectiveness of an 11-week exercise intervention for patients with hip or knee osteoarthritis: results of a quasi-experimental pragmatic trial

Inga Krauss  1   2 , Inka Roesel  3   4 , Peter Martus  3 , Marco Giurgiu  5 , Gerhard Mueller  5   6
Affiliations

Effectiveness of an 11-week exercise intervention for patients with hip or knee osteoarthritis: results of a quasi-experimental pragmatic trial

Inga Krauss et al. BMC Sports Sci Med Rehabil. .

Abstract

Objective: To assess the effectiveness of exercise and education in addition to standard care (SC) compared to SC alone in patients with hip or knee osteoarthritis (OA) during 24 months follow-up.

Design: We conducted a quasi-experimental pragmatic clinical trial in care centers of a health insurance company. Overall, 1,030 subjects with hip and/or knee OA were included. The intervention group was recruited from clients participating in a hip/knee training (HKT, n = 515) in addition to SC. The control group (CO, n = 515) receiving SC only was recruited from the insurance database. HKT comprised 8 group sessions (1/week) of exercise and education, complemented by a 11-week structured home-exercise program (2/week). Primary endpoints were change of joint-related pain and function (WOMAC Index, score 0-10) after 3 months. Secondary endpoints related to follow-ups at 6, 12 and 24 months. All patient reported outcome measures were analyzed using linear mixed models (LMMs) investigating a time x treatment effect. A multivariable cox proportional hazards regression model was used to identify differences of joint replacement during follow-up between groups.

Results: LMMs revealed statistically significant differences in favor of HKT for the primary outcomes WOMAC pain = 0.47 (CI 0.27-0.66; Effect Size (ES) = 0.22, p < 0.001) and WOMAC function = 0.27 (CI 0.11-0.44; ES = 0.13, p < 0.001). HKT was superior to CO for 6, 12, and 24 months as well (ES < 0.2, p ≤ 0.006). HKT was inferior regarding the first incidence of hip or knee AJR during follow-up in comparison to CO (adjusted hazard ratio, HR = 1.57; CI 1.08-2.30; p = 0.020).

Conclusions: This trial demonstrated short-, mid- and long-term superiority of exercise versus control. However, differences were smaller than those reported in previous efficacy trials, raising questions regarding clinical importance. Responder analysis will follow to identify possible predictors for patient responsiveness on an individual level. Further studies should investigate the frequency and reasons for joint replacement following exercise therapy.

Trial registration: German Clinical Trial Register (DRKS00009251). Registered 10 September 2015.

Keywords: Function; Group training; Health services research; Health-related quality of life; Hip osteoarthritis; Home-exercise; Joint replacement; Knee osteoarthritis; Long-term effects; Pain.

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Conflict of interest statement

The non-profit health insurance company AOK Baden-Wuerttemberg (AOK-BW) was involved in the trial set-up, data acquisition, conduction of the intervention and data analysis. GM is an employee of the AOK-BW. IK got royalties for the exercise book that every patient of the intervention group received. The Department of Sports Medicine of the University Hospital Tuebingen got financial reimbursement of the fee for the 2-days group education program that was offered to all exercise instructors of the hip and knee training programs in advance to the study. IR, PM and MG have no financial or other interests related to the manuscript submitted to BMC Public Health that might constitute a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram
Fig. 2
Fig. 2
a Estimated marginal means (EMM) ± standard error (SE) of WOMAC Pain: 24-months follow-up. b Estimated marginal means (EMM) ± standard error (SE) of WOMAC Function: 24-months follow-up. a/b legend: Hip Knee Training (HKT), Control (CO). Logarithmic EMM were back-transformed to the original scale
Fig. 3
Fig. 3
Adjusted cox regression model: cumulative survival probability
Fig. 4
Fig. 4
Hazard ratios cox regression model: risk factors for artificial joint replacement
See this image and copyright information in PMC

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