ROME (FRONTLINE MEDICAL NEWS)There was no advantage to individually prescribed exercises for knee osteoarthritis over usual physiotherapy in a multicenter, longitudinal, randomized study reported at the European Congress of Rheumatology.

Indeed, the results of the United Kingdom–based Benefits of Effective Exercise for knee Pain ( BEEP ) study showed that all of three of the interventions tested improved patients’ pain and physical function to a similar degree over the 18-month follow-up period.

“Clearer identification of those who respond to exercise, rather than changing the characteristics of exercise programs, is needed in future research,” suggested the presenting author Emma Healey, Ph.D. , of Keele University, Staffordshire, England.

The aim of the BEEP was to see if changing the characteristics of exercise programs could improve patients’ outcomes when compared with usual physiotherapy. A total of 65 general practices, five National Health Service physiotherapy services, and 47 physiotherapists took part in the study and recruited 526 adults aged 45 years or older with knee osteoarthritis (OA) from a total of 1,530 who had been screened.

Three different interventions were compared: usual physiotherapy care consisting of up to four treatment sessions over 12 weeks (176 patients), an individually tailored and supervised exercise (ITE) program consisting of six to eight sessions over 12 weeks (178 patients), and a targeted exercise adherence (TEA) program consisting of 8-10 sessions over 6 months (172 patients). Data were collected at 3, 6, 9 and 18 months via postal questionnaires.

Participants in all groups received an advice booklet outlining the benefits of exercise and exercises to perform. Exercises were focused on the lower limb and selected from a template in the usual care group but individually prescribed and supervised in the other two groups. Patients in the TEA group also had exercises aimed at improving their overall fitness. An exercise diary was completed by those in the ITE group and an ‘adherence-enhancing toolkit’ was used by the TEA group.

The primary outcome measure used was change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scales at 6 months. On a scale of 0-20, no clinically or statistically significant differences were seen between the groups, with pain scores of 6.4, 6.4, and 6.2 for the usual care, ITE, and TEA groups, respectively. A similar pattern was seen for function scores (21.4, 22.3, 21.5, respectively) assessed on a scale of 0-68. These findings didn’t change over time, with all patients doing well with longer follow-up, Dr. Healey observed.

Clinical effectiveness was also evaluated according to Outcome Measures in Rheumatology–Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria, but again no differences between the groups were found, with around half of the study population fitting responder criteria at 6 months.

Although patients’ self-reported adherence to their exercise was high at the 3-month assessment (75%-77%), it gradually declined over the course of the follow-up period. “Exercise behavior was back to baseline levels by 18 months,” Dr. Healey noted. Self-reported adherence appeared to remain higher for longer in the TEA group, but differences between treatment groups were again not statistically significant upon closer evaluation.

Usual physiotherapy had an edge over the other interventions in terms of both effectiveness measured in quality-adjusted life-years and knee OA–related resource use at 18 months’ follow-up, according to an economic evaluation.

“Economic analysis suggests usual care is ‘treatment of choice,’ ” Dr. Healey said.

The research was funded by the National Institute for Health Research and Arthritis UK. Dr. Healey reported having no financial disclosures.


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