A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol

Bennell, Kim L., Ahamed, Yasmin, Bryant, Christina, Jull, Gwendolen, Hunt, Michael A., Kenardy, Justin, Forbes, Andrew, Harris, Anthony, Nicholas, Michael, Metcalf, Ben, Egerton, Thorlene and Keefe, Francis J. (2012) A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol. Bmc Musculoskeletal Disorders, 13 129.1-129.17. doi:10.1186/1471-2474-13-129


Author Bennell, Kim L.
Ahamed, Yasmin
Bryant, Christina
Jull, Gwendolen
Hunt, Michael A.
Kenardy, Justin
Forbes, Andrew
Harris, Anthony
Nicholas, Michael
Metcalf, Ben
Egerton, Thorlene
Keefe, Francis J.
Title A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol
Journal name Bmc Musculoskeletal Disorders   Check publisher's open access policy
ISSN 1471-2474
Publication date 2012-07
Sub-type Article (original research)
DOI 10.1186/1471-2474-13-129
Open Access Status DOI
Volume 13
Start page 129.1
End page 129.17
Total pages 17
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2013
Language eng
Formatted abstract
Background: Knee osteoarthritis (OA) is a prevalent chronic musculoskeletal condition with no cure. Pain is the primary symptom and results from a complex interaction between structural changes, physical impairments and psychological factors. Much evidence supports the use of strengthening exercises to improve pain and physical function in this patient population. There is also a growing body of research examining the effects of psychologist delivered pain coping skills training (PCST) particularly in other chronic pain conditions. Though typically provided separately, there are symptom, resource and personnel advantages of exercise and  PCST being delivered together by a single healthcare professional. Physiotherapists are a logical choice to be trained to deliver a PCST intervention as they already have expertise in administering exercise for knee OA and are cognisant of the need for a biopsychosocial approach to management. No studies to date have examined the  effects of an integrated exercise and PCST program delivered solely by  physiotherapists in this population. The primary aim of this multisite randomised controlled trial is to investigate whether an integrated 12-week PCST and exercise  treatment program delivered by physiotherapists is more efficacious than either program alone in treating pain and physical function in individuals with knee OA.
Methods/design: This will be an assessor-blinded, 3-arm randomised controlled trial of a 12-week intervention involving 10 physiotherapy visits together with home practice. Participants with symptomatic and radiographic knee OA will be recruited from the community in two cities in Australia and randomized into one of three groups: exercise alone, PCST alone, or integrated PCST and exercise. Randomisation will be stratified  by city (Melbourne or Brisbane) and gender. Primary outcomes are overall average  pain in the past week measured by a Visual Analogue Scale and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale. Secondary outcomes include global rating of change, muscle strength, functional performance, physical activity levels, health related quality of life and  psychological factors. Measurements will be taken at baseline and immediately  following the intervention (12 weeks) as well as at 32 weeks and 52 weeks to examine maintenance of any intervention effects. Specific assessment of adherence to the  treatment program will also be made at weeks 22 and 42. Relative cost-effectiveness will be determined from health service usage and outcome data.
Discussion: The findings from this randomised controlled trial will provide evidence for the efficacy of an integrated PCST and exercise program delivered by  physiotherapists in the management of painful and functionally limiting knee OA compared to either program alone.
Keyword Low-Back-Pain
Self-Efficacy Questionnaire
Quality-of-Life
Older-Adults
Gastrointestinal Cancer
Clinical-Trials
Arthritis Pain
Breast-Cancer
Nhanes-I
Management
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

 
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