Dr. Jones has received consultancies (less than $10,000) from AstraZeneca.
Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: A cluster randomized trial†
Article first published online: 28 SEP 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis Care & Research
Volume 57, Issue 7, pages 1211–1219, 15 October 2007
How to Cite
Hurley, M. V., Walsh, N. E., Mitchell, H. L., Pimm, T. J., Patel, A., Williamson, E., Jones, R. H., Dieppe, P. A. and Reeves, B. C. (2007), Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: A cluster randomized trial. Arthritis & Rheumatism, 57: 1211–1219. doi: 10.1002/art.22995
- Issue published online: 28 SEP 2007
- Article first published online: 28 SEP 2007
- Manuscript Accepted: 20 MAR 2007
- Manuscript Received: 27 SEP 2006
- Arthritis Research Campaign Research Fellowship
- Integrated rehabilitation;
- Knee pain
Chronic knee pain is a major cause of disability and health care expenditure, but there are concerns about efficacy, cost, and side effects associated with usual primary care. Conservative rehabilitation may offer a safe, effective, affordable alternative. We compared the effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies (Enabling Self-management and Coping with Arthritic Knee Pain through Exercise [ESCAPE-knee pain]) with usual primary care in improving functioning in persons with chronic knee pain.
We conducted a single-blind, pragmatic, cluster randomized controlled trial. Participants age ≥50 years, reporting knee pain for >6 months, were recruited from 54 inner-city primary care practices. Primary care practices were randomized to continued usual primary care (i.e., whatever intervention a participant's primary care physician deemed appropriate), usual primary care plus the rehabilitation program delivered to individual participants, or usual primary care plus the rehabilitation program delivered to groups of 8 participants. The primary outcome was self-reported functioning (Western Ontario and McMaster Universities Osteoarthritis Index physical functioning [WOMAC-func]) 6 months after completing rehabilitation.
A total of 418 participants were recruited; 76 (18%) withdrew, only 5 (1%) due to adverse events. Rehabilitated participants had better functioning than participants continuing usual primary care (−3.33 difference in WOMAC-func score; 95% confidence interval [95% CI] −5.88, −0.78; P = 0.01). Improvements were similar whether participants received individual rehabilitation (−3.53; 95% CI −6.52, −0.55) or group rehabilitation (−3.16; 95% CI −6.55, −0.12).
ESCAPE-knee pain provides a safe, relatively brief intervention for chronic knee pain that is equally effective whether delivered to individuals or groups of participants.