medwireNews: Findings from a randomized trial show that the STEP-KOA exercise program, with intensification of the intervention for participants not meeting response criteria, may improve the symptoms of knee osteoarthritis (OA).
The trial included 345 veterans (85% men) aged an average of 60 years with symptomatic knee OA and an average baseline WOMAC score of 47.5 points who were randomly assigned to take part in the STEP-KOA program or a control intervention in which they received educational materials in the post.
Writing in the Annals of Internal Medicine, Kelli Allen (Durham VA Health Care System, North Carolina, USA) and team explain that the intervention began with an internet-based exercise program, stepping up sequentially to telephone-based coaching (step 2) and in-person physical therapy (step 3) at 3-month intervals for participants who did not achieve clinically meaningful improvements in OA symptoms according to OMERACT–OARSI criteria.
The investigators report that average WOMAC total scores improved by 5.5 points from baseline to the 9-month follow-up among patients in the STEP-KOA group, compared with a 1.4-point worsening among patients in the control group, giving a significant mean difference of 6.8 points between the groups.
Similarly, average WOMAC pain and function subscale scores improved to a significantly greater degree among individuals in the STEP-KOA compared with the control arm, with between-group differences of 1.4 points and 4.6 points, respectively.
In all, 65% of the 230 participants taking part in the exercise program progressed to step 2 of the intervention, while 35% progressed to step 3.
Allen and team say these findings indicate “that more intensive therapy may be appropriate for a substantial proportion of patients,” but “health systems may benefit from engaging patients in other exercise-based interventions before [physical therapy] referral” in light of challenges with access to in-person care in some settings.
They acknowledge that the improvements in WOMAC score seen in the trial were “on the lower end of clinically relevant improvement for WOMAC scores,” and suggest that limited engagement with the intervention may have reduced its impact. For instance, 17.8% of participants missed their follow-up assessments at 3 and 6 months, and 28.0% of people in the STEP-KOA group did not access the website as instructed.
Moreover, the authors caution that the findings from their study of predominantly male veterans may not be generalizable to other populations.
Nevertheless, they believe that “[t]his type of stepped care strategy could preserve health care resources and tailor programs to patients’ needs.”
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