Authors (including presenting author) :
LAU NLK(1), CHEUNG PCT(1), NGAI THJ(1), SUEN MYAB(1), MAK MYM(2), CHAN LCJ(3)
Affiliation :
(1)Department of Physiotherapy, Tin Shui Wai Hospital, (2)Department of Physiotherapy, Tuen Mun Hospital, (3)Department of Physiotherapy, Pok Oi Hospital
Introduction :
Knee osteoarthritis(OA) is one of the largest patient groups in physiotherapy out-patient department.
Objectives :
This study aims to evaluate the effectiveness of a revamped exercise class approach in knee care education and pain relief.
Methodology :
Knee OA patients referred to NTWC Physiotherapy Department, who accepted exercise training approach were included. Patients with potentially unstable medical or mental conditions, pregnancy, communication barriers, injury-on-duty, traumatic knee conditions or with ongoing litigation were excluded.
All patients would receive 2 sessions of education class on knee OA knowledge, knee care techniques, stretching and strengthening exercises.
Re-assessment was carried out afterwards, patients would then be stratified into 2 groups. Group A, which were patients with pain level ≥5 out of 10 as measured by Numerical Pain Rating Scale(NPRS) or with body mass index(BMI) ≥25, would be offered a 6-session pain relief course or a 3-session weight management class respectively. The remaining patients, namely group B, would be discharged directly after the 2 sessions of education class.
Outcome measures were 1)NPRS, 2)Knee injury and osteoarthritis outcome score short form(KOOS-3), 3)Knowledge, attitudes, and practices survey(KAP). NPRS was measured pre- and post-program. KOOS-3 and KAP scores were measured before and after the 2-session education class.
Result & Outcome :
From 11 Jun 2019 to 30 Nov 2019, 91.5% of recruits (65 out of 71) successfully completed their designated sessions based on the stratification result, whereas 6 patients defaulted our appointment. There are 33 patients in group A and 32 patients in group B. Paired t-test was used for comparison of NPRS and all 3 domains of KOOS-3. Wilcoxon signed ranked test was used for KAP evaluation as parametric tests criterion are not met.
Both groups showed significant improvement in NPRS(p< 0.001), pain domain in KOOS(group A p=0.05; group B p=0.016) and KAP(group A p=0.001, z=-3.295; group B p=0.001, z=-3.455) post program, indicating improvement in pain level and knee care knowledge. However, both groups did not show any significant improvement in physical function(PS)(group A p=0.298, group B p= 0.072) and quality of life(QoL) (group A p=0.874, group B p=0.064) domain in KOOS-3.
This may due to the fact that PS and QoL actually would take longer time to show significant improvement. Longer follow-up period may be needed in order to observe such changes.
To conclude, this revamped knee OA exercise class is effective in knowledge education and pain relief but not in long-term outcomes like PS and QoL. A longer time frame may be needed to observe whether the program can bring any changes to those outcomes.
