Authors (including presenting author) :
LI MKJ1 , TAM MPD1, CHAN LCJ1, NG CLC1, MOK YCM1 , CHAK YTC1
Affiliation :
1)Department of Physiotherapy, Pok Oi Hospital
Introduction :
Knee osteoarthritis (OA) is one of the most common degenerative diseases affecting elderly in Hong Kong. It greatly affects patient’s physical activity, quality of life and increases burden to the health care system. Exercise therapy has been proven to be beneficial to OA knee patients. The conventional OA knee class in Pok Oi Hospital consists of two sessions of home-based exercise program. However, some patients failed to exercise regularly because of fear of pain and recurrent exacerbation. Therefore, a novel clinical trial for knee pain patients which integrated self-management, coping strategies and tailor-made exercise programme has been implemented to improve the function of knee pain patients.
Objectives :
To investigate the clinical effectiveness of an integrated self-management programme (ISMP-knee) as compared with conventional OA knee class for knee pain patients.
Methodology :
OA knee patients were recruited to ISMP-knee voluntarily from May to September in 2019. The ISMP-knee consisted of six sessions in which knowledge of knee pain management, exercise recommendation and self-management for flare-up condition were covered throughout the program by a trained physiotherapist. Moreover, the patients would practise 60 minutes of exercises supervised by the physiotherapist in each session. Outcome measures included Numeric Pain Rating Scale (NPRS), Knee Injury and Osteoarthritis Outcome Score (KOOS), 6-metre timed walk (6MTW), Self-efficacy for Exercise-Chinese version (SEE-C), 30-second chair stand test and Numeric Global Rating of Change Scale (NGRCS). All outcome measures were assessed at baseline and at the end of the program. Data from conventional OA knee class collected from November 2018 to May 2019 were retrospectively analysed and compared with ISMP-knee. Patients who had completed all outcome measures assessment were included. All data were analysed by SPSS 26.
Result & Outcome :
A total of 17 patients (3 males and 14 female) joined the ISMP-knee from May to September 2019. Their mean age was 63.6±5.1 and their reported mean of NGRCS was 4.7±2.9 (out of 10). In addition, all other outcome measures were improved. NPRS was significantly reduced from 6.4±1.9 to 4.2±2.2 (out of 10) (p< 0.05). KOOS-pain score was significantly improved from 53.0±16.7 to 60.1±17.3 (out of 100) (p< 0.05). KOOS-physical function score was significantly improved from 59.4±14.2 to 67.6±9.6 (out of 100) (p< 0.05). KOOS-Quality of Life (QoL) score was improved from 32.5±16.6 to 40.5±24.1 (out of 100) (p=0.128). The walking speed of 6MTW test was significantly increased from 0.94±0.19 m/s to 1.04±0.18 m/s (p< 0.05). The number of repetitions completed in 30-second chair stand test was significantly increased from 6.6±1.8 times to 10.0±3.4 times (p< 0.05). SEE-C was improved from 3.9±2.4 to 4.9±2 (p=0.22). In the conventional OA knee class, 47 patients (13 males and 34 female) were recruited and their mean age was 61.3±5.8. When comparing ISMP-Knee and the conventional OA knee class, the reported mean of NGRCS of ISMP-knee was significantly greater than the conventional group (4.65±2.89 out of 10 in ISMP-knee while 2.49±2.61 out of 10 in conventional group) (p< 0.05). Moreover, the decrease in mean NPRS in ISMP-knee was greater than the conventional group (from 6.47 to 4.17 out of 10 in ISMP-knee while from 6.06 to 5.30 out of 10 in conventional group) (p< 0.05). Overall subjective improvement and level of knee pain of patients were significantly better after completion of ISMP-knee when compared to conventional OA knee class. Although ISMP-knee consists of more sessions than conventional OA knee class, it improves the self-efficacy of patients to do exercises and may prevent the reliance on health care system in the long term. Therefore, ISMP-knee is highly recommended to OA knee patients.
