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Knee Osteoarthritis Symptoms Improved With Stepped Care

TUESDAY, Dec. 29, 2020 -- A stepped exercise program results in modest improvements for symptoms of knee osteoarthritis, according to a study published online Dec. 29 in the Annals of Internal Medicine.

Kelli D. Allen, Ph.D., from the Durham VA Health Care System in North Carolina, and colleagues conducted a randomized controlled trial at two U.S. Department of Veterans Affairs sites involving 345 patients with symptomatic knee osteoarthritis. Participants were randomly assigned in a 2:1 ratio to either a stepped exercise program for patients with knee osteoarthritis (STEP-KOA) or an arthritis education control group. The STEP-KOA intervention included three months of an internet-based exercise program (step 1); three months of biweekly physical activity coaching calls (step 2) for those who did not meet response criteria for improvement in pain and function after step 1; and in-person physical therapy visits (step 3) for those who did not meet response criteria after step 2.

The researchers found that 150 (65 percent) of 230 participants in the STEP-KOA group progressed to step 2 and 81 (35 percent) progressed to step 3. For the full sample, the estimated baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 47.5. The estimated WOMAC score at nine-month follow-up was 6.8 points lower in the STEP-KOA group than the control group.

"This type of stepped care strategy could preserve health care resources and tailor programs to patients' needs," the authors write.

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Posted: December 2020

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