Durham VA Health Care System, Durham, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (K.D.A.).
Durham VA Health Care System, Durham, North Carolina (S.W., D.B., N.J.H.).
Ann Intern Med. 2021 Mar;174(3):298-307. doi: 10.7326/M20-4447. Epub 2020 Dec 29.
Evidence-based models are needed to deliver exercise-related services for knee osteoarthritis efficiently and according to patient needs
To examine a stepped exercise program for patients with knee osteoarthritis (STEP-KOA).
Randomized controlled trial. (ClinicalTrials.gov: NCT02653768).
2 U.S. Department of Veterans Affairs sites.
345 patients (mean age, 60 years; 15% female; 67% people of color) with symptomatic knee osteoarthritis.
Participants were randomly assigned in a 2:1 ratio to STEP-KOA or an arthritis education (AE) control group, respectively. The STEP-KOA intervention began with 3 months of an internet-based exercise program (step 1). Participants who did not meet response criteria for improvement in pain and function after step 1 progressed to step 2, which involved 3 months of biweekly physical activity coaching calls. Participants who did not meet response criteria after step 2 went on to in-person physical therapy visits (step 3). The AE group received educational materials via mail every 2 weeks.
Primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Scores for the STEP-KOA and AE groups at 9 months were compared by using linear mixed models.
In the STEP-KOA group, 65% of participants (150 of 230) progressed to step 2 and 35% (81 of 230) to step 3. The estimated baseline WOMAC score for the full sample was 47.5 (95% CI, 45.7 to 49.2). At 9-month follow-up, the estimated mean WOMAC score was 6.8 points (CI, -10.5 to -3.2 points) lower in the STEP-KOA than the AE group, indicating greater improvement.
Participants were mostly male veterans, and follow-up was limited.
Veterans in STEP-KOA reported modest improvements in knee osteoarthritis symptoms compared with the control group. The STEP-KOA strategy may be efficient for delivering exercise therapies for knee osteoarthritis.
Department of Veterans Affairs, Health Services Research and Development Service.
需要循证模型来高效地提供与膝关节骨关节炎相关的运动服务，并满足患者的需求。
研究针对膝关节骨关节炎患者的阶梯式运动方案（STEP-KOA）。
随机对照试验。（ClinicalTrials.gov：NCT02653768）。
美国 2 个退伍军人事务部站点。
345 名患有症状性膝关节骨关节炎的患者（平均年龄 60 岁；15%为女性；67%为有色人种）。
参与者按照 2:1 的比例随机分配至 STEP-KOA 或关节炎教育（AE）对照组。STEP-KOA 干预首先进行 3 个月的基于互联网的运动方案（第 1 步）。第 1 步后疼痛和功能改善未达到应答标准的参与者进展至第 2 步，这涉及 3 个月的每两周一次的体能活动教练电话咨询。第 2 步后仍未达到应答标准的参与者继续接受面对面的物理治疗（第 3 步）。AE 组每 2 周通过邮件接收教育材料。
主要结局指标是西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评分。通过线性混合模型比较 9 个月时 STEP-KOA 和 AE 组的评分。
在 STEP-KOA 组中，65%的参与者（230 名中的 150 名）进展到第 2 步，35%（230 名中的 81 名）进展到第 3 步。全样本的基线 WOMAC 评分估计值为 47.5（95%CI，45.7 至 49.2）。在 9 个月的随访时，与 AE 组相比，STEP-KOA 组的 WOMAC 评分估计值平均低 6.8 分（CI，-10.5 至 -3.2 分），表明改善程度更大。
参与者主要是男性退伍军人，随访时间有限。
与对照组相比，STEP-KOA 组的退伍军人膝关节骨关节炎症状有适度改善。对于提供膝关节骨关节炎的运动治疗，STEP-KOA 策略可能是有效的。
美国退伍军人事务部，卫生服务研究与发展服务部。
