Chen H, Zheng X, Huang H, et al. The effects of a home-based exercise intervention on elderly patients with knee osteoarthritis: a quasi-experimental study. BMC Musculoskelet Disord. 2019 Apr 9;20(1):160. doi: 10.1186/s12891-019-2521-4. (Original study)

BACKGROUND: Knee osteoarthritis (KOA) is common in elderly people, causes pain, loss of physical functioning, and disability. This was a two-arm, superiority, quasi-experimental trial. The aim of this study was to evaluate the effectiveness of a home-based exercise intervention (HBEI) to reduce KOA symptoms and improve the physical functioning of elderly patients.

METHODS: A total of 171 elderly patients (60 years of age or older) with KOA were recruited from four community centers. Patients from two community centers were randomly assigned to the intervention group (IG) and the other two centers were randomly assigned to the control group (CG). Participants in the IG received a 12-week HBEI (including four 2-h sessions supervised by a physiotherapist and fortnightly telephone support) combined with health education, while patients in the CG only received health education. The participants and physiotherapists were aware of the group assignment and alternative treatment components, but the study's hypotheses were not disclosed to the participants. Pain intensity, joint stiffness, lower-limb muscle strength, balance, mobility, and quality of life were measured before and after the intervention by the same blinded assessor.

RESULTS: A total of 171 patients (IG: n = 84, CG: n = 87) were enrolled. Data were obtained from 141 patients with an average age of 68 (range, 60-86 years) who completed the 12-week study (IG: n = 71, CG: n = 70). No significant group differences were found in any outcome measures at baseline. At week 12, the pretest/posttest changes 3significant between-group differences in decreases in pain intensity (- 1.60 (CI, - 2.75 to - 0.58)) and stiffness (- 0.79 (CI, - 1.37 to - 0.21)), with the IG exhibiting significantly larger improvements on both measures than the CG. The IG also showed significantly greater improvements on all the secondary outcomes than the CG did.

CONCLUSIONS: HBEI may be effective for relieving KOA symptoms, increasing the physical functioning, and improving quality of life in community-dwelling KOA elderly patients. A large randomized controlled trial with long-term follow-up is needed to confirm these findings.

TRIAL REGISTRATION: Chinese Clinical Trails Registry number ChiCTR1800017026 (retrospectively registered). Registered 9 July 2018.

Discipline Area Score
Rehab Clinician (OT/PT) 5 / 7
Comments from MORE raters

Rehab Clinician (OT/PT) rater

Given the modest nature of the home exercise program, I was surprised by the magnitude of the improvements.

Rehab Clinician (OT/PT) rater

When evaluating the putative clinical and wider benefits associated with an unblinded tailored intervention compared against a generic non-specific intervention, aside from the risk of chance, bias and confounding in an unblinded study, I am inclined to bear in mind the difference between statistically beneficial outcomes and putative clinically beneficial outcomes. We all recognise that statistical significance is not the same as clinical significance, which should also bring into analysis a cost-benefit analysis. I believe that such interventions should also be measured against unsupervised, minimal-cost or cost-free, general exercise (walking or aquajogging). I am also concerned that this study deems 60 year-olds as "elderly," which seems at odds with the standard age for retirement being pushed to 67 yoa in many developed countries.
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