Background/Purpose: Chronic knee pain is a major cause of disability. Management guidelines recommend exercise and self-management interventions. We previously described a rehabilitation programme that integrates exercise and self-management (Enabling Self-Management and Coping with Arthritic Knee Pain through Exercise, ESCAPE-knee pain) that produced short term improvements in pain and physical function. Sustaining these improvements is problematic. In addition, the programme is untried in the community where it is most likely to be delivered. This study evaluated the feasibility of delivering ESCAPE-knee painin a community setting, and compared its clinical effectiveness and costs with Out-Patient Physiotherapy.

Methods: This was a pragmatic, randomised controlled trial. 64 people with chronic knee pain were randomised to receive Out-Patient Physiotherapy or the ESCAPE-knee painprogramme in a Local Adult Education Community Centre. Primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes included pain, objective functional performance, anxiety, depression, exercise-related health beliefs, exercise self-efficacy and healthcare utilisation. All outcomes were assessed at baseline and 12 months after completing the interventions (primary endpoint). ANCOVA investigated between-group differences.

Results: Both groups demonstrated similar improvements in clinical outcomes, except health beliefs and self-efficacy where imporvements were greater in ESCAPE-knee pain participants. Out-Patient Physiotherapy cost £130 per person and its participants had healthcare utilisation costs over one year of £583, the ESCAPE-knee painprogramme cost £64 per person and participant’s healthcare utilisation was £320.

Conclusion: ESCAPE-knee pain and Out-Patient Physiotherapy produced sustained physical and psychosocial benefits, but ESCAPE-knee pain cost less and was more cost-effective. Greater improvements in beliefs about the role of exercise in the management of knee pain, and their confidence in their abilty to perform exercise that will help their knee pain (exercise self-efficacy), may make ESCAPE-knee pain participants more self-reliant and utilise less healthcare resources, thereby accounting for the better cost-effectiveness of ESCAPE-knee pain.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-effectiveness-and-costs-of-an-integrated-rehabilitation-programme-compared-with-outpatient-physiotherapy-for-chronic-knee-pain/