Background/Purpose: Chronic knee pain causes personal suffering and impairs physical function and quality of life. Usual primary care involves prolonged drug therapy in spite of growing concerns about effectiveness and side-effects. Exercise and self-management interventions can have good short-medium term (up to 6 months) benefits, but whether short term benefits are sustained is largely unknown. Since chronic knee pain is a long term problem establishing long term outcome is important. We devised 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-medium term (6-months) improvements in physical functioning. To measure long term effects of the programme we continued to follow participants for 30 months after completing the programme.

Methods: 418 people from 54 primary care surgeries were (cluster) randomised to receive i) usual care, or ESCAPE-knee pain delivered to ii) individual or iii) groups of 8 participants. As there no differences in the baseline or post-rehabilitation data between participants who received the programme individually or in groups these data were combined. Subjective physical function was measured by the Western Ontario and McMasters University Osteoarthritis Index function sub-scale (WOMAC-func) was assessed at baseline, immediately post-rehabilitation, 6-months, 18-months and 30-months after completing the ESCAPE-knee pain programme. Multilevel Modelling was performed to adjust for clustering, baseline WOMAC-func and missing data.

Results: At baseline physical function in both groups were similar. Immediately after the intervention, participants who undertook ESCAPE-knee pain reported better physical function than participants who remained on usual primary care. In the following 30 months, physical function of participants who remained on usual care remained unchanged. Physical function of participants who undertook the ESCAPE-knee pain programme improved at each assessment compared to baseline value, i.e. mean WOMAC-func decreased, (post-rehabilitation WOMAC-func -5.49 (95%CI -7.78, -3.19; p<0.0001); 6-month WOMAC-func -4.44 (-6.54, -2.33; p<0.0001); 18-month WOMAC-func -3.10 (-5.44, -0.76; p<0.0095) 30-month WOMAC-func -2.78 (-5.32, -0.23; p<0.0323)), but declined over time becoming more similar to the usual care values.

Conclusion: ESCAPE-knee pain is an exercise-based rehabilitation programme for chronic knee pain that has sustained improvement in physical function for up to 2½ years after completing the programme. Models of care should be developed that will sustain for longer the large initial improvement in physical functioning.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sustained-improvement-physical-function-following-an-integrated-rehabilitation-programme-for-chronic-knee-pain/