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An evidence-based walking program among older people with knee osteoarthritis: the PEP (participant exercise preference) pilot randomized controlled trial

Abstract

Knee osteoarthritis is a common joint problem leading to an increase of pain and a loss of function in older individuals. The main objective of this study was to evaluate if a participant who was randomly assigned to his preferred group improved his adherence to an effective walking program compared to a participant who did not receive his preferred group. This was a 9-month pilot randomized clinical trial, based on a patient treatment preferences design. The 69 eligible participants had a diagnosis of knee osteoarthritis. Participants were randomized to one of two groups: a supervised community-based or unsupervised walking program, based on the Ottawa Panel guidelines. At 6 months, participants who expressed a preference, either for the supervised or unsupervised program, and who were assigned to their preferred choice of program showed significantly higher adherence to walking sessions (supervised 60.7 ± 12.3%, P < 0.0001; unsupervised 43.1 ± 12.1%, P = 0.03), compared to the participants who did not obtain their preferred choice of program. After 9 months, significant improvements were shown according to the level of stiffness evaluated with the WOMAC (P = 0.01) and the functional status assessed with the Timed Up and GO Test (P = 0.04), among the adherent participants who obtained their preference, as compared to those who did not receive their preference. We show this approach promotes long-term adherence to a community-based walking program, while ensuring the maintenance of clinical benefits of walking, among older adults susceptible to avoid or not properly engage in physical activity.

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References

  1. 1.

    Heidari B (2011) Knee osteoarthritis prevalence, risk factors, pathogenesis and features: part I. Caspian J Intern Med 2(2):205–212

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Bathia D, Bejarano T, Novo M (2013) Current interventions in the management of knee osteoarthritis. J Pharm Bioallied Sci 5(1):30–38

    Article  Google Scholar 

  3. 3.

    Fransen M, Simic M, Harmer AR (2014) Determinants of MSK health and disability: lifestyle determinants of symptomatic osteoarthritis. Best Pract Res Clin Rheumatol 28:435–460

    Article  PubMed  Google Scholar 

  4. 4.

    Loew L, Brosseau L, Wells GA, Tugwell P, Kenny GP, Reid R, Maetzel A, Huijbregts M, McCullough C, De Angelis G, Coyle D (2012) Ottawa Panel evidence-based clinical practice guidelines for walking programs in the treatment of osteoarthritis. Arch of Phys Med Rehabil 69:1269–1284

    Article  Google Scholar 

  5. 5.

    Dunlop DD, Song J, Semanik PA, Chang RW, Sharma L, Bathon JM, Eaton CB (2011) Hochberg measurement in the osteoarthritis initiative: are guidelines being met? Arth Rheum 63(11):3372–3383

    Article  Google Scholar 

  6. 6.

    Bombardier C, Hawker G, Mosher D (2011) The impact of arthritis in Canada: today and over the next 30 years. Arthritis Alliance of Canada, Toronto, pp 1–52

    Google Scholar 

  7. 7.

    Pisters MF, Veenhof C, Bakker DH, Schellevis FG, Dekker J (2010) Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis: a cluster-randomised trial. J Physiother 56:41–47

    Article  PubMed  Google Scholar 

  8. 8.

    Broughton R, Rathbone B (2001) What makes good clinical guideline? Hayward medical communications. UK 1(11):1–8

    Google Scholar 

  9. 9.

    Loew L, Brosseau L, Kenny GP, Durand-Bush N, Poitras S, Wells GA (2015) Factors influencing adherence among older people with osteoarthritis. Clin Rheumatol 35 (9):2283-91. doi:10.1007/s10067-015-3141-5

  10. 10.

    Brosseau L, Wells GA, Kenny GP, Reid R, Maetzel A, Tugwell P, Huijbregts M, McCullough C, De Angelis G, Chen L (2012) The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis (OA): a knowledge translation (KT) randomized controlled trial (RCT): Part I: the uptake of the Ottawa Panel clinical practice guidelines (CPGs). BMC Public Health 12:871. doi:10.1186/1471-2458-12-871

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Nieuwenhuijsen ER, Zemper E, Miner KR, Epstein M (2006) Health behavior change models and theories: contributions to rehabilitation. Disabil Rehabil 28(5):245–356

    Article  PubMed  Google Scholar 

  12. 12.

    Nicholas MK (2015) Expanding patients’ access to help in managing their chronic pain. Pain: Clin Updates 13(1):1–8

    Google Scholar 

  13. 13.

    Jordan JL, Holden MA, Mason EEJ, Foster NE (2010) Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults (review). Cochrane Libr 1:1–64

    Google Scholar 

  14. 14.

    King M, Nazareth I, Lampe F, Bower P, Chandler M, Morou M et al (2005) Conceptual framework and systematic review of the effects of participants’ and professionals’ preferences in randomised controlled trials. Health Technol Assess 9(35):1–186 iii-iv

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Lutfey K (2005) On practices of ‘good doctoring’: reconsidering the relationship between provider roles and patient adherence. Sociol Health Illn 27(4):421–447

    Article  PubMed  Google Scholar 

  16. 16.

    Miranda J (2009) An exploration of participants’ treatment preferences in a partial RCT. Can J Nurs Res 41(1):276–290

    PubMed  Google Scholar 

  17. 17.

    Slade SC, Molloy E, Keating JL (2009) People with non-specific chronic low back pain who have participated in exercise programs have preferences about exercise: a qualitative study. Aust JPhysiother 55(2):115–121

    Article  Google Scholar 

  18. 18.

    Thomas E, Craft PR, Paterson SM, Dziedzic K, Hay EM (2004) What influences participants’ treatment preference and can it influence outcome? Results from a primary care-based randomised trial for shoulder pain. Br J Gen Pract 54:93–96

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Corrigan PW, Salzer MS (2003) The conflict between random assignment and treatment preference: implications for internal validity. Eval Program Plann 26:109–121

    Article  PubMed  Google Scholar 

  20. 20.

    TenHave TR, Coyne J, Salzer M, Katz I (2003) Research to improve the quality of care for depression: alternatives to the simple randomized clinical trial. Gen Hosp Psychiatry 25:115–123

    Article  PubMed  Google Scholar 

  21. 21.

    Brosseau L, Wells GA, Kenny GP, Reid R, Maetzel A, Tugwell P, Huijbregts M, McCullough C, De Angelis G, Chen L (2012) The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis (OA): a knowledge translation (KT) randomized controlled trial (RCT): part II: clinical outcomes. BMC Public Health 12:1073

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Adamson SJ, Sellman DJ, Dore GM (2005) Therapy preference and treatment outcome in clients with mild to moderate alcohol dependence. Drug Alcohol Rev 24(3):209–216

    Article  PubMed  Google Scholar 

  23. 23.

    Carr JL, Kleber Moffett JA, Howarth E, Richmond SJ, Torgerson DJ, Jackson DA, Metcalfe CJ (2005) A randomized trial comparing a group exercise programme for back pain patients with individual physiotherapy in a severely deprived area. Disabil Rehabil 27(16):929–937

    Article  PubMed  Google Scholar 

  24. 24.

    Johnson RE, Jones GT, Wiles NJ, Chaddock C, Potter RG, Roberts C, Symmons DP, Watson PJ, Torgerson DJ, Macfarlane GJ (2007) Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial. Spine 32(15):1578–1585

    Article  PubMed  Google Scholar 

  25. 25.

    Salter GC, Roman M, Bland MJ, MacPherson H (2006) Acupuncture for chronic neck pain: a pilot for a randomised controlled trial. BMC Musculoskelet Disord 9:99

    Article  Google Scholar 

  26. 26.

    Tilbrook H (2008) Patients’ preferences within randomised trials: systematic review and patient level of meta-analysis. BMJ 337:1864. doi:10.1136/bmj.a1864

    Article  Google Scholar 

  27. 27.

    Millat B, Borie F, Fingerhut A (2005) Patient’s preference and randomization: new paradigm of evidence-based clinical research. World J Surg 29:596–600

    Article  PubMed  Google Scholar 

  28. 28.

    Loew L, Kenny GP, Durand-Bush N, Poitras S, De Angelis G, Wells GA, Brosseau L (2014) The implementation of an effective aerobic walking program based on Ottawa Panel guidelines for older individuals with mild to moderate osteoarthritis: a participant exercise preference pilot randomized clinical protocol design. Br J Med Med Res 4(18):3491–3511

    Article  Google Scholar 

  29. 29.

    Makovey J, Metcalf B, Zhang Y, Sheng Chen J, Bennell K, March L, Hunter D (2015) Web-based study of risk factors for pain exacerbation in osteoarthritis of the knee (SPARK-Web): design and rationale. JMIR Res Protoc 4(3):e80

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Miller GD, Nicklas BJ, Davis C, Loeser RF, Lenchik L, Messier SP (2006) Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis. Obes 14(7):1219–1230

    Article  Google Scholar 

  31. 31.

    Sallis JF, Haskell WL, Wood PD, Fortmann SP, Rogers T, Blair SN, Paffenbarger R (1985) Physical activity assessment methodology in the Five City project. Am J Epidemiol 121:91–106

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, Beavers DP, Hunter DJ, Lyles MF, Eckstein F, Williamson JD, Carr J, Guermazi A, Loeser RF (2013) Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis the IDEA randomized clinical trial. J Am Med Ass 310(12):1263–1273

    CAS  Article  Google Scholar 

  33. 33.

    Balke B (1963) A simple field test for the assessment of physical fitness. Rep Civ Aeromed Res Inst 53:1–8

    Google Scholar 

  34. 34.

    Focht B, Rejeski WJ, Ambrosius W, Katula J, Messier S (2005) Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Arth rheum 53(5):659–665

    Article  Google Scholar 

  35. 35.

    Podsiadlo D, Richardson S (1991) The Timed up & go: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Alghadir A, Anwer S, Brismée JM (2015) The reliability and minimal detectable change of timed up and go test in individuals with grade 1–3 knee osteoarthritis. BMC Musculoskelet Disord 16:174

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Bellamy N, Buchanan WW (1986) A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the knee and hip. Clin Rheumatol 5(2):231–241

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    White DK, Keysor JJ, Lavalley MP, Lewis CE, Torner JC, Nevitt MC, Felson DT (2010) Clinically important improvement in function is common in people with or at high risk of knee OA: the MOST study. J Rheumatol 37(6):1244–1251

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    The EuroQol Group (1990) EuroQol-a new facility for the measurement of health-related quality of life. Health Pol 16(3):199–208

    Article  Google Scholar 

  40. 40.

    Conner-Spady BL, Marshall DA, Bohm E, Dunbar MJ, Loucks L, Khudairy AA, Noseworthy TW (2015) Reliability and validity of the EQ-5D-5L compared to the EQ-5D-3L in patients with osteoarthritis referred for hip and knee replacement. Qual Life Res 24(7):1775–1784

    Article  PubMed  Google Scholar 

  41. 41.

    Kwan BM, Dimidjian S, Rizvib SL (2010) Treatment preference, engagement, and clinical improvement in pharmacotherapy versus psychotherapy for depression. Behav Res Ther 48(8):799–804

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Harmon-Jones E, Harmon-Jones C (2007) Cognitive dissonance theory after 50 years of development. Z Soz Psychol 38(1):1–16

    Google Scholar 

  43. 43.

    WHO (2003) Adherence to long-term therapies—evidence for action: noncommunicable diseases and mental health adherence to long term therapies project in Switzerland. Report World Health Organisation, Geneva Available http://apps.who.int/iris/bitstream/10665/42682/1/9241545992.pdf. Accessed 2016 March 1

  44. 44.

    Freene N, Waddington G, Chesworth W, Davey R, Goss J (2011) ‘Physical activity at home (PAAH)’, evaluation of a group versus home based physical activity program in community dwelling middle aged adults: rationale and study design. BMC Public Health 11:883

    Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Menard, MB (2002) Methodological issues in the design and conduct of massage therapy research. Massage Ther 27–41. doi: 10.1016/B978-0-7234-3217-3.50007-7

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Acknowledgements

The authors are grateful to Ana Lakic, Prinon Rahman, the Pacesetters Walking Club and Marion Russell-D. from the Arthritis Society. The Arthritis Health Professions Association (AHPA) and The Arthritis Research Foundation Movement and Mobility supported the pilot trial. The study protocol was awarded the 2012 Arthritis Research Foundation Movement and Mobility Award. In addition, the first author received multiple other funds to support this work. The scholarships were from Fonds de recherche en santé du Québec (FRSQ), University of Ottawa Research Chair, Knowledge Translation Canada, in collaboration with the Canadian Institutes of Health Research (CIHR), Ontario Physiotherapy Association (OPA), Government of Ontario, and the University of Ottawa Research Chair (Graduate Students Salary Support).

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Correspondence to Laurianne Loew.

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Ethical standards

Ethics approval was obtained from the Research Ethics Board of the University of Ottawa without modifications to the design and measurement as registered for the pilot RCT (H01-07-08C).

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Trial Registration

International Standard Randomized Controlled Trial Number Register (ISRCTN no. 51981241) and Current Controlled Trials.

Electronic supplementary material

ESM 1

CONSORT checklist (PDF 256 kb)

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Full study protocol published (PDF 492 kb)

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Loew, L., Brosseau, L., Kenny, G.P. et al. An evidence-based walking program among older people with knee osteoarthritis: the PEP (participant exercise preference) pilot randomized controlled trial. Clin Rheumatol 36, 1607–1616 (2017). https://doi.org/10.1007/s10067-017-3606-9

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Keywords

  • Clinical trials
  • Implementation
  • Knee
  • Osteoarthritis
  • Preference
  • Walking