RESUMEN
OBJECTIVE: Assess the efficacy of an 8-week virtual, physiotherapist (PT)-guided knee health program (Stop OsteoARthritis (SOAR)) to improve knee extensor strength in individuals at risk of post-traumatic knee osteoarthritis (PTOA). METHOD: In this superiority, randomized delayed-control trial, persons aged 16-35 years, 1-4 years after a self-reported knee joint injury were randomly assigned (1:1) to receive the SOAR program immediately (experimental group) or after a 9-week delay (control group). SOAR includes 1) one-time Knee Camp (virtual PT-guided group education, knee assessment, 1:1 exercise and physical activity (PA) goal-setting); 2) Weekly personalized home-based exercise and PA program with tracking; 3) Weekly 1:1 PT counseling (virtual). The primary outcome was a change in isokinetic knee extensor strength (baseline to 9-weeks). Additional outcomes included change in self-reported knee-related quality-of-life (QOL), self-efficacy, self-management and kinesiophobia, and PA (accelerometer) at 9 and 18-weeks. Linear regression models estimated the effect of the 8-week intervention at the primary endpoint (9-week). RESULTS: 49 of 54 randomized participants completed the study (91%). Participants were a mean ± standard deviation age of 27 ± 5.0 years, and 2.4 ± 0.9 years post-injury. No mean between group differences for the primary (0.05; 95% confidence interval (CI): -0.10, 0.19) or other outcomes were seen at 9 weeks except for greater improvements in perceived self-management (Partner in Health Scale; 11.3/96, 95%CI: 5.5, 17.1) and kinesiophobia (Tampa Scale of Kinesiophobia; -4.4/33, 95%CI: -7.0, -1.8). CONCLUSION: For active persons with elevated risk of PTOA, an 8-week SOAR program did not change knee-related strength, QOL, self-efficacy, or PA, on average, but may benefit the ability to self-manage knee health and kinesiophobia.
Asunto(s)
Terapia por Ejercicio , Traumatismos de la Rodilla , Osteoartritis de la Rodilla , Humanos , Osteoartritis de la Rodilla/etiología , Masculino , Femenino , Adulto , Adolescente , Adulto Joven , Terapia por Ejercicio/métodos , Traumatismos de la Rodilla/complicaciones , Calidad de Vida , Fuerza Muscular , Resultado del Tratamiento , AutoeficaciaRESUMEN
Objective: Describe participants' perspectives about the feasibility of a virtual, physiotherapist-guided knee health program for people at risk of post-traumatic osteoarthritis after a sport-related knee injury. Design: Qualitative description study nested within a quasi-experimental study evaluating the feasibility of the Stop OsteoARthritis (SOAR) with persons with sport-related knee injuries. SOAR includes: 1) one-time Knee Camp (group education, 1:1 exercise/activity goal-setting); 2) weekly home-based exercise/activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning. Upon program completion, semi-structured 1:1 interviews were conducted with participants identified by convenience and maximum variation sampling (age, gender, program satisfaction). Open-ended questions elicited participants' experiences with the program. Content analysis was conducted. Results: 12 women and 4 men [median (min-max) age; 30 (19-46) years] were interviewed. Four categories depicted participants' experiences: 1) 'SOAR satisfies an unmet need' portrayed the perceived relevance and need for a program that promotes knowledge about knee health and self-efficacy for independent exercise behaviour, 2) 'Regaining control of knee health' described how SOAR empowered participants and fostered a sense of 'leading the charge' to their own knee health, 3) 'Social support encourages exercise participation' highlighted that weekly physiotherapy interactions provided accountability for achieving exercise goals, and that relating to other participants was inspirational, 4) 'Program refinements and barriers' suggested enhancements to meet the needs of future participants. Conclusions: Participants report the SOAR program to be acceptable, relevant, and empowering. Improved knowledge about one's knee health, self-efficacy, autonomy, and social support may encourage exercise adherence and self-management of future knee OA risk.
RESUMEN
Objective: Assess the feasibility of a virtually-delivered, physiotherapist-guided knee health program (SOAR) that targets self-management of knee health and osteoarthritis risk after an activity-related knee injury. Design: In this quasi-experimental feasibility study, individuals with varied lived experience of knee trauma completed a 4-week SOAR program. This included: 1) Knee Camp (group education, 1:1 exercise and activity goal-setting); 2) weekly home-based exercise and activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning. SOAR program feasibility was assessed with implementation (attrition, adherence, intervention fidelity), practicality (adverse events, goal completion), acceptability and efficacy (change in Knee injury and Osteoarthritis Outcome Score subscales, Patient Specific Functional Scale (PSFS), Godin Leisure-Time Exercise Questionnaire (GLTEQ), Partner in Health Scale (PHS)) outcomes. Descriptive statistics, disaggregated by gender, were calculated. Results: Thirty participants (60% women, median (min-max) age 30 years (19-50), time from injury 5.6 years (1.2-25.2)) were enrolled. No participant attrition or adverse events were reported, and 90% of mandatory program components were completed. Participants rated their adherence at 80%, and 96% of exercise-therapy and 95% of activity goals were fully or partially achieved. Both women and men reported significant group mean (95%CI) improvements in GLTEQ scores (women: 22 METS (6,37), men: 31 METS (8,54)), while women alone reported improvements in PHS (-7 (-11,-3) and PSFS (1.7 (0.6,2.8) scores. Conclusion: The SOAR program is feasible for persons at various timepoints post-knee trauma, and gender may be an important consideration for SOAR implementation and assessment. A randomized controlled trial to assess intervention efficacy is warranted.
RESUMEN
BACKGROUND: Knee trauma permanently elevates one's risk for knee osteoarthritis. Despite this, people at-risk of post-traumatic knee osteoarthritis rarely seek or receive care, and accessible and efficacious interventions to promote knee health after injury are lacking. Exercise can ameliorate some mechanisms and independent risk factors for osteoarthritis and, education and action-planning improve adherence to exercise and promote healthy behaviours. METHODS: To assess the efficacy of a virtually-delivered, physiotherapist-guided exercise-based program (SOAR) to improve knee health in persons discharged from care after an activity-related knee injury, 70 people (16-35 years of age, 12-48 months post-injury) in Vancouver Canada will be recruited for a two-arm step-wedged assessor-blinded delayed-control randomized trial. Participants will be randomly allocated to receive the intervention immediately or after a 10-week delay. The program consists of 1) one-time Knee Camp (group education, 1:1 individualized exercise and activity goal-setting); 2) weekly individualized home-based exercise and activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning with optional group exercise class. Outcomes will be measured at baseline, 9- (primary endpoint), and 18-weeks. The primary outcome is 9-week change in knee extension strength (normalized peak concentric torque; isokinetic dynamometer). Secondary outcomes include 9-week change in moderate-to-vigorous physical activity (accelerometer) and self-reported knee-related quality-of-life (Knee injury and OA Outcome Score subscale) and self-efficacy (Knee Self Efficacy Scale). Exploratory outcomes include 18-week change in primary and secondary outcomes, and 9- and 18- week change in other components of knee extensor and flexor muscle function, hop function, and self-reported symptoms, function, physical activity, social support, perceived self-care and kinesiophobia. Secondary study objectives will assess the feasibility of a future hybrid effectiveness-implementation trial protocol, determine the optimal intervention length, and explore stakeholder experiences. DISCUSSION: This study will assess the efficacy of a novel, virtually-delivered, physiotherapist-guided exercise-based program to optimize knee health in persons at increased risk of osteoarthritis due to a past knee injury. Findings will provide valuable information to inform the management of osteoarthritis risk after knee trauma and the conduct of a future effectiveness-implementation trial. TRIAL REGISTRATION: Clinicaltrials.gov reference: NTC04956393. Registered August 5, 2021, https://clinicaltrials.gov/ct2/show/NCT04956393?term=SOAR&cond=osteoarthritis&cntry=CA&city=Vancouver&draw=2&rank=1.