Group Physical Therapy for Knee Osteoarthritis
Group Physical Therapy for Knee Osteoarthritis
Osteoarthritis (OA) is a common cause of pain and disability. Physical therapy is a key part
 of treatment for OA, but VA Medical Centers are often limited in their capacity to provide
 physical therapy services for veterans with knee OA. The goal of this study is to perform a
 preliminary work on a group-based physical therapy program for veterans with knee
 osteoarthritis (OA), in preparation for a larger project. This work will allow us to assess
 the feasibility of conducting group-based physical therapy program and to plan a larger grant
 submission based on the findings of this initial study. We hypothesize that the group-based
 program will be feasible to administer and will result in improved pain and function.
Background / Rationale: Osteoarthritis (OA) is the one of the most common chronic conditions
 among veterans, and over half of VA health care users with OA report being limited in their
 daily activities because of joint symptoms. Physical therapy and ongoing exercise help to
 reduce pain and improve physical function. However, the majority of veterans with OA are
 physically inactive. Furthermore, physical therapy appointments in the VA health care system
 are a limited resource, with demand often exceeding supply, resulting in long wait periods
 and a limited number of visits (1 or 2) per patient. Extending physical therapy services to a
 larger number of veterans with OA, in a cost effective manner, may play a key role in
 improving outcomes in this large patient group. Objective: The objective of this pilot study
 is to perform preliminary evaluation of group-based physical therapy program for veterans
 with knee OA, in preparation for a larger grant submission. This pilot work will allow us to
 assess the feasibility of group-based sessions, refine the intervention session components as
 needed, assess the planned recruitment and enrollment methods, estimate the number of
 potentially eligible veterans at the Durham VAMC, and conduct sample size and power analyses
 for a larger clinical trial. Methods: All participants will be involved in a 12-week
 group-based physical therapy program, with study measures being obtained at baseline and
 immediately following program completion. Participants will be Durham VAMC patients with
 symptomatic knee OA. Our goal is to enroll 20 participants who complete the program and
 follow-up measures, but we may recruit up to 25 participants total, if some participants drop
 out of the program before completion. Participants will attend group physical therapy
 sessions bi-weekly for twelve weeks (total of six visits), with each session lasting
 approximately one hour. Two study team members, a licensed physical therapist and research
 assistant with training in exercise for knee OA, will lead each session. The research
 assistant will lead group exercises, and the physical therapist will assess the progress and
 monitor for any potential problems or special needs of individual patients. During the first
 10-15 minutes of each group session, one study team member will talk with participants about
 a topic related to OA care, such as joint protection, weight management, joint injections and
 surgery, and stress management. The remainder of the session will involve group warm-up /
 stretching exercises, then a series of strengthening exercises tailored for patients with
 knee OA. Participants will also be instructed to perform stretching exercises daily and
 strengthening exercises three times total each week. Primary outcome measures will be
 self-reported pain and function. Statistical analyses will compare pre- and post-intervention
 pain and function, including effect size calculations to assist with sample size estimates
 for a larger study. Impact: This study is significant because it examines a novel health
 services delivery method for improving outcomes among patients with OA - a highly prevalent
 condition that is also one of the main causes of pain among veterans. Specifically, this
 pilot study is a key first step toward examining the efficacy and cost-effectiveness of a
 method for delivering physical therapy services to a larger number of veterans with OA. This
 delivery method could also be applied to other common orthopedic and neurologic conditions
 that require physical therapy service.
Inclusion Criteria:

 -  Radiographic Evidence of Knee Osteoarthritis and a Clinician's Diagnosis

 -  Current knee symptoms

 Exclusion Criteria:

 -  Presence of other rheumatological conditions (such as rheumatoid arthritis and
 fibromyalgia) - Other health-related problem that would prevent safe participation in
 a physical therapy program - Currently undergoing physical therapy for knee OA,
 participation in another interventional study, scheduled or on waiting list for joint
 replacement surgery, resident of nursing home