Effects of two physiotherapy booster sessions on outcomes with home exercise in people with knee osteoarthritis

The objective of this study was to enhance exercise adherence over the longer-term is an important goal in self-management of knee OA. After an initial period of more intensive exercise supervision, this study investigated whether two additional physiotherapy visits improved outcomes with continued home exercise over a subsequent 24-week period. 78 people with medial knee OA (age 62.1±6.9 years, body mass index 29.4±4.0 kg/m2 , radiographic disease severity 19% mild, 49% moderate, 32% severe) who completed a 12-week physiotherapist-supervised exercise trial were placed at random into two 30-minute physiotherapy booster sessions (delivered by 8 physiotherapists in private clinics) or no booster sessions for the subsequent 24 weeks. All participants were asked to continue home exercises four times weekly. Primary outcomes were change in pain using a 100mm visual analogue scale and in self-reported physical function measured using the Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index. Participants and physiotherapists were unblinded to group allocation although participants were blinded to the study hypothesis. 74 (95%) participants completed the trial. There wasn’t any significant difference between groups for change in pain (mean difference (95% confidence intervals) -0.7mm (-9.4, 8.0); p=0.88) or physical function (-0.3 units (-4.0, 3.5); p=0.88). The mean (SD) percentage of home exercise sessions completed was 56% (34%) in the booster group and 51% (37%) in the control group (p>0.05).

Two booster sessions with a physiotherapist didn’t influence pain or physical function outcomes, or measures of home exercise adherence. These findings indicated that other more effective strategies are needed to maximise longer-term adherence with the aim to achieve superior improvements in clinical outcomes from exercise in this patient population.