Community physiotherapy results in effective self-management of knee pain

Abstract

Are community physiotherapy or enhanced pharmacy review interventions effective compared with standard advice in patients aged over 55 with knee pain? Pragmatic randomised controlled trial. Primary care (15 medical practices in North Staffordshire, UK). 325 adults aged 55 years or more (mean age 68 years) consulting their primary care practitioner with knee pain, stiffness, or both. All participants received information leaflets on osteoarthritis. Participants were then randomly allocated to one of three groups: community physiotherapy, enhanced pharmacy review, or control. The community physiotherapy group received education about activity and pacing and 3 to 6 sessions of individualised aerobic, strengthening and stretching exercises, designed and progressed by a community physiotherapist. The enhanced pharmacy review group received pharmacological management according to an algorithm. The control group received one monitoring telephone call. Primary outcomes were the pain and physical function subscale scores of the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) at 3, 6, and 12 months. Secondary outcome measures included use of co-interventions (self-reported consultations with health practitioners and drug use). Participant global assessment of change (five point ordinal scale) and participant perceptions about the usefulness of treatment (simple categorical data) were also recorded at each time point. The mean difference in change scores for physiotherapy compared with controls at 3 months was 1.15 (95% CI 0.2 to 2.1) for pain, and 3.99 (95% CI 1.2 to 6.8) for function; for pharmacy it was 1.18 (95% CI 0.3 to 2.1) for pain, and 1.80 (95% CI −0.8 to 4.5) for function. These differences were not sustained at 6 or 12 month follow-up. Participants in the physiotherapy group, but not the pharmacy group, reported significantly fewer consultations with their general practitioner for knee pain (15% reduction (95% CI 5 to 25). Use of non-steroidal anti-inflammatory drugs (NSAIDs) was lower in both the physiotherapy (16%) and pharmacy (15%) groups, compared with the control group at six months. Both interventions were associated with high patient satisfaction. Both community physiotherapy and enhanced pharmacy review were effective interventions for patients aged over 55 years with knee pain for short-term pain reduction as well as reduced use of NSAIDs and high patient satisfaction. The physiotherapy intervention produced additional benefits of improved physical function and fewer general practitioner consults.