Stratified exercise therapy by physical therapists in primary care is feasible in patients with knee osteoarthritis

Abstract

Background There is strong evidence that exercise therapy is effective in reducing pain and activity limitations in knee osteoarthritis (OA), but effect sizes are low to moderate. Stratified exercise therapy tailored to clinically relevant subgroups of patients is expected to optimise treatment effects in a cost-effective manner. Objectives This study aimed to explore the feasibility of a newly developed model of stratified exercise therapy in primary care. Methods A mixed method design was used, consisting of an uncontrolled pretest-posttest design and a process evaluation. Eligible patients visiting a participating primary care physical therapist (PT) were included. Based on our model, participants were allocated to the ‘high muscle strength subgroup’, ‘low muscle strength subgroup’, ‘obesity subgroup’ or ‘depression subgroup’, and received subgroup-specific, protocolised, 4 month exercise therapy. Feasibility of stratified exercise therapy according to this model was evaluated by a process evaluation (process documentation, semi-structured interviews and focus group meeting) and outcome (physical functioning (KOOS-ADL) and knee pain (NRS), assessed at baseline and 4 months follow-up). Results We included 50 patients, of which 3 patients dropped out. The process evaluation suggests that our model is feasible for patients and PTs, with some adaptations for further optimisation. We found clinically relevant improvements on physical functioning (p Conclusions Our model of stratified exercise therapy is feasible in primary care. Minor adaptations could further optimise the feasibility. Future research should determine the (cost-)effectiveness of this model, compared to usual, non-stratified exercise therapy. Disclosure of Interest None declared