The effects of a six-week physiotherapist-led exercise and education intervention in patients with osteoarthritis, awaiting an arthroplasty in South Africa

Abstract

Background: Osteoarthritis (OA) is one of the leading causes of disability worldwide. A major challenge facing this population is long waiting lists delaying access to joint replacements. Patients are known to wait more than 5 years for a joint replacement in the Western Cape of South Africa (SA). The main complaint in this population is pain and its consequences including reduced quality of life, activity restrictions and participation limitations. Hip or knee OA is not merely joint degeneration but a condition requiring holistic management, even while waiting for surgery. Most of the literature in this field is available from high income countries exploring the effects of interventions during short waiting periods; research is warranted in a low income country such as SA in those waiting for long periods. Purpose: To explore the effects of a six-week physiotherapist-led exercise and education intervention in patients with hip/knee OA who have been placed on a long waiting list for an arthroplasty in SA. Methods: A single blinded randomised controlled trial was performed at Tygerberg Hospital in the Western Cape. The experimental group attended a six-week group-based physiotherapist-led intervention comprising of a two-hour session once a week including education, exercise and relaxation. The control group continued to receive usual care. The primary outcome measure was pain with secondary measures of disability, function, quality of life and self-efficacy. Measures were obtained at weeks 0, 6, 12 and 24 by a blinded physiotherapist. An open ended questionnaire was completed by the participants in the experimental group at week 24. Analysis was by intention to treat. Two-way analysis of variance and post-hoc Tukey comparisons were used for parametric data, Pearson Chi squared calculations for non-parametric. Results: 42 participants from the waiting list for a hip or knee arthroplasty were recruited. Mean waiting time was 3.6± 2.5 years. Compared to the control group, the experimental group had significant improvements in pain interference from baseline to week 24 with a large effect size (3.49± 2.63 vs. 6.09± 2.43; p= 0.02, ES = 1.08) and a significant improvement in function measured by the 15m walk at fastest speed with a large effect size (15.09± 6.04s vs 20.10± 8.79s; p= 0.03, ES = 1.88). Furthermore, the experimental group displayed significant (p< 0.01) and sustained improvements from baseline measures to week 24 in pain severity, disability and function (15m walk at normal speed, sit-stand, 6-minute walk tests). Participants enjoyed the intervention reporting improved knowledge, function and activity, pain relief and improvement in psychosocial aspects. Conclusion(s): A six-week physiotherapist-led exercise and education intervention brought about significant long term improvements in pain interference and functional walking ability in patients with osteoarthritis, awaiting a joint replacement compared with a control group. Such a programme appears to have significant and sustained improvements in pain severity, disability and function. Due to large standard deviations in this sample; further researchwith a larger sample size is indicated to establish these effects. Implications: Such an intervention is effective and enjoyable for patients with OA of the hip and/or knee on a long waiting list and should be incorporated into practice for these individuals.