16.1.9 - Assessment of Dynamic Mechanical Biomarkers to Assist Primary Care Physicians in the Management of Knee Osteoarthritis: A Cluster RCT
- A. Fuentes (Montreal, CA)
- A. Cagnin (Montreal, CA)
- M. Choinière (Montreal, CA)
- N. Bureau (Montreal, CA)
- M. Durand (Montreal, CA)
- N. Mezghani (Montreal, CA)
- N. Gaudreault (Sherbrooke, CA)
- N. Hagemeister (Montreal, CA)
Abstract
Purpose
Primary care physicians (PCP) highlighted the lack of validated tools to objectively assess the knee joint function to guide conservative treatment decision-making, as recommended in guidelines. Assessing mechanical factors linked to disease progression with a knee kinesiography exam (Knee-KG) is a promising avenue to fill this clinical gap and help PCPs guide joint preservation strategies. This study assessed the impact on clinical outcomes of adding a Knee-KG exam to current medical management (CMM) of knee osteoarthritis patients.
Methods and Materials
In this 6-month cluster randomized controlled trial, eligible patients from a primary care clinic were defined as a cluster and randomized to one of the 3 groups: 1-CMM by PCPs, 2-CMM+Knee-KG, and 3-CMM+Knee-KG+Education (one-hour session on self-management and two follow-up supervised group meetings). Primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS).
Results
Eligibility was assessed for 894 patients from 87 clinics: 515 were randomized and 449 (87.2%) completed the study. At 6-month follow-up, patients in both Knee-KG groups reported a statistically significant reduction in symptoms and pain, and improvement in function during activities of daily living on KOOS compared to the control group (all p<0.05). They also demonstrated higher satisfaction levels regarding their treatment (both p<0.01). Patients in Group 3-CMM+Knee-KG+Education significantly improved in objective functional tests and showed a greater global impression of change in pain, function, quality of life, and global condition relative to the two other groups (all p<0.05).
Conclusion
Results support the added value of assessing mechanical biomarkers linked to osteoarthritis progression to assist PCPs in the management of their knee osteoarthritis patients. Providing them with objective information on mechanical markers through a Knee-KG exam yields improvements in patients’ pain, function, and satisfaction. A maximum of three sessions including education and follow-up reinforces adherence to PCPs recommendations and further improves patient outcomes.