P167 - Dynamic Mechanical Markers Linked to Knee Osteoarthritis Progression Can be Modified Through Personalized Exercises: A Cluster RCT
Disease progression, pain, and functional limitations in knee osteoarthritis patients are known to be associated with dynamic mechanical markers. These are difficult to assess clinically and the addition of a knee kinesiography exam (Knee-KG) could help tailor rehabilitation strategies. While generic exercises showed improvements in clinical outcomes, none demonstrated significant impact on mechanical risk factors. The study’s objective was to assess the efficacy of personalized home-based exercises to address mechanical risk factors identified by a Knee-KG exam.
Methods and Materials
In this cluster randomized controlled trial, each participating primary care clinic was defined as a cluster and randomized into one of the 3 groups: 1-current medical management (CMM) by PCPs, 2-CMM+Knee-KG, 3-CMM+Knee-KG+Education+two follow-up meetings. In Knee-KG groups, the therapist who performed the Knee-KG exam established a personalized home-based exercise program targeting the identified mechanical risk factors. Exercise program was given either by the PCP (Group 2), or by the therapist during a self-management education session (Group 3).
226 patients from 56 clinics participated. Patients from Group 3 who adhered to their tailored home-based exercises to address mechanical factors showed to correct osteoarthritis progression risk factors like varus thrust and external tibial rotation at heel contact compared to patients in Group 1 (both p<0.01). Adherence to exercises for the 6-month period was higher in Group 3 (76%) compared to Group 2 (55%; p<0.01). Per-protocol analysis (N=160) showed that patients in Knee-KG groups significantly improved their knee condition compared to Group 1 (Western Ontario McMaster Universities Arthritis Index; Group 1: +0.6, Group 2: +6.9, Group 3: +6.7; both p<0.01).
Results support that personalized home-based exercises targeting dynamic mechanical markers linked to osteoarthritis progression identified by a Knee-KG exam can be modified and have a significant impact on clinical outcomes when patients comply with their exercises.