See our coronavirus content including current restrictions by country, vaccines, PPE, maintaining safe services, private practice, workplace and test and trace
On Friday 14th January, we will be upgrading our telephony system which may result in some intermittent disruption when telephoning the CSP. Regular service will resume as soon as possible.
 

An exercise group for the management of chronic knee pain

Purpose

This project was undertaken to review the current provision of patients with knee OA or chronic (>3 months duration) knee pain within a city centre musculoskeletal department. This objective was created alongside the strategic transformation pathway (STP) 'ESCAPE' pain group to compare current provision.

The primary objective was to review patient satisfaction and pre and post-treatment outcome measures. Secondary objectives include updating group resources and delivery style in response to patient feedback, analysing creating follow up questionnaires to review longer term patient progress, improving group attendance, and implementing new clinical exercises and patient resources.

A total of 42 patients attended the sessions;
however, 15 patients did not complete the entire programme resulting in a 64% completion rate.
Of the remaining 27,
19 demonstrated that their KOOS-PS score reduced over the six-week programme. 2 patients stayed at the same score with 6 producing worse scores.
The mean change was a 3-point improvement
(standard deviation 4.6).
On average 50% of patients reported
they would feel confident to continue exercising independently.

Approach

Patients with knee pain (duration > 3 months) participated in a 'Knee-Fit' Group programme consisting of education, including that for osteoarthritis management and a range of strengthening and balance exercises over a 1-hour duration, once a week, for 6 weeks in an acute hospital rehabilitation gymnasium.

Pre and post programme outcomes of the Knee injury and Osteoarthritis Outcome Score; Physical Function Short form (KOOS-PS) and the number of sit to stands completed in 1 minute were recorded. Patients were asked to complete a combined quantitative and qualitative feedback questionnaire at the end of the 6-week program. Outcome data was analysed and evaluated to develop service improvements for future programs.

Outcomes

A total of 43 patients presenting with various diagnosis of knee pain enrolled onto the 4 knee fit programmes delivered within the period July 2018 to March 2019. Outcome measures of sit to stands in one minute and the Knee Injury and Osteoarthritis Outcome Score short form (KOOS-PS) were taken pre and post class.

A total of 42 patients attended the sessions; however, 15 patients did not complete the entire programme resulting in a 64% completion rate. There were no reported injuries and verbal participant satisfaction feedback was high.

Of the remaining 27, 19 demonstrated that their KOOS-PS score reduced over the six-week programme. 2 patients stayed at the same score with 6 producing worse scores. The mean change was a 3-point improvement (standard deviation 4.6). The KOOS-PS is a 7-item measure of physical function with a maximum score of 28. Minimal clinical important difference is considered to be 2.2.

Satisfaction questionnaires completed at the end of the programme reported generally positive outcomes. On average 50% of patients reported they would feel confident to continue exercising independently. Constructive feedback was received regarding printed patient information given and the set up and structure of the group which was acted upon for future cohorts.

Implications

The group was successful in demonstrating improvement in most patients.

This service improvement highlighted the importance of collecting, analysing and evaluating qualitative and quantitative outcomes and patient involvement to implement changes within services for improvement.

Future management of OA knee pain should include the continual review and evaluation of service provision to ensure it meets patient's holistic needs, expectations and current guidelines. Further work will include designing a questionnaire to evaluate ongoing patient activity and functional scores 3 months after completing the group to evaluate the longevity of outcomes and reviewing the pre-group screening processes.

Funding acknowledgements

This work was not funded. 

Additional notes

This work was presented at Physiotherapy UK 2019