Group Versus Individual Physical Therapy for Veterans With Knee Osteoarthritis: Randomized Clinical Trial

被引:23
作者
Allen, Kelli D. [1 ,2 ,3 ,4 ]
Bongiorni, Dennis [5 ]
Bosworth, Hayden B. [4 ,6 ,7 ,8 ]
Coffman, Cynthia J. [9 ,10 ]
Datta, Santanu K. [9 ,11 ]
Edelman, David [9 ,11 ]
Hall, Katherine S. [4 ,7 ,12 ]
Lindquist, Jennifer H. [6 ]
Oddone, Eugene Z. [9 ,11 ]
Hoenig, Helen [4 ,5 ,7 ]
机构
[1] Durham VA Med Ctr, Hlth Serv Res & Dev Serv 152, 508 Fulton St, Durham, NC 27705 USA
[2] Univ N Carolina, Dept Med, Chapel Hill, NC USA
[3] Univ N Carolina, Thurston Arthrit Res Ctr, Chapel Hill, NC USA
[4] Duke Univ, Ctr Aging & Human Dev, Durham, NC USA
[5] Durham VA Med Ctr, Phys Med & Rehabil Serv, Durham, NC 27705 USA
[6] Durham VA Med Ctr, Hlth Serv Res & Dev Serv, Durham, NC 27705 USA
[7] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA
[8] Duke Univ, Dept Psychiat & Behav Sci, Durham, NC USA
[9] Duke Univ, Durham VA Med Ctr, Hlth Serv Res & Dev Serv, Durham, NC USA
[10] Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA
[11] Duke Univ, Dept Med, Durham, NC USA
[12] Durham VA Med Ctr, Geriatr Res Educ & Clin Ctr, Durham, NC 27705 USA
来源
PHYSICAL THERAPY | 2016年 / 96卷 / 05期
关键词
URINARY-INCONTINENCE; GROUP REHABILITATION; OLDER-ADULTS; SINGLE-BLIND; MANAGEMENT; HIP; ARTHRITIS; EXERCISE; OUTCOMES; QUALITY;
D O I
10.2522/ptj.20150194
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
Background. Efficient approaches are needed for delivering nonpharmacological interventions for management of knee osteoarthritis (OA). Objective. This trial compared group-based versus individual physical therapy interventions for management of knee OA. Design and Methods. Three hundred twenty patients with knee OA at the VA Medical Center in Durham, North Carolina, (mean age=60 years, 88% male, 58% nonwhite) were randomly assigned to receive either the group intervention (group physical therapy; six 1-hour sessions, typically 8 participants per group) or the individual intervention (individual physical therapy; two 1-hour sessions). Both programs included instruction in home exercise, joint protection techniques, and individual physical therapist evaluation. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range=0-96, higher scores indicate worse symptoms), measured at baseline, 12 weeks, and 24 weeks. The secondary outcome measure was the Short Physical Performance Battery (SPPB; range=0-12, higher scores indicate better performance), measured at baseline and 12 weeks. Linear mixed models assessed the difference in WOMAC scores between arms. Results. At 12 weeks, WOMAC scores were 2.7 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% confidence interval [CI] = -5.9, 0.5; P=.10), indicating no between-group difference. At 24 weeks, WOMAC scores were 1.3 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% CI=-4.6, 2.0; P=.44), indicating no significant between-group difference. At 12 weeks, SPPB scores were 0.1 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% CI=-0.5, 0.2; P=.53), indicating no difference between groups. Limitations. This study was conducted in one VA medical center. Outcome assessors were blinded, but participants and physical therapists were not blinded. Conclusions. Group physical therapy was not more effective than individual physical therapy for primary and secondary study outcomes. Either group physical therapy or individual physical therapy may be a reasonable delivery model for health care systems to consider.
引用
收藏
页码:597 / 608
页数:12
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