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The effectiveness of behavioral graded activity in patients with osteoarthrits of hip and/or knee: a randomized clinical trial.
Veenhof, C., Köke, A.J.A., Dekker, J., Oostendorp, R.A., Bijlsma, J.W.J., Tulder, M.W. van, Ende, C.H.M. van den. The effectiveness of behavioral graded activity in patients with osteoarthrits of hip and/or knee: a randomized clinical trial. Annals of the Rheumatic Diseases: 2006, 65(suppl. 2) 409. Abstract. Annual European Congress of Rheumatology on 21-24 june 2006 in Amsterdam, the Netherlands.
Objective: To determine the effectiveness of a behavioral graded activity program (BGA) compared to usual care (UC, mainly exercise therapy) according to the Dutch guideline physiotherapy in patients with osteoarthritis (OA) of hip and/or knee. The BGA intervention consisted of an exercise program with boostersessions, using operant treatment principles with the goal to increase activity levels in the long term. Method: A cluster randomised controlled trial involving 200 patients with hip and/or knee OA (ACR-criteria) was performed. Primary outcome measures were pain (VAS and WOMAC), physical function (WOMAC) and global patient assessment (GPA), assessed at week 0, 13, 39 and 65. Data were analysed according to intention-to-treat principle. Additional subgroup-analyses were performed. Results: Both treatments showed beneficial within-group effects both in the short term and long term. The mean differences between the two groups for the primary outcome measures pain and functional status were not statistically significant. Significant differences in favour of BGA were found for the functional scale MACTAR and 5 meter walking test at week 65. Furthermore, significant interaction effects were found for the subgroup of patients according to their baseline-level of physical function on the outcomes pain and physical function. This means that patients with a low level of physical function at baseline responded significantly better on BGA-treatment compared to UC. Conclusion: Since both interventions resulted in beneficial long term effects, the superiority of BGA over UC, in general, could not be demonstrated. However, evidence was found for the particular benefit of BGA in the subgroup of patients with a low level of physical function at baseline. Therefore, BGA is recommended for patients with OA of hip and/or knee with a low level of physical function at the start of treatment. (aut. ref.)
Objective: To determine the effectiveness of a behavioral graded activity program (BGA) compared to usual care (UC, mainly exercise therapy) according to the Dutch guideline physiotherapy in patients with osteoarthritis (OA) of hip and/or knee. The BGA intervention consisted of an exercise program with boostersessions, using operant treatment principles with the goal to increase activity levels in the long term. Method: A cluster randomised controlled trial involving 200 patients with hip and/or knee OA (ACR-criteria) was performed. Primary outcome measures were pain (VAS and WOMAC), physical function (WOMAC) and global patient assessment (GPA), assessed at week 0, 13, 39 and 65. Data were analysed according to intention-to-treat principle. Additional subgroup-analyses were performed. Results: Both treatments showed beneficial within-group effects both in the short term and long term. The mean differences between the two groups for the primary outcome measures pain and functional status were not statistically significant. Significant differences in favour of BGA were found for the functional scale MACTAR and 5 meter walking test at week 65. Furthermore, significant interaction effects were found for the subgroup of patients according to their baseline-level of physical function on the outcomes pain and physical function. This means that patients with a low level of physical function at baseline responded significantly better on BGA-treatment compared to UC. Conclusion: Since both interventions resulted in beneficial long term effects, the superiority of BGA over UC, in general, could not be demonstrated. However, evidence was found for the particular benefit of BGA in the subgroup of patients with a low level of physical function at baseline. Therefore, BGA is recommended for patients with OA of hip and/or knee with a low level of physical function at the start of treatment. (aut. ref.)