Physical activity and exercise adherence in physical therapy exercise treatment in patients with osteoarthritis of hip or knee.

Purpose: a lack of regular physical activity in patients with osteoarthritis (OA) of the hip and/or knee is an important risk factor for functional decline. The ultimate goal of exercise therapy is to improve the overall physical function and to help individuals meet the demands of daily living. Earlier research has shown that both Behavioural Graded Activity (BGA) and usual exercise therapy treatment by physical therapists according to the Dutch guideline (UC) result in positive effects on pain and physical functioning. BGA is an exercise program based on operant behavioural principles and self-regulation principles consisting of an facility based treatment period followed by additional booster sessions. The objective of the present study was to determine whether BGA results in better exercise adherence and a higher level of physical activity compared to UC in patients with osteoarthritis of hip and/or knee in the shorts- and long-term. Methods: A cluster randomized trial involving 200 patients with hip and/or knee OA (ACR-criteria). Exercise adherence was measured with a self-report questionnaire. Physical activity was measured with the Short Questionnaire to Assess Health Enhancing Physical Activity (SQUASH), which allows calculating if patients meet the recommendation for physical activity from the American College of Sports Medicine. Assessments were conducted after 13 weeks (post-treatment) and 65 weeks. Data were analyzed with multiple logistic regression analyses according to the intention to treat principle. Results: Short-term (OR=3.68 [7.48; 1.81] to home exercises was significantly higher in patients treated with BGA compared to UC. Furthermore, in the BGA group significantly more patients meet the recommendations for the amount of moderate-vigorous intensity physical activity compared with patient from the UC group, both at 13 (OR)=4.55 [11.67; 1.77]) and 65 weeks follow-up (OR=2.58 [5.63; 1.18]) Conclusion: BGA results in better adherence to home exercises than usual physical therapy treatment, both at the short- and long-term. Furthermore, the BGA treatment results in a higher level of physical activity than usual physical therapy treatment. (aut. ref.)