Alix Cagnin1, Manon Choinière2, Nathalie J Bureau3, Madeleine Durand4, Neila Mezghani1, Nathaly Gaudreault5, Nicola Hagemeister1. 1. Laboratoire de recherche en imagerie et orthopédie de l'École de technologie supérieure, Research centre of the Centre hospitalier de l'Université de Montréal, Montreal, Canada. 2. Faculty of Medicine, Department of Anesthesiology and Pain Medicine, Research centre of the Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada. 3. Faculty of Medicine, Department of Radiology, Research centre of the Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada. 4. Faculty of Medicine, Department of Medicine, Research centre of the Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada. 5. Faculté de Médecine et des sciences de la santé, School of Rehabilitation, Sherbrooke research and development centre, Université de Sherbrooke, Sherbrooke, Canada.
Abstract
Objective: An important clinical gap reported by primary care physicians (PCPs) in managing knee osteoarthritis patients is the lack of validated tools to help them guide conservative treatment decision-making. This study aimed at evaluating the clinical utility of adding to current medical management (CMM) by PCPs, a dynamic knee kinesiography (KneeKG) exam assessing biomechanical risk factors linked to osteoarthritis progression.Design: In this 6-month cluster randomized controlled trial, primary care clinics were randomized into three groups: 1-CMM by PCPs, 2-CMM+KneeKG, and 3-CMM+KneeKG+Education (a self-management education session and two follow-up group meetings). Primary outcomes were scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales and overall score. Results: Of the 894 patients referred from 87 clinics, 515 participated, 449 (87.2%) completed the study. At 6-month follow-up, patients in both KneeKG groups reported statistically significant improvement on the KOOS overall score (Group2: +5.5; Group3: +5.0), and on the symptoms, pain, and activities of daily living subscales compared to control group (all p < 0.05). They also reported significantly higher satisfaction levels with global care (both p < 0.01). Group 3-CMM+KneeKG+Education showed statistically significant improvements in objective functional tests as well as greater global impression of change in pain, function, quality of life, and global condition (all p < 0.05).Conclusions: Results demonstrated significant improvements in terms of pain, function, and satisfaction in KneeKG groups relative to the CMM. Adding education and supervision further improves clinical outcomes. These findings may support the added value of a KneeKG exam in assisting PCPs in the management of knee osteoarthritis patients.
RCT Entities:
Objective: An important clinical gap reported by primary care physicians (PCPs) in managing knee osteoarthritispatients is the lack of validated tools to help them guide conservative treatment decision-making. This study aimed at evaluating the clinical utility of adding to current medical management (CMM) by PCPs, a dynamic knee kinesiography (KneeKG) exam assessing biomechanical risk factors linked to osteoarthritis progression.Design: In this 6-month cluster randomized controlled trial, primary care clinics were randomized into three groups: 1-CMM by PCPs, 2-CMM+KneeKG, and 3-CMM+KneeKG+Education (a self-management education session and two follow-up group meetings). Primary outcomes were scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales and overall score. Results: Of the 894 patients referred from 87 clinics, 515 participated, 449 (87.2%) completed the study. At 6-month follow-up, patients in both KneeKG groups reported statistically significant improvement on the KOOS overall score (Group2: +5.5; Group3: +5.0), and on the symptoms, pain, and activities of daily living subscales compared to control group (all p < 0.05). They also reported significantly higher satisfaction levels with global care (both p < 0.01). Group 3-CMM+KneeKG+Education showed statistically significant improvements in objective functional tests as well as greater global impression of change in pain, function, quality of life, and global condition (all p < 0.05).Conclusions: Results demonstrated significant improvements in terms of pain, function, and satisfaction in KneeKG groups relative to the CMM. Adding education and supervision further improves clinical outcomes. These findings may support the added value of a KneeKG exam in assisting PCPs in the management of knee osteoarthritispatients.
Entities:
Keywords:
KneeKG; Osteoarthrtis; knee; knee kinesiography; mechanical markers; primary health care