Introduction
Chronic knee pain affects 31% of elderly in Hong Kong (HK). The waiting list for total knee replacement (TKR) was doubled dramatically from 2014 to 2018. Guidelines recommend exercise and self-management education as core management for knee osteoarthritis (OAK). The National Health Service of the United Kingdom adopted an evidence-based ESCAPE-knee pain programme, mandatory before TKR. Cultural adaptation of this programme was undertaken for HK Chinese –Integrated Exercise and Self-management Programme (IPES-knee) – and found to be feasible in clinical application and acceptable to patients. Potential improvement in exercise adherence and health care utilisation was found at one-year follow-up compared with usual physiotherapy. The next step was adoption and implementation of IPES-knee in local clinical setting while maintaining fidelity for effectiveness.
Objectives
1) To adopt IPES-knee for implementation of local OAK management 2) To observe retention rate and clinical benefits of IPES-knee in a physiotherapy out-patient clinic (PT clinic); 3) To compare outcomes of the shortened IPES with the original ESCAPE-knee pain HK.
Methodology
The original 10-sessions programme was modified and shortened to match with local demand and current manpower situation. A physiotherapist led discussion on self-management and exercise in all six-weekly sessions, 75-minutes each. Topics included exercise benefits, goal-setting, flare-management and others. One-day staff training was conducted to update evidence on OAK, management strategies, ESCAPE-knee pain and motivational skills. IPES-knee was provided to OAK patients referred to the PT clinic. Patient demographics and attendance were recorded. Outcome measures included Knee injury and Osteoarthritis Outcome Score (KOOS), Patient-specific Functional Score (PSFS), Self-efficacy for Exercise (SEE-C), walk-speed and chair-stand tests, numeric pain (NPR) and global improvement (GIR). Descriptive statistics was analysed for completers and defaulters of the programme.
Results & Outcome
In 2018, 464 OAK patients received IPES-knee. A total of 323 (69.6%) patients completed the final visit (mean 5.91 sessions), with 68.1% female, mean age 66.0(SD 8.5), body-weight index 26.6, and pain for 4 years. Those defaulted (2.4 sessions) were excluded from the analysis and did not differ from completers in their baseline characteristics except 2 years younger. All outcome measures showed significant improvement (p=.000): KOOS-pain 8.13(15.12)/100, physical function 7.15(15.39)/100, quality-of-life (QoL) 7.67(18.88)/100 points; PSFS 1.67(1.66)/10; SEE-C 1.52(2.24)/10; walk-speed 0.19(0.63) m/s, chair-stand 2 times and GIR 5.52/10 points. The Cohen'sd for pain, PS and QoL were 0.48, 0.41 and 0.40 respectively. Compared with the original study, the shortened IPES-knee showed 50% as good in pain and QoL, 70% in reported functions and 100% in physical testing. IPES-knee is recommended as territory-wide implementation for OAK management under constraints.
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