A pain science education and walking program to increase physical activity in people with symptomatic knee osteoarthritis: a feasibility study

Tasha R Stanton; Emma L Karran; David S Butler; Melissa J Hull; Sarah N Schwetlik; Felicity A Braithwaite; Hannah G Jones; G Lorimer Moseley; Catherine L Hill; Christy Tomkins-Lane; Carol Maher; Kim Bennell

doi:10.1097/PR9.0000000000000830

A pain science education and walking program to increase physical activity in people with symptomatic knee osteoarthritis: a feasibility study

Pain Rep. 2020 Sep 24;5(5):e830. doi: 10.1097/PR9.0000000000000830. eCollection 2020 Sep-Oct.

Authors

Tasha R Stanton^{1

2}, Emma L Karran¹, David S Butler^{1

3}, Melissa J Hull⁴, Sarah N Schwetlik^{1

4}, Felicity A Braithwaite¹, Hannah G Jones^{1

5}, G Lorimer Moseley^{1

2}, Catherine L Hill^{6

7}, Christy Tomkins-Lane⁸, Carol Maher⁴, Kim Bennell⁹

Affiliations

¹ IIMPACT in Health, Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia.
² Neuroscience Research Australia, Sydney, New South Wales, Australia.
³ Neuro Orthopaedic Institute Australasia PTY LTD, Adelaide, South Australia, Australia.
⁴ Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia.
⁵ Department of Psychology, University of Bath, Bath, United Kingdom.
⁶ Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
⁷ Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, South Australia, Australia.
⁸ Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada.
⁹ Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia.

Abstract

Introduction: Nine of 10 people with knee osteoarthritis are inactive. Unhelpful pain beliefs may negatively influence physical activity levels. Targeting these unhelpful pain beliefs, through contemporary pain science education (PSE), may provide benefit.

Objectives: To evaluate the feasibility of conducting a clinical trial to determine the effect of adding PSE (vs adding sham ultrasound) to an individualised, physiotherapist-led education and walking program in people with painful knee osteoarthritis.

Methods: Twenty participants were randomised (1:1) into the PSE group or Control group, each receiving 4 in-person weekly treatments, then 4 weeks of at-home activities (weekly telephone check-in). Clinical outcomes and physical activity (7 days of wrist-worn accelerometry) were assessed at baseline, 4 (clinical outcomes only), 8, and 26 weeks. A priori feasibility criteria for recruitment, intervention adherence, viability of wrist-based accelerometry, and follow-up retention were set. Perceived intervention credibility, acceptability, and usefulness from participants and clinicians were assessed (ratings, written/verbal feedback).

Results: Most feasibility criteria were met. On average, 7 adults/wk were eligible, with 70% recruited. Treatment compliance was high (in-person: 80% PSE; 100% Control; at-home: 78% PSE; 75% Control). Wrist-based accelerometry had >75% valid wear-time. Sufficient follow-up rates were not achieved (26 weeks: 65%). Participant and clinician feedback highlighted that PSE was too complex and did not match patient expectations of "physiotherapy", that sham ultrasound was problematic (clinician), but that both treatments had high credibility, acceptability, and usefulness.

Conclusions: Progression to a full trial is warranted. Strategies to increase participant retention, refine the PSE content/delivery, and replace/remove the sham intervention are required.

Keywords: Osteoarthritis; Pain; Pain science education; Physical activity; Sham ultrasound; Walking program.