Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: A cluster randomized trial

Objective Chronic knee pain is a major cause of disability and healthcare expenditure, but there are concerns about efficacy, cost and side-effects associated with usual primary care. Conservative rehabilitation may offer a safe, effective, affordable alternative. We compared the effectiveness of a rehabilitation programme integrating exercise, self-management and active coping strategies - Enabling Self-management and Coping with Arthritic knee Pain through Exercise, ESCAPE-knee pain - with usual primary care in improving functioning in people with chronic knee pain. Methods This was a single blind, pragmatic, cluster randomised controlled trial. Participants aged 50 years and over, complaining of knee pain for more than 6 months, were recruited from 54 inner city primary care practices. Primary care practices were randomised to i) continue usual primary care (i.e. whatever intervention a participant’s primary care physicians deemed appropriate), ii) usual primary care plus the rehabilitation programme delivered to individual participants, or iii) usual primary care plus the rehabilitation programme delivered to groups of 8 participants. Primary outcome was self-reported functioning (WOMAC-func) 6 months after completing rehabilitation. Results 418 participants were recruited; 76 (18%) withdrew, only 5 (1%) due to adverse events. Rehabilitated participants had better functioning than participants continuing usual primary care (-3.33 WOMAC-func points, CI -5.88 to -0.78; p=0.01). Improvements were similar whether participants received individual (-3.53, CI -6.52 to -0.55) or group rehabilitation (-3.16, CI -6.55 to -0.12). Conclusions ESCAPE-knee pain provides a safe, relatively brief intervention for chronic knee pain, equally effective whether delivered to individuals or groups of participants.