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A “step-by-step” approach to exercise can help the knee with arthritis

By Steven Reinberg HealthDay Reporter

Tuesday, December 29, 2020 (HealthDay News)

Millions of Americans suffer from arthritic knee pain. However, new research has found that innovative retirement homes can help relieve discomfort and improve knee function.

This program is called STEP-KOA (short for step-by-step exercise program for patients with knee osteoarthritis). It begins with gentle exercise at home and moves on to telephone counseling and face-to-face physiotherapy as needed.

“STEP-KOA may be an efficient way to provide exercise and physiotherapy services to people with knee osteoarthritis. This is more for people who do not improve early. To book a step that consumes resources, “said lead author Kelly Allen. She is a research and health scientist at the Durham VA Medical Center in North Carolina.

“This can be important if you’re trying to maximize your resources, or if you have limited access to physiotherapy,” Allen said.

In this study, researchers at the Veterans Affairs Health Care System randomly assigned more than 300 painful patients with knee osteoarthritis to STEP-KOA or arthritis education. Osteoarthritis is the most common form of arthritis in the knee. This is a deformable “wear” type of arthritis.

STEP-KOA begins with an internet-based exercise program. If it is not effective, the patient goes to step 2. This includes coaching calls twice a month for three months.

If the pain still does not improve, the patient goes to step 3. This includes face-to-face physiotherapy.

Materials were mailed to participants in the arthritis education group every two weeks.

Nine months later, 65% of STEP-KOA patients went to step 2 and 35% went to step 3.

The researchers reported that the step-by-step care group had greater improvement in pain and function than the educated participants.

This strategy has the potential to reduce medical costs and tailor the program to the needs of patients, the study authors said.

However, prominent orthopedists have called this approach the other way around.

Dr. Jeffrey Schildhorn of Lenox Hill Hospital in New York City said he should start with physiotherapy instead and move to patients who are exercising on their own.

“This study seemed to be designed for a style of medicine that most of us wouldn’t appreciate,” Schildhorn said. “It was like trying to do everything remotely and hold the patient accountable for a future with limited resources,” he added.

Schildhorn said 90 patients dropped out of the program and only 10% remained in Step 1 throughout the study.

He said effective programs need to be designed individually because each patient’s perception of knee injury and pain is unique.

“I think it’s imperative for people with mild to moderate illness to try whatever they can, with or without face-to-face physiotherapy,” Schildhorn said.

The important thing is to keep your joints moving with gentle exercise. He said that a multimodal approach, including regular check-in by the therapist, is a viable approach to directly show how to make a move with follow-up by phone or video chat.

However, Schildhorn emphasized that patients need to exercise at home every day.

“People who get physiotherapy three times a week will not be as good as those who go three times a week and practice on their own. Most of the value lies in the daily stretching exercises at home,” Schildhorn said. I will. .. “If you don’t do anything for the other five days after receiving physiotherapy twice a week, it’s not worth it.”

The report was published online on December 29th. Annual report of internal medicine..

For more information

Find out more about knee osteoarthritis from the American Academy of Orthopedic Surgeons.

Source: Dr. Kelly Allen, Research and Health Scientist at the Durham VA Medical Center in Durham, North Carolina, and Deputy Director of the Durham Innovation Center to Accelerate Discovery and Practice Transformation. Jeffrey Schildhorn, MD, Orthopedic Surgeon, Lenox Hill Hospital, New York City. Annual report of internal medicine, December 29, 2020, online

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