An implementation study of two evidence-based exercise and health education programmes for older adults with osteoarthritis of the knee and hip. Feeling good rather than feeling better matters more to patients. Activity Increase Despite Arthritis (AÏDA): design of a Phase II randomised controlled trial evaluating an active management booklet for hip and knee osteoarthritis [ISRCTN24554946] Activity Increase Despite Arthritis (AÏDA): phase II randomised controlled trial of an active management booklet for hip and knee osteoarthritis in primary care. The Arthritis, Diet and Activity Promotion Trial (ADAPT): design, rationale, and baseline results. Structural changes in the knee during weight loss maintenance after a significant weight loss in obese patients with osteoarthritis: a report of secondary outcome analyses from a randomized controlled trial. Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials Effect of a 16 weeks weight loss program on osteoarthritis biomarkers in obese patients with knee osteoarthritis: a prospective cohort study. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2x2 factorial design. Progressive resistance exercise in women with osteoarthritis of the knee: a randomized controlled trial Is increased joint loading detrimental to obese patients with knee osteoarthritis? A secondary data analysis from a randomized trial. The Influence of Surgically-Induced Weight Loss on the Knee Joint Changes in lower extremity muscle mass and muscle strength after weight loss in obese patients with knee osteoarthritis: a prospective cohort study. Multidisciplinary and multifaceted outpatient management of patients with osteoarthritis: protocol for a randomised, controlled trial Comparing two low-energy diets for the treatment of knee osteoarthritis symptoms in obese patients: a pragmatic randomized clinical trial. Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial
Implementation studies are recommended to assess the feasibility and effectiveness in real-life of programmes which have been tested in r and omized controlled trials ( RCTs ) . We report on an implementation study of two evidence -based exercise and health education programmes for older adults with osteoarthritis ( OA ) of the knee or hip . Three types of primary health-care providers ( n = 18 ) delivered the OA Knee programme ( n = 20 ) and the OA Hip programme ( n = 20 ) , supported by programme manuals and implementation guidelines , in four regions . The outcome measures were pain and mobility . The Knee programme had OA knowledge and self-efficacy as additional outcome measures . Differences in outcome measures and background variables of participants were assessed between the RCTs and the implementation study . Positive effects ( P < 0.05 ) were found for OA knowledge , pain and self-efficacy in the Knee programme ( n = 157 ) , and for pain in the Hip programme ( n = 132 ) . No effect was found for mobility . Effect sizes of the RCTs and the present study were comparable . Background variables did not explain the variance in the outcome measures . The outcomes of the previous RCTs and the implementation study were comparable , and indicated the ecological validity of the two programmes . The implication s for nationwide dissemination and implementation in The Netherl and s are discussed OBJECTIVE To determine the most appropriate means to assess the response to treatment in terms of  pain and functional impairment in a chronic rheumatic condition ( knee osteoarthritis [ OA ] ) and an acute rheumatic condition ( rotator cuff syndrome [ RCS ] ) . METHODS Two prospect i ve studies were conducted consisting of 1,019 out patients with knee OA and 271 patients with acute RCS . The minimal clinical ly important improvement and the patient acceptable symptom state were determined for knee OA pain using a visual analog scale , and for knee OA function using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale ; for acute RCS pain , a numeral rating scale was used , and the Neer function subscale was used for RCS function . RESULTS The minimal clinical ly important improvement was shown to be the change required to achieve the patient acceptable symptom state , whatever the baseline level of symptom , the outcome ( pain or function ) , or type of condition ( chronic or acute ) . This acceptable state for pain was higher for chronic ( 27.0 - 36.4 across the baseline score ) than acute ( 16.7 - 24.1 ) conditions . The level of functional impairment considered satisfactory by patients with knee OA was higher for more disabled patients ( 43.1 ) than for less disabled patients ( 20.4 ) . CONCLUSION Patients consider that they experienced an important improvement only if this improvement allowed them to achieve a state they consider satisfactory . The most appropriate means to assess the response to therapy seems to be to assess whether patients feel good ( i.e. , achieve the patient acceptable symptom state ) Background Hip and knee osteoarthritis is a common cause of pain and disability , which can be improved by exercise interventions . However , regular exercise is uncommon in this group because the low physical activity level in the general population is probably reduced even further by pain related fear of movement . The best method of encouraging increased activity in this patient group is not known . A booklet has been developed for patients with hip or knee osteoarthritis . It focuses on changing disadvantageous beliefs and encouraging increased physical activity . Methods / Design This paper describes the design of a Phase II r and omised controlled trial ( RCT ) to test the effectiveness of this new booklet for patients with hip and knee osteoarthritis in influencing illness and treatment beliefs , and to assess the feasibility of conducting a larger definitive RCT in terms of health status and exercise behaviour . A computerised search of four general medical practice patients ' record data bases will identify patients older than 50 years of age who have consulted with hip or knee pain in the previous twelve months . A r and om sample of 120 will be invited to participate in the RCT comparing the new booklet  with a control booklet , and we expect 100 to return final question naires . This trial will assess the feasibility of recruitment and r and omisation , the suitability of the control intervention and outcome measurement tools , and will provide an estimate of effect size . Outcomes will include beliefs about hip and knee pain , beliefs about exercise , fear avoidance , level of physical activity , health status and health service costs . They will be measured at baseline , one month and three months . Discussion We discuss the merits of testing effectiveness in a phase II trial , in terms of intermediate outcome measures , whilst testing the processes for a larger definitive trial . We also discuss the advantages and disadvantages of testing the psychometric properties of the primary outcome measures concurrently with the trial . Trial registration Current Controlled Trials IS RCT BACKGROUND The Hip & Knee Book : Helping you cope with osteoarthritis was developed to change disadvantageous beliefs and encourage physical activity in people with hip or knee osteoarthritis . AIM To assess the feasibility of conducting a definitive r and omised controlled trial ( RCT ) of this evidence -based booklet in people with hip or knee osteoarthritis . DESIGN Phase II feasibility r and omised controlled trial ( RCT ) . METHOD Computerised search es of patients ' record data bases identified people with osteoarthritis of the hip or knee , who were invited to participate in the RCT comparing the new booklet with a control booklet . Outcomes were measured at baseline , 1 month , and 3 months , and included : beliefs about hip and knee pain , exercise , and fear avoidance ; level of physical activity ; and health service use . RESULTS The trial methods were feasible in terms of recruitment , r and omisation , and follow-up , but most participants recruited had longst and ing established symptoms . After one and 3 months , there was a small relative improvement in illness , exercise , and fear-avoidance beliefs and physical activity level in The Hip & Knee Book group ( n = 59 ) compared with the control group ( n = 60 ) , which provides some proof of principle for using these outcomes in future trials . CONCLUSION This feasibility study provided proof of principle for testing The Hip & Knee Book in a larger definitive RCT Osteoarthritis ( OA ) of the knee leads to restrictions of physical activity and ability to perform activities of daily living . Obesity is a risk factor for knee OA and it appears to exacerbate knee pain and disability . The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was developed to test the efficacy of lifestyle behavioral changes on physical function , pain , and disability in obese , sedentary older adults with knee OA . This controlled trial r and omized 316 sedentary overweight and obese older adults in a two-by-two factorial design into one of four 18-month duration intervention groups : Healthy Lifestyle Control ; Dietary Weight Loss ; Structured Exercise ; or Combined Exercise and Dietary Weight Loss . The weight-loss goal for the diet groups was a 5 % loss at 18 months . The intervention was modeled from principles derived from the group dynamics literature and social cognitive theory . Exercise training consisted of aerobic and strength training for 60 minutes , three times per week in a group and home-based setting . The primary outcome measure was self-report of physical function using the Western Ontario and McMaster University Osteoarthritis Index . Other measurements included timed stair climb , distance walked in 6 minutes , strength , gait , knee pain , health-related quality of life , knee radiographs , body weight , dietary intake , and cost-effectiveness of the interventions . We report baseline data stratified by level of overweight and obesity focusing on self-reported physical function and physical performance tasks . The results from ADAPT will provide approaches clinicians should recommend for behavioral therapies that effectively reduce the incidence of disability associated with knee OA OBJECTIVE To compare structural knee joint changes in obese patients with knee osteoarthritis ( OA ) that after an intensive weight loss therapy were r and omized to continuous dietetic support , a specialized knee exercise program , or ' no attention ' for 1 year . METHODS 192 obese individuals with knee OA underwent an intensive 16-week weight loss program with subsequent r and omization to one of the three treatment groups . Changes in cartilage loss , bone marrow lesions ( BMLs ) , synovitis , and effusion were assessed using semi quantitative assessment s of magnetic resonance imaging ( MRI ) obtained at weeks 0 and 68 applying the BLOKS score . RESULTS During the 52 weeks maintenance period the continuous dietary maintenance group support on average gained 1.1 kg ( 95 % CI : -0.3:2.5 ) body mass , the exercise group gained 6.6 kg ( 95 % CI 5.4:7.8 ) and the no-attention group gained 4.8 kg ( 95 % CI : 2.9:6.7 ) . There were no statistically significant between-group differences in changes in cartilage loss , synovitis or effusion at the follow-up ( analysis of covariance ; ANCOVA , P > 0.16 ) , while there was an increased number of medial tibiofemoral BMLs in the exercise group ( ANCOVA , P = 0.015 ) compared to both diet ( difference : -0.21 [ 95%CI -0.40:-0.03 ] ) and " no attention " ( difference : -0.26 [ 95%CI -0.44:-0.07 ] ) groups . CONCLUSION In this 1 year follow-up after weight-loss in obese knee OA patients , we found a potentially increased number of BMLs in the exercise group compared to the diet and no attention groups , with no between-group differences in changes in cartilage loss , synovitis or effusion . These findings should be interpreted with caution for exercise compliance , MRI methodology and follow-up time . ( Clinical Trials.gov identifier : NCT00655941 ) Background Osteoarthritis ( OA ) of the hip and knee are among the most common chronic conditions , result ing in substantial pain and functional limitations . Adequate management of OA requires a combination of medical and behavioral strategies . However , some recommended therapies are under-utilized in clinical setting s , and the majority of patients with hip and knee OA are overweight and physically inactive . Consequently , interventions at the provider-level and patient-level both have potential for improving outcomes . This manuscript describes two ongoing r and omized clinical trials being conducted in two different health care systems , examining patient-based and provider-based interventions for managing hip and knee OA in primary care . Methods / Design One study is being conducted within the Department of Veterans Affairs ( VA ) health care system and will compare a Combined Patient and Provider intervention relative to usual care  among n = 300 patients ( 10 from each of 30 primary care providers ) . Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only , Provider Only , and Combined ( Patient + Provider ) interventions relative to usual care  among n = 560 patients across 10 clinics . Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis , are overweight , and do not meet current physical activity guidelines . The 12-month , telephone-based patient intervention focuses on physical activity , weight management , and cognitive behavioral pain management . The provider intervention involves provision of patient-specific recommendations for care ( e.g. , referral to physical therapy , knee brace , joint injection ) , based on evidence -based guidelines . Outcomes are collected at baseline , 6-months , and 12-months . The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index ( self-reported pain , stiffness , and function ) , and secondary outcomes are the Short Physical Performance Test Protocol ( objective physical function ) and the Patient Health Question naire-8 ( depressive symptoms ) . Cost effectiveness of the interventions will also be assessed . Discussion Results of these two studies will further our underst and ing of the most effective strategies for improving hip and knee OA outcomes in primary care setting s . Trial registration NCT01130740 ( VA ) ; NCT 01435109 ( NIH OBJECTIVE Changes in biomarkers for bone and cartilage in knee osteoarthritis ( KOA ) may reflect changes in tissue turnover induced by interventions . The aim of this study was to assess the effect on osteoarthritis biomarkers of an intensive weight loss intervention in obese KOA patients . METHODS 192 obese KOA patients followed a 16 weeks weight loss intervention ( Clinical Trials.gov : NCT00655941 ) . Serum Cartilage Oligomeric Matrix Protein ( sCOMP ) , Urine C-terminal telopeptide of collagen type II ( uCTX-II ) and type I ( uCTX-I )  were determined by enzyme-linked immunoassay ( ELISA ) at baseline and after 16 weeks . Patient-reported symptoms were assessed by the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) Question naire without the sports and recreation score ( KOOS-4 ) . Change from baseline was analyzed using Analysis of CoVariance ( ANCOVA ) adjusting for sex , age , and body mass index ( BMI ) . Bivariate associations were analyzed using Spearman 's test of rank correlation . RESULTS 175 patients completed the treatment and lost mean 13.4 ( 95 % CI : 12.5 - 14.4 )  kg . sCOMP concentration decreased on average 1.1 ( 95 % CI : -1.5 to -0.8 ) U/L with a correlation to weight loss ( r = -0.17 , P = 0.028 ) , but not to change in KOOS-4 ( r = -0.13 , P = 0.091 ) . uCTX-II increased significantly , mean 69 ( 95 % CI : 31 - 106 ) ng/mmol creatinine , with no relation to weight loss ( P = 0.14 ) . Change in uCTX-II was reversely related to change in KOOS-4 ( r = -0.28 , P = 0.0003 ) . uCTX-I increased , mean 67 ( 95 % CI : 47 - 87 ) μg/mmol creatinine , and correlated to weight loss ( r = 0.22 , P = 0.0007 ) , while not to KOOS-4 ( P = 0.93 ) . CONCLUSION A rapid substantial weight loss in obese KOA patients was weakly , while significantly associated with a reduction in sCOMP , and increases in both uCTX-II and OBJECTIVE To examine changes in mobility-related self efficacy following exercise and dietary weight loss interventions in overweight and obese older adults with knee osteoarthritis ( OA ) , and to determine if self efficacy and pain mediate the effects of the interventions on mobility task performance . METHODS The Arthritis , Diet , and Activity Promotion Trial was an 18-month , single-blind , r and omized , controlled trial comparing the effects of exercise alone , dietary weight loss alone , a combination of exercise plus dietary weight loss , and a healthy lifestyle control intervention in the treatment of 316 overweight or obese older adults with symptomatic knee OA . Participants completed measures of stair-climb time and 6-minute walk distance , self efficacy for completing each mobility task , and self-reported pain at baseline , 6 months , and 18 months during the trial . RESULTS Mixed model analyses of covariance of baseline adjusted change in the outcomes demonstrated that the exercise + dietary weight loss intervention produced greater improvements in mobility-related self efficacy ( P = 0.0035 ) , stair climb ( P = 0.0249 ) and 6-minute walk performance ( P = 0.00031 ) , and pain ( P = 0.09 ) when compared with the healthy lifestyle control intervention . Mediation analyses revealed that self efficacy and pain served as partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb time . CONCLUSION Exercise + dietary weight loss results in improved mobility-related self efficacy ; changes in these task-specific control beliefs and self-reported pain serve as independent partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb performance BACKGROUND Diary recording of pain and disabling activities in osteoarthritis ( OA ) is widely recommended , but , to our knowledge , its impact on symptoms has not been investigated . Exercise programmes have been shown to be effective when patients are closely supervised by nurses or physiotherapists ; however , data are lacking on the efficacy of an unsupervised home based exercise regimen in patients with OA . OBJECTIVES To evaluate the clinical efficacy of patient administered assessment tools and an unsupervised home based exercise programme alone or in combination in patients with OA . METHODS The study was a 24 week , open cluster r and omised controlled trial with a factorial design . Rheumatologists ( n = 867 ) were assigned to four groups according to the treatment given : st and ardised tools ( ST ; n = 220 ) , exercises ( EX ; n = 213 ) , both tools and exercises ( ST+EX ; n = 213 ) , or usual care ( n = 221 ) . Each rheumatologist was to enroll four patients who met the American College of Rheumatology criteria for OA ( three with knee OA , one with hip OA ) . " Tools " consisted of weekly recording of pain and disabling activities in a diary . A home based exercise programme was performed daily at least four times per week with the aid of videotape and booklet . In addition to exercise and assessment , all patients received 12.5 mg or 25 mg of the non-steroidal anti-inflammatory drug rofecoxib once daily . Outcome variables were : pain ( measured on a visual analogue scale , 0 - 100 ) ; Western Ontario and McMaster Universities Osteoarthritis Index , function subscale ( 0 - 100 ) ; and patient assessment of the quality of care ( 0 - 100 ) . RESULTS Overall , 2957 patients with OA ( 2216 knee , 741 hip ) were included . After 24 weeks , both pain and function improved in the ST , EX , ST+EX , and usual care groups ( mean ( SD ) -17 ( 27 ) , -20 ( 29 ) , -15 ( 27 ) , -19 ( 29 ) ; and -11 ( 19 ) , -12 ( 19 ) , -10 ( 19 ) , -11 ( 20 ) , respectively ) , without significant differences between groups . However , patients in the EX and ST+EX groups were more likely to agree that their rheumatologist had done his best to preserve their functional and physical activities . CONCLUSION Although patients ' assessment s favoured the exercise programme , results from this study failed to demonstrate a short term symptomatic effect of the two non-pharmacological treatments ( weekly recording of condition and exercise ) in patients with OA concurrently receiving nonsteroidal anti-inflammatory drugs Objective : To determine the effect of a progressive resistance exercise ( PRE ) program on women with osteoarthritis ( OA ) of the knee . Methods : Eligible subjects included women aged 40 to 70 years with pain between 3 and 8 on a 10-cm pain scale . Among the 144 subjects screened , 60 met the eligibility criteria and were r and omized to the experimental group ( EG ) or control group ( CG ) . Subjects in the EG participated in a 12-week PRE program twice a week and CG remained on a waiting list for physical therapy . The PRE program consisted of strengthening exercises for knee extensors , knee flexors , hip abductors and hip adductors , all performed with 50 % and 70 % of the one-repetition maximum ( 1RM ) using machines with free weights . Resistance was reevaluated every two weeks . Assessment s of pain , muscle strength , walking distance , function and quality of life were performed at baseline , six weeks and 12 weeks by a blinded assessor . Results : Twenty-nine female subjects were r and omly assigned to the EG and 31 were r and omly assigned to the CG . Repeated- measures ANOVA revealed significantly better results in the EG pain ( from 7.0±1.3 to 4.3±3.1 in the EG and from 7.0±1.2 to 6.6±1.5 in the CG - p<0.001 ) , function ( p<0.001 ) , some domains of quality of life ( physical function : p=0.002 ; physical role limitation : p=0.002 ; and pain : p=0.044 ) and muscle strength ( extensors : p<0.001 ; flexors : p=0.002 ; and abductors : p<0.001 ) . Conclusion : The PRE program was effective in reducing pain and improving function , some quality of life domains and strength in women with OA of the knee OBJECTIVE To investigate whether increased knee joint loading due to improved ambulatory function and walking speed following weight loss achieved over 16 weeks accelerates symptomatic and structural disease progression over a subsequent 1 year weight maintenance period in an obese population with knee osteoarthritis ( OA ) . METHODS Data from a prospect i ve study of weight loss in obese patients with knee OA ( the CARtilage in obese knee OsteoarThritis ( CAROT ) study ) were used to determine changes in knee joint compressive loadings ( model estimated ) during walking after a successful 16 week weight loss intervention . The participants were divided into ' Unloaders ' ( participants that reduced joint loads ) and ' Loaders ' ( participants that increased joint loads ) . The primary symptomatic outcome was changes in knee symptoms , measured with the Knee injury and Osteoarthritis Outcome Score ( KOOS ) question naire , during a subsequent 52 weeks weight maintenance period . The primary structural outcome was changes in tibiofemoral cartilage loss assessed semi-quantitatively ( Boston Leeds Knee Osteoarthritis Score ( BLOKS ) from MRI after the 52 weight maintenance period . RESULTS 157 participants ( 82 % of the CAROT cohort ) with medial and /or lateral knee OA were classified as Unloaders ( n = 100 ) or Loaders ( n = 57 ) . The groups showed similar significant changes in symptoms ( group difference : -2.4 KOOS points [ 95 % CI -6.8:1.9 ] ) and cartilage loss ( group difference : -0.06 BLOKS points [ 95 % CI -0.22:0.11 ) after 1 year , with no statistically significant differences between Loaders and Unloaders . CONCLUSION For obese patients undergoing a significant weight loss , increased knee joint loading for 1 year was not associated with accelerated symptomatic and structural disease progression compared to a similar weight loss group that had reduced ambulatory compressive knee joint loads . CLINICAL TRIALSGOV NCT00655941 Background : The causal relationship between obesity and osteoarthritis ( OA ) of the knee is generally accepted . Weight loss has been shown to reduce the development of OA and improve the radiological parameters of existing disease . However , inducing weight reduction is difficult , and thus the number of patients studied has been small . We wished to determine the effects of surgically-induced weight loss on objective , radiological evidence of OA in the knee joint . Methods : 64 consecutive patients that were referred to the Bariatric Surgical Unit were enrolled in the study . The only exclusion criterion was the prior diagnosis of OA . Knee pain alone did not exclude patients from the study . The study was performed in a prospect i ve manner as a before-after trial . Radiographic data was evaluated by an independent radiologist not involved in the patient care or follow-up . Upright film of the knee was taken prior to surgery and 3 months following surgery .  Minimal medial joint space width ( JSW ) was measured by a digital image computer . In addition , patients were clinical ly assessed using the American Knee Society Score ( AKSS ) at these times . Results : 59 of 64 patients were available for followup . BMI decreased from 43.4 to 36.9 ( P<0.01 ) . The medial joint space increased from 4.6 mm to 5.25 mm ( P<0.001 ) . The AKSS improved from 78.5 points ( perfect function = 100 points ) to 90.69 points ( P<0.01 ) . Conclusion : Surgically-induced weight loss  is an effective , rapid and dependable means of reversing the radiological signs of early changes associated with OA OBJECTIVE To investigate the effects of low-energy diet-induced weight loss on lower-extremity muscle mass and knee muscle strength in obese patients with knee osteoarthritis ( OA ) , and the associations of these effects . METHODS We studied 159 obese patients with knee OA and available data from body composition analysis that had been performed using dual x-ray absorptiometry scanning and isometric muscle strength testing of the knee in extension and in flexion . The data had been obtained as part of a r and omized controlled trial , with measurements performed before and after a supervised low-energy diet-induced weight loss intervention lasting 16 weeks . RESULTS The patients lost an average of 12.9 kg ( 95 % confidence interval [ 95 % CI ] 10.2 , 15.7 ) ( 13 % of baseline weight ) . The weight loss consisted of 10.9 kg fat mass ( 95 % CI 8.9 , 12.9 ) , of which 3.8 kg ( 95 % CI 2.7 , 4.9 ) was leg fat mass . Total lean body mass was reduced by 1.9 kg ( 95 % CI 0.05 , 3.8 ) , of which 0.785 kg ( 95 % CI 0.09 , 1.476 ) was leg lean mass . Absolute muscle strength decreased by ∼3 - 4 % after the weight loss , whereas body mass-normalized muscle strength increased by 11 - 12 % . At baseline , leg lean mass was significantly related to muscle strength , but changes in these measurements at followup were not related . CONCLUSION Weight loss induced by a low-energy diet led to independent losses of leg muscle tissue and strength . The weight loss was accompanied by increased normalized muscle strength along with improved self-reported disability and pain -- all of which are beneficial to patients with knee OA . The present results suggest that significant weight loss in patients with knee OA should be followed by an exercise regimen to restore or increase muscle mass Background Osteoarthritis ( OA ) is a prevalent joint disorder with a need for efficient and evidence -based management strategies . Objectives The primary purpose of this study is to compare the effects of a multidisciplinary outpatient clinic , including a brief group-based educational programme , with a traditional individual outpatient clinic for patients with hip , knee , h and or generalized OA . A secondary purpose is to investigate the effects of a telephone follow-up call . Methods This is a pragmatic r and omised single-blind controlled study with a total of 400 patients with hip , knee , h and or generalized OA between 40 and 80 years referred to an outpatient rheumatology hospital clinic . The r and omisation is stratified according to the diagnostic subgroups . The experimental group is exposed to a multidisciplinary and multifaceted intervention , including a 3.5 hour group-based patient education programme about OA in addition to individual consultations with members of a multidisciplinary team . The control intervention is based on regular care with an individual outpatient consultation with a rheumatologist ( treatment as usual ) . Primary outcomes are patient satisfaction measured at 4 months and cost-effectiveness measured at 12 months . Secondary outcomes are pain and global disease activity measured on a numeric rating scales ( NRS ) , generic and disease specific functioning and disability using Short Form-36 ( SF-36 ) health survey , the Western Ontario and McMaster Universities Osteoarthritis Index 3 ( WOMAC ) , the Australian/Canadian Osteoarthritis H and Index ( AUSCAN ) , and a patient-generated measure of disability ( Patient-Specific Functional scale , PSFS ) . Global perceived effect of change in health status during the study period is also reported . At 4-month follow-up , patients in both groups will be r and omly allocated to a 10-minute telephone call or no follow-up ( " treatment as usual " ) . After additional 8 months ( 12-month follow-up ) the four groups will be compared in a secondary analysis with regard to health outcomes and health care costs . Discussion This trial will provide results on how multidisciplinary and multifaceted management of patients with OA affects health outcomes and health care costs . Trial registration Current Controlled Trials IS RCT OBJECTIVES To evaluate in a prospect i ve , r and omized clinical trial ( RCT ) , symptom response among obese knee osteoarthritis ( OA ) patients following a feasible , intensive weight-loss program for 16 weeks . METHODS Eligible patients were obese [ body mass index ( BMI ) > 30 kg/m(2 ) ] ; > 50 years old , with primary knee OA . Participants were r and omized to either a very-low-energy diet ( VLED ) or a low-energy diet ( LED ) ( 415 kcal/day and 810 kcal/day , respectively ) , using commercially available formula foods - only for the first 8 weeks , managed by dieticians . The 8 weeks were followed by an additional 8-week period of a hypo-energetic diet consisting of normal food plus meal replacements ( 1200 kcal/day ) . The primary endpoint was the number of patients responding according to the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International ( OMERACT-OARSI ) responder criterion . The statistical analysis was based on a non-responder intention-to-treat ( ITT ) population ( baseline observation carried forward ) . RESULTS One hundred and ninety two patients ( 155 ( 80.7 % ) females ) with a mean age 62.5 years [ st and ard deviation ( SD ) 6.4 ; range 50 - 78 years ] ; average BMI 37.3 ( SD 4.8 ) were included . At 16 weeks , similar proportions of the VLED and LED groups , 59 ( 61.5 % ) , and 63 ( 65.6 % ) patients , respectively , met the OMERACT-OARSI responder criteria , with no statistical significant difference between the groups ( P=0.55 ) . Combining the groups the pooled estimate was 64 % meeting the responder criteria [ 95 % confidence interval ( CI ) 57 % , 70 % ] . There was an overall reduction in pain , corresponding to an average pain reduction on the visual analogue scale ( VAS ) of 11.1 ( 95%CI 13.6 , 8.5 ) in the combined groups . At week 16 weight loss in the combined groups was 12.8 kg ( 95%CI : 11.84 - 13.66 ; P<0.001 ) . 71 % lost > or = 10 % body weight in both diet groups , with a pooled estimate of 74 % ( 95%CI : 68 - 80 % ) . CONCLUSION No clinical ly significant differences were found between the 415 kcal/day and 810 kcal/day diets . A 16-week formula-diet weight-loss program result ed in a fast and effective weight loss with very few adverse events result ing in a highly significant improvement in symptoms in overweight patients with knee OA Background Osteoarthritis ( OA ) is a degenerative disease , considered to be one of the major public health problems . Research suggests that patient education is feasible and valuable for achieving improvements in quality of life , in function , well-being and improved coping . Since 1994 , Primary Health Care in Malmö has used a patient education programme directed towards OA . The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy , function and self-perceived health . Method The study was a single-blind , r and omized controlled trial ( RCT ) in which the  EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity . Results We found differences between the intervention group and the control group , comparing the results at baseline and after 6 months in EuroQol-5D ( p < 0.001 ) and in st and ing one leg eyes closed ( p = 0.02 ) in favour of the intervention group . No other differences between the groups were found . Conclusion This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree , but not self-efficacy . Further research to investigate the effect of exercise performance on function , as well as self-efficacy is warranted . Trial registration The trial is registered with Clinical Trials.gov . Registration number :
Clinical efficacy on pain reduction was present , although not predictable after weight loss .
Meta-regression analysis indicated that physical disability of patients with knee OA and overweight diminished after a moderate weight reduction regime .
This review aims to assess by meta- analysis of r and omised controlled trials ( RCTs ) changes in pain and function when overweight patients with knee osteoarthritis ( OA ) achieve a weight loss .