A multi-arm cluster randomized clinical trial of the use of knee kinesiography in the management of osteoarthritis patients in a primary care setting. Issue 1 (2nd January 2020) - Cagnin, Alix
ABSTRACT: Objective : An important clinical gap reported by primary care physicians (PCPs) in managing knee osteoarthritis patients is the lack of validated tools to help them guide conservative treatment decision-making. This study aimed at evaluating the clinical utility of adding to current medical management (CMM) by PCPs, a dynamic knee kinesiography (KneeKG) exam assessing biomechanical risk factors linked to osteoarthritis progression. Design : In this 6-month cluster randomized controlled trial, primary care clinics were randomized into three groups: 1-CMM by PCPs, 2-CMM+KneeKG, and 3-CMM+KneeKG+Education (a self-management education session and two follow-up group meetings). Primary outcomes were scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales and overall score. Results : Of the 894 patients referred from 87 clinics, 515 participated, 449 (87.2%) completed the study. At 6-month follow-up, patients in both KneeKG groups reported statistically significant improvement on the KOOS overall score (Group2: +5.5; Group3: +5.0), and on the symptoms, pain, and activities of daily living subscales compared to control group (all p < 0.05). They also reported significantly higher satisfaction levels with global care (both p < 0.01). Group 3-CMM+KneeKG+Education showed statistically significant improvements in objective functional tests as well as greater global impression of change in pain, function, quality of life, and global condition (all p < 0.05). Conclusions : Results demonstrated significant improvements in terms of pain, function, and satisfaction in KneeKG groups relative to the CMM. Adding education and supervision further improves clinical outcomes. These findings may support the added value of a KneeKG exam in assisting PCPs in the management of knee osteoarthritis patients.