During two years, what is the difference between an exclusive two-day educational program on OA and a program that adds multimodal attention for 6 moths in the treatment of OA?

Purpose: Osteoarthritis (OA) is the leading skeletal cause of years lived in disability. Education/self-management, diet if overweight and exercise are considered core treatment in several guidelines including OARSI’s 2014 and 2019. The aim of this study was to evaluate the effectiveness in reducing body fat and secondarily reducing knee pain, improving function and increasing exercise hours of a six months (20 interventions) educational/multiprofessional care program to a two-day educational program. Methods: Prospective randomized clinical trial with 116 patients with grades II and III K&L knee OA (KOA) and multiple OA were randomized to one of two groups: control (usual care with medical appointments at inclusion, six, 12 and 24 months) and two periods of 5 hours of lectures, two month apart, about OA with a multiprofessional group) and a group with an extended intervention program (same as the control group and seven sessions of collective physical therapy, seven sessions of group physical fitness, two group sessions of discussion about diet with the nutritionist and two about engaging the program with the psychotherapist) along the first six months of the program. Six months after inclusion, patients of the extended interventation group (EIG) were oriented to continue diet and to exercise at local gyms or at home. All patients were evaluated at inclusion, six, 12 and 24 months. VAS, WOMAC, Lequesne, and measures of BMI, percentage of lean and body fat, Body weight, fat weight, lean weight, Hip-waist ratio (HWR), timed up and go (TUG), 30 second chair stand test (30CST), Timed up and down stairs (TUDS), 6-minute walk test (6MWT) and adherence to physical activity (IPAQ) were taken at baseline, six, twelve and 24 months. Results: Tables 1, 2 and 3 summarize the results. Groups were similar at baseline (p>0.05) except for WOMAC stiffness, that in all moments was, in average, 0.68 less in the study group (p=0.019) despite both groups improving progressively throughout the study period (p<0.05). Control group had a higher number of dropouts at one year (15 in total (25%), 13 in the first six months, without dropouts in the second year), whereas seven (12%) abandoned the EIG (six in the first six months and one before one year). At six months evaluation, all parameters were better in the study group (p<0.05) with the exception of HWR, TUG and lean weight. HWR and TUG did not vary during the study. Only the EIG improved pain (VAS) from baseline to all moments (p<0,002), but both groups improved pain by WOMAC pain with similar results at 2 years. Lequesne, TUDS, 6MWT, IPAQ results improved in all moments for both groups without a significant difference between groups. WOMAC function and total and the 30CST improved faster in the EIG with more than 15 points difference in WOMAC at 6 months (At two years, groups presented similar results with loss of the EIG results and continued gain of the CG). Only the EIG reduced body weight (p<0.001), BMI (p=0.002), fat weight (p<0.05) in all moments. Both groups reduced and had similar percentage of body fat at two years follow-up (with gain in body fat percentage of the EIG in the second year and continued loss of the CG during the study period). Conclusions: In patients with multiple OA (and knee OA), both methods improve pain and function. The extended intervention program improves more rapidly pain, adherence to the program and physical activity level, and function when compared to a two-day class only group. Loss of body weight, fat weight and BMI was only achieved by the extended program with partial loss of results probably due to ceasing group interventions after 6 months.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)