Comparative impact of nonpharmacological interventions on pain of knee osteoarthritis patients reporting at a tertiary care institution: A randomized controlled trial

Abstract

Context: Nonpharmacological interventions (NPIs) have been advocated for knee osteoarthritis (KOA). There are many gaps in the evidence to their efficacy in India. Aims: The study aims to compare the impact of two packages of NPIs on various outcome variables of KOA patients. Settings and Design: This was a randomized controlled trial in a tertiary care hospital. Subjects and Methods: A study population (n = 123) of KOA patients aged 40-65 years. Stratified block randomization was done for mild or moderate KOA into two groups. Group 'A' patients received a package of NPIs including a set of supervised exercise sessions, kinesthesia, balance, and agility (KBA), meditation, weight reduction advice, and weekly telephonic reminders. Group 'B' patients received the same package except for KBA & meditation. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) and performance-based measures were measured. Analysis: t-test and repeat measures ANOVA were undertaken. Results: A significant intragroup reduction in WOMAC score was seen from baseline in Group A (P = 0.00, mean difference: -9.7) as well as in Group B (P = 0.00, -12.9). There was also significant reduction inVAS scores at the end of intervention in Group A and Group B as compared from baseline (-3.62, -3.8, P = 0.00). No intergroup difference was observed in either of the scores. VAS score reduction to 0 at different stages of intervention was noticed in 46% (n = 57) cases. There was a significant intergroup difference for 50-Foot Walk Test (P = 0.055, F = 3.28) at 12 months. Conclusion: Both packages of NPIs were effective in providing relief in symptoms. No specific benefit of KBA or meditation was seen except for 50FWT.