Stratified exercise therapy by physical therapists in primary care is feasible in patients with knee osteoarthritis

  • J. K
  • M. V
  • M. V
  • et al.
ISSN: 1522-9653
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Purpose: There is strong evidence that exercise therapy is effective in reducing pain and activity limitations in knee osteoarthritis (OA), but effect sizes are low to moderate. Stratified exercise therapy tailored to clinically relevant subgroups of patients is expected to optimize treatment effects in a cost-effective manner. This study aimed to explore the feasibility of a newly developed model of stratified exercise therapy in primary care. Methods: A mixed method design was used (uncontrolled pretestposttest design with process evaluation). Eligible patients visiting a participating primary care physical therapist (PT) were included. Based on our model, participants were allocated to the 'high muscle strength subgroup', 'depression subgroup', 'obesity subgroup' or 'low muscle strength subgroup', and received subgroup-specific, protocolized, 4-month exercise therapy. Feasibility of stratified exercise therapy according to this model was evaluated by a process evaluation (process documentation, semi-structured interviews and focus group meeting) and outcome (physical functioning and knee pain, assessed at baseline and 4-months follow-up). Results: We included 50 patients, of which 3 patients dropped out. PTs provided on average 10 sessions (ranging from 2 to 24). The process evaluation suggests that our model is feasible for patients and PTs, with some adaptations for further optimization. We found clinically relevant improvements on physical functioning and knee pain (P < 0.001 for both) for the total group. Conclusions: Our model of stratified exercise therapy is feasible in primary care. Minor adaptations could further optimize the feasibility. Future research should determine the (cost-) effectiveness of this model, compared to usual, non-stratified exercise therapy.




J., K., M., V. D. L., M., V. D. E., M., D. R., W.F., P., K.L., B., … W.F., L. (2018). Stratified exercise therapy by physical therapists in primary care is feasible in patients with knee osteoarthritis. Osteoarthritis and Cartilage, 26(Supplement 1), S324. Retrieved from

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