Physical Therapy Journal: Group-Based Physical Therapy No More Effective Than 1-on-1 Care for Knee OA
In a recent clinical trial published in the May issue of Physical Therapy (PTJ), APTA’s science journal, group physical therapy for individuals with knee osteoarthritis (OA) was found to be no more effective in reducing pain and improving functional outcomes than 1-on-1 sessions—contrary to researchers’ expectations.
Researchers randomly assigned 320 patients with pain, aching, stiffness, or swelling associated with knee OA at a Veterans Administration (VA) medical center to either group or individual physical therapy. Most (88%) were male.
Most aspects of care were the same for both groups. All patients were instructed in a home exercise program, educated on joint protection and activity pacing, and screened to determine if they required braces, assistive devices, or shoe lifts.
To start, they all were instructed to perform the same 4 stretching exercises daily and 6 strengthening exercises 3 times a week. As they progressed, they were given opportunities to increase the difficulty of their exercises.
The physical therapists (PTs) gave all participants written and illustrated instructions, exercise logs, and therapy bands, as well as reminder calls before each therapy session.
Here is what researchers found:
WOMAC scores were no different for each group.
At the 12-week and 24-week follow-up assessments, Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were slightly lower for patients who received group-based sessions, but with no meaningful difference. On average, patients in both groups improved from baseline, even at 24 weeks.
Satisfaction with physical function didn’t improve much for either group.
Both groups self-reported similar levels of satisfaction with physical function on the SPPB at 12 weeks. There was also no significant change over time for either group.
6-Minute Walk Test distances improved for patients in groups, decreased for individual settings.
The only significant difference was change from baseline for the 6-Minute Walk Test at 12 weeks. Group physical therapy participants improved by 14.3 meters, while the individual program patients actually had a mean decrease of 3.2 meters.
Researchers stated, although the group physical therapy approach allowed more contact and group support, the individual physical therapy visits allowed greater one-on-one time with a physical therapist.”
Authors noted several limitations of the study.
For example, all outcome measures were self-reported, and actual strength and range of motion were not objectively measured. And, while the researchers “assessed adherence” to physical therapy sessions, they did not measure performance of home exercises.
Even though results of both approaches were nearly equivalent, authors of the study believe that group-based treatment for knee OA may be worth a closer look.
“Given the expected rise in prevalence of knee OA and the general need to provide efficient health care,” authors note, “a physical therapist–led, group-based approach to delivering non-pharmacological treatment of knee OA could be a useful approach in many health care settings.”