Authors (including presenting author) :
Chan LY(1),Tam MP(1), Liu PS(1), Chan KW(1), Chan LC(1), TSE CW(1), Leung KW(2), Wun YC(2)
Affiliation :
(1)Physiotherapy Department, Pok Oi Hospital (2)Department of Orthopaedic and Traumatology, NTWC
Introduction :
Knee osteoarthritis (OA) patients can be presented with pain, limited activity and impaired quality of life. Various guidelines suggested structured exercise program and self-management program as effective conservative management for knee OA [1,2]. Joint replacement surgery is reserved for patients with advanced stage of knee OA who failed conservative management. The median waiting time for total joint replacement (TJR) surgery of the New Territories West Cluster in 2020 was 39 months and increased to 50 months in 2021. The increasing waiting time indicates a need for continuous monitoring of change in knee condition while patients await TJR surgery. The Structured Non-Surgical Treatment Program (SNTP), a 4-year physiotherapy program, was launched in October 2021 to provide holistic education, exercise empowerment and longer follow-up period to knee OA. The course content covers introduction to disease progress of knee OA, therapeutic exercise, self-management techniques and weight management advice. Patients attend SNTP once per week for a total of 6 weeks in the first year. Each session consists of 20 minutes of group sharing and discussion, and 60 minutes of physiotherapist-supervised exercise training. Follow-up sessions are scheduled once every half year during the second to fourth year. Symptoms, functional performance and exercise compliance of patients are assessed. Progress of patients are reviewed and documented by physiotherapists, which will be later reviewed by orthopaedics doctors.
Objectives :
To evaluate the effect of SNTP on pain and disability level, and physical function of patients with knee OA at the sixth session of the first year and at the first FU follow-up session of the second year.
Methodology :
This is a retrospective study. Patients who were diagnosed with knee OA and attended at least six sessions of SNTP during October 2021 to November 2022 were recruited. Patients who could not communicate with Cantonese, were unable to comprehend exercise instruction, failed to complete all the baseline assessments, or were categorized as MFAC
Result & Outcome :
A total of 689 patients were recruited. The mean age of patients was 66±6.81 years old. The Wilcoxon Signed Rank Test was utilized for data analysis. All the outcome measures showed significant improvement at both the sixth and seventh session. NGRCS increased to 3.22±2.55 at the sixth session (p<0.001) and 2.49±2.06 at the seventh session (p<0.001). NPRS decreased from 6.6±2.04 to 5.57±2.22 at the sixth session (p<0.001) and 5.72±2.19 at the seventh session (p<0.001). The 30s-CST results significantly improved from 6.01±4.78 repetitions at baseline to 7.55±4.47 repetitions (p<0.001) and 7.67±5.24 repetitions (p<0.001) at the sixth and seventh session respectively. All subscales of KOOS presented with significant improvement (p<0.001) – The Pain Subscale increased from 47.97±19.2% to 53.37±28.79% at the sixth session and 52.47±19.76% at the seventh session; The Symptoms Subscale increased from 58.29±16.12% to 60.71±15.27% and 60.03±17.41% at the sixth and seventh session respectively; The Quality-of-Life Subscale improved from 33.27±18.57% to 37.08±19.32% at the sixth session and 36.86±20.56% at the seventh session. Conclusion The Structured Non-Surgical Program (SNTP) effectively decreases pain, disability and improves physical function of patients with knee OA in the first and second year of follow-up.
