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• W2090595898 abstract "Purpose: Physical therapy (PT) is an established treatment for knee OA, with clear benefits in symptoms including pain, function, and stiffness. However, despite the general improvements associated with PT, there exists considerable response heterogeneity at the individual level. Better understanding of this heterogeneity has great potential to optimize, and perhaps personalize, use of PT. Here, our objective was to explore potential predictors of response to physical therapy (PT). Specifically, in a group of Veterans participating in a comparison of group and individual PT, we sought to identify predictors of 12-week response in total WOMAC score across both groups. This was a hypothesis generating investigation with an objective to explore associations of treatment response with multiple baseline variables in a number of categories including demographics, self-reported OA-symptoms, OA-treatment use, self-reported and objective physical function, physical activity, prior injury, exercise self-efficacy, and co-morbidities. Methods: Participants were n=247 Veterans with diagnoses of knee OA (88% male, mean age = 60.2 ± 10.0 years) who completed both baseline and 12 week assessments (n=73 missing assessments) of a clinical trial of group PT (six one-hour sessions over 12 weeks, eight patients per group) or individual PT (two one-hour sessions over 12 weeks). Because primary analyses showed that treatment response was the same across group and individual PT arms, we combined arms for these analyses. The outcome for these analyses was percent change in total score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from baseline to 12-week follow-up, computed so that an increase indicated symptom improvement. Using Pearson correlations, bivariate associations were examined between percent WOMAC change and the following baseline participant characteristics: Age, gender, body mass index, race, marital status, self-reported health, tobacco use, alcohol use, co-morbidities, intermittent and constant osteoarthritis pain, pain visual analog scale, duration of arthritis symptoms, satisfaction with physical function, history of knee injuries, history of knee surgeries, use of assistive devices for knee OA, number of arthritis medications, history of knee injection, exercise self-efficacy, foot symptoms, fatigue, quality of life, six-minute walk time, balance time, chair-stands, and Community Healthy Activities Model Program for Seniors (CHAMPS)-assessed physical activity. To identify variables that were related to WOMAC response independently, baseline characteristics correlated with WOMAC response at P<0.10 were included in a multivariable linear regression model. Analyses were performed in SAS 9.1 with P<0.05 established as significant. Results: In these PT interventions for knee OA, percentage change in WOMAC from baseline to 12 weeks ranged from -180 to 91 percent (see Figure). In bivariate analyses, percentage change in WOMAC was positively correlated with poorer baseline WOMAC score, the presence of back pain, and endorsing ever having any knee injury (P<0.05 for all); percentage change in WOMAC was inversely related to satisfaction with physical function (P<0.03). In multivariable models, improvement in percentage change in WOMAC score was related to baseline total WOMAC score (as baseline WOMAC scores increase, percentage change in WOMAC improved) and endorsement of ever having a knee injury (R2= 0.08; Pmodel<0.001; PBlWOMAC<0.001; PBlInjury0.03). After accounting for the other variables, presence of back pain and satisfaction with physical function were not related independently to change in WOMAC (P>0.05 for both). Conclusions: There was considerable heterogeneity in 12 week OA symptom responses to group and individual PT interventions. Better responses were observed for those with more baseline OA symptoms as well as those with a prior knee injury. These findings need validation in additional cohorts but suggest that PT might be particularly beneficial for persons with more OA symptoms and those with prior knee injuries. Additionally, the relationship between better PT responses and prior knee injury suggests that underlying biomechanical abnormalities may be a critical factor affecting response to standard PT interventions for knee OA." @default.
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• W2090595898 date "2015-04-01" @default.
• W2090595898 modified "2023-09-25" @default.
• W2090595898 title "Poorer initial symptoms and prior knee injuries are indicative of better symptom responses to physical therapy for knee OA" @default.
• W2090595898 doi "https://doi.org/10.1016/j.joca.2015.02.689" @default.
• W2090595898 hasPublicationYear "2015" @default.
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