title: Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and/or knee: A randomized clinical trial.
abstract: OBJECTIVE
  To determine the effectiveness of a behavioral graded activity program (BGA) compared with usual care (UC; exercise therapy and advice) according to the Dutch guidelines for physiotherapy in patients with osteoarthritis (OA) of the hip and/or knee. The BGA intervention is intended to increase activity in the long term and consists of an exercise program with booster sessions, using operant treatment principles.
  
  
  METHODS
  We conducted a cluster randomized trial involving 200 patients with hip and/or knee OA. Primary outcome measures were pain (visual analog scale [VAS] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), physical function (WOMAC), and patient global assessment, assessed at weeks 0, 13, 39, and 65. Secondary outcome measures comprised tiredness (VAS), patient-oriented physical function (McMaster Toronto Arthritis Patient Preference Disability Questionnaire [MACTAR]), 5-meter walking time, muscle strength, and range of motion. Data were analyzed according to intent-to-treat principle.
  
  
  RESULTS
  Both treatments showed short-term and long-term beneficial within-group effects. The mean differences between the 2 groups for pain and functional status were not statistically significant. Significant differences in favor of BGA were found for the MACTAR functional scale and 5-meter walking test at week 65.
  
  
  CONCLUSIONS
  Because both interventions resulted in beneficial long-term effects, the superiority of BGA over UC has not been demonstrated. Therefore, BGA seems to be an acceptable method to treat patients with hip and/or knee OA, with equivalent results compared with UC.
authors.affiliation: Netherlands Institute for Health Services Research, Utrecht, The Netherlands. c.veenhof@nivel.nl
authors.forename: Cindy
authors.initials: C
authors.lastname: Veenhof
authors.forename: Albère J A
authors.initials: AJ
authors.lastname: Köke
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.forename: Rob A
authors.initials: RA
authors.lastname: Oostendorp
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
authors.forename: Cornelia H M
authors.initials: CH
authors.lastname: van den Ende
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000523:psychology / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000523:psychology / Q000628:therapy*; D010146:Pain / Q000523:psychology; D059408:Pain Management; D012054:Reinforcement, Psychology; D016896:Treatment Outcome