Effectiveness and clinical applicability of integrated rehabilitation programs for knee osteoarthritis.
OBJECTIVE
Knee osteoarthritis is a common and increasing cause of pain and disability. Exercise and self-management interventions reduce pain and improve function. These interventions are usually delivered separately but, theoretically, the benefits of the physical approach of exercise and the educational approach of self-management interventions could be additive. If correct, rehabilitation programmes that integrate exercise and self-management components might be more effective. This review summarizes and comments on the clinical effectiveness, practicality, cost and implementation of recent studies of integrated rehabilitation programmes.


RESULTS
The programmes varied considerably in content and duration, but in general were safe and effective (improving pain, physical function and other relevant variables). The length, complexity and burden of some programmes limit their acceptability, clinical applicability and increase costs. The most recent programmes have addressed these issues producing programmes that are more clinically and cost-effective than usual care. Implementation of these programmes will require considerable effort and commitment.


CONCLUSIONS
Integrated rehabilitation programmes that are acceptable, clinically effective, deliverable and affordable may be the best way of managing the large and increasing number of people suffering chronic knee pain.
Hurley
Michael V
MV
King's College London, UK. mike.hurley@kcl.ac.uk
Walsh
Nicola E
NE