title: Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized controlled trial comparing two different physical therapy interventions.
abstract: OBJECTIVE
  To determine if behavioral graded activity (BGA) results in better long-term effectiveness (5 years after inclusion) than usual exercise therapy (UC; usual care) in patients with osteoarthritis (OA) of the hip or knee.
  
  
  METHODS
  Long-term follow-up study of a single blind cluster randomized trial comparing BGA and UC. One hundred and forty-nine patients out of the 200 included were followed until 60 months' follow-up. Primary outcome measures were pain, physical function, and patient global assessment. Furthermore, patient-oriented physical function, physical performance, health care utilization and the number of joint replacement surgeries were assessed. Assessments took place at 3, 9, 15 and 60 months' follow-up. Data were analyzed according to intent-to-treat principle.
  
  
  RESULTS
  Both treatments showed beneficial within-groups effects in the long-term. In patients with knee OA no differences between treatments were found on the short-, mid-long and long-term. In patients with hip OA significant differences in favor of BGA were found at 3 months' (pain and physical performance) and 9 months' follow-up (pain, physical function, patients global assessment and patient-oriented physical function). Furthermore, UC resulted in patients with hip OA in more joint replacement surgeries compared to BGA (hazard ratio [HR], 2.87; 95% confidence interval [CI], 1.1; 7.3).
  
  
  CONCLUSIONS
  No differences between treatment groups were found in the long-term on the primary outcome measures. Although more research is needed to confirm the study findings, the results indicate that BGA reduces the risk for joint replacement surgeries compared to UC in patients with hip OA, which probably can be explained by better outcome in favor of BGA in the short- and mid-long-term.
authors.affiliation: Netherlands Institute for Health Services Research, Utrecht, The Netherlands. m.pisters@nivel.nl
authors.forename: M F
authors.initials: MF
authors.lastname: Pisters
authors.forename: C
authors.initials: C
authors.lastname: Veenhof
authors.forename: F G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: D H
authors.initials: DH
authors.lastname: De Bakker
authors.forename: J
authors.initials: J
authors.lastname: Dekker
mesh_terms: D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010147:Pain Measurement; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome