title: The effects of a non-operative multimodal programme on osteoarthritis of the knee.
abstract: BACKGROUND
  The purpose of this study was to determine if a multimodal programme including physiotherapy and education could improve the symptoms of osteoarthritis of the knee across various severities of disease.
  
  
  METHODS
  Seventy-two patients with osteoarthritis of the knee confirmed on radiographic evidence were referred over a 13-month period for a lower limb programme which consisted of 12 classes over 6 weeks of group physiotherapy and included education on osteoarthritis, diet and exercise. Six patients went on to have joint arthroplasty at a mean time of 6.5 months with three placed on the waiting list during follow-up.
  
  
  RESULTS
  Pre-intervention, the mean WOMAC score was 42.0 and the mean Oxford Knee Score was 32.8. Post-intervention at a mean follow-up of 12 months, the mean WOMAC score was 31.6 and the mean Oxford Knee Score 24.3. The change in scores following intervention was statistically significant (P < 0.01). Using the WOMAC scoring system, the greatest effect size was seen in patients with Kellgren-Lawrence grade IV whilst using the Oxford knee scoring system, the greatest effect size was seen in patients with Kellgren-Lawrence grade II.
  
  
  CONCLUSIONS
  At 12 months, a multimodal programme of non-operative interventions has an excellent impact upon the symptoms of osteoarthritis of the knee with improved patient-reported scores. The level of improvement cannot be inferred from the radiographic grade of osteoarthritis. This modality could be considered for all patients with mild-to-moderate osteoarthritis of the knee.
authors.affiliation: Department of Trauma and Orthopaedics, University College Hospital, London, UK. shelain.patel@doctors.org.uk
authors.forename: Shelain
authors.initials: S
authors.lastname: Patel
authors.forename: Fahad S
authors.initials: FS
authors.lastname: Hossain
authors.forename: Bruce
authors.initials: B
authors.lastname: Paton
authors.forename: Fares S
authors.initials: FS
authors.lastname: Haddad
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D010353:Patient Education as Topic / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome