title: A physiotherapist-delivered, combined exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a pilot study.
abstract: BACKGROUND
  Osteoarthritis (OA) of the knee is associated with a number of physical and psychological impairments. Unfortunately, very few treatment strategies are capable of addressing both types of impairments concurrently. We performed a pilot, randomized controlled, proof of principle trial investigating the feasibility and effects of an intervention combining physical exercise and pain coping skills training (PCST).
  
  
  METHODS
  Twenty patients with a clinical and radiographical diagnosis of tibiofemoral OA were randomized to receive either 10 weeks of physiotherapist supervised exercises (lower limb strengthening and walking) combined with non-directive counseling (NDC) or the same exercise program delivered concurrently with PCST. Primary outcomes included self-reported pain and pain coping, while secondary outcomes included self efficacy and self-reported physical function.
  
  
  RESULTS
  Ten participants were randomized to each group and both groups exhibited significant improvements in isometric knee strength, self-reported knee pain and physical function, self efficacy for control of pain management and other arthritis symptoms. Only those in the exercise + PCST group reported statistically significant improvements in pain control coping and rational thinking. No between-group differences existed in any outcome (0.07 < p < 0.98). Based on our findings, 63 participants per group would be needed for future large-scale studies using similar outcome measures and design.
  
  
  CONCLUSIONS
  Our study showed that an intervention that combines exercise and PCST within the same treatment session and delivered by specially-trained physiotherapists is feasible and can improve both physical and psychological outcomes in individuals with knee OA.
  
  
  METHODS
  Level II Clinical Trials Registry number: ACTRN12609000623291.
authors.affiliation: Department of Physical Therapy, University of British Columbia, Vancouver, Canada. michael.hunt@ubc.ca
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hunt
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: Christina
authors.initials: C
authors.lastname: Bryant
authors.forename: Ben R
authors.initials: BR
authors.lastname: Metcalf
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Ahamed
authors.forename: Michael K
authors.initials: MK
authors.lastname: Nicholas
authors.forename: Kim L
authors.initials: KL
authors.lastname: Bennell
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D018771:Arthralgia / Q000523:psychology* / Q000628:therapy*; D003376:Counseling; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000523:psychology* / Q000628:therapy*; D010147:Pain Measurement; D010865:Pilot Projects; D020377:Self Efficacy; D016037:Single-Blind Method