title: Group Versus Individual Physical Therapy for Veterans With Knee Osteoarthritis: Randomized Clinical Trial.
abstract: BACKGROUND
  Efficient approaches are needed for delivering nonpharmacological interventions for management of knee osteoarthritis (OA).
  
  
  OBJECTIVE
  This trial compared group-based versus individual physical therapy interventions for management of knee OA.
  
  
  METHODS
  Three hundred twenty patients with knee OA at the VA Medical Center in Durham, North Carolina, (mean age=60 years, 88% male, 58% nonwhite) were randomly assigned to receive either the group intervention (group physical therapy; six 1-hour sessions, typically 8 participants per group) or the individual intervention (individual physical therapy; two 1-hour sessions). Both programs included instruction in home exercise, joint protection techniques, and individual physical therapist evaluation. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; range=0-96, higher scores indicate worse symptoms), measured at baseline, 12 weeks, and 24 weeks. The secondary outcome measure was the Short Physical Performance Battery (SPPB; range=0-12, higher scores indicate better performance), measured at baseline and 12 weeks. Linear mixed models assessed the difference in WOMAC scores between arms.
  
  
  RESULTS
  At 12 weeks, WOMAC scores were 2.7 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% confidence interval [CI]=-5.9, 0.5; P=.10), indicating no between-group difference. At 24 weeks, WOMAC scores were 1.3 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% CI=-4.6, 2.0; P=.44), indicating no significant between-group difference. At 12 weeks, SPPB scores were 0.1 points lower in the group physical therapy arm compared with the individual physical therapy arm (95% CI=-0.5, 0.2; P=.53), indicating no difference between groups.
  
  
  CONCLUSIONS
  This study was conducted in one VA medical center. Outcome assessors were blinded, but participants and physical therapists were not blinded.
  
  
  CONCLUSIONS
  Group physical therapy was not more effective than individual physical therapy for primary and secondary study outcomes. Either group physical therapy or individual physical therapy may be a reasonable delivery model for health care systems to consider.
authors.affiliation: K.D. Allen, PhD, Health Services Research and Development Service 152, Durham VA Medical Center, 508 Fulton St, Durham, NC 27705 (USA); Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina; and Center for Aging and Human Development, Duke University, Durham, North Carolina. kelli.allen@va.gov.
authors.forename: Kelli D
authors.initials: KD
authors.lastname: Allen
authors.affiliation: D. Bongiorni, DPT, Physical Medicine and Rehabilitation Service, Durham VA Medical Center.
authors.forename: Dennis
authors.initials: D
authors.lastname: Bongiorni
authors.affiliation: H.B. Bosworth, PhD, Health Services Research and Development Service, Durham VA Medical Center; Center for Aging and Human Development, Duke University; Department of Medicine, Duke University Medical Center; and Department of Psychiatry and Behavioral Science, Duke University.
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.affiliation: C.J. Coffman, PhD, Health Services Research and Development Service, Durham VA Medical Center, and Department of Biostatistics and Bioinformatics, Duke University.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.affiliation: S.K. Datta, PhD, Health Services Research and Development Service, Durham VA Medical Center, and Department of Medicine, Duke University Medical Center.
authors.forename: Santanu K
authors.initials: SK
authors.lastname: Datta
authors.affiliation: D. Edelman, MD, MHS, Health Services Research and Development Service, Durham VA Medical Center, and Department of Medicine, Duke University Medical Center.
authors.forename: David
authors.initials: D
authors.lastname: Edelman
authors.affiliation: K.S. Hall, PhD, Center for Aging and Human Development, Duke University; Department of Medicine, Duke University Medical Center; and Geriatric Research, Education, and Clinical Center, Durham VA Medical Center.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Hall
authors.affiliation: J.H. Lindquist, MStat, Health Services Research and Development Service, Durham VA Medical Center.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Lindquist
authors.affiliation: E.Z. Oddone, MD, MHSc, Health Services Research and Development Service, Durham VA Medical Center, and Department of Medicine, Duke University Medical Center.
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.affiliation: H. Hoenig, MD, MPH, Center for Aging and Human Development, Duke University; Department of Medicine, Duke University Medical Center; and Physical Medicine and Rehabilitation Service, Durham VA Medical Center.
authors.forename: Helen
authors.initials: H
authors.lastname: Hoenig
mesh_terms: D000368:Aged; D005080:Exercise Test; D005081:Exercise Therapy / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000534:rehabilitation*; D010379:Peer Group; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome; D014481:United States; D058014:Veterans Health