title: Significant improvements in pain after a six-week physiotherapist-led exercise and education intervention, in patients with osteoarthritis awaiting arthroplasty, in South Africa: a randomised controlled trial.
abstract: A major challenge facing those with late stage osteoarthritis is delayed surgery due to waiting lists. In South Africa patients wait years for a hip/knee arthroplasty. Affected patients require effective management to address their pain, especially while awaiting surgery. Existing literature is mostly available from high income countries exploring effects of interventions during short waiting periods. Research is warranted in low income countries where long waiting periods are common. This study explored the effects of a six-week physiotherapist-led exercise and education intervention on pain in this population.
  
  
  
  A randomised controlled trial was performed at two public hospitals in South Africa. Ethical approval and informed consent was obtained. 74 participants from arthroplasty waiting lists were randomly allocated to an intervention (n = 35) or control group (n = 39). The intervention included six physiotherapist-led group-based sessions (two hours/week of education, exercise and relaxation). The control group received usual care. Data collection was conducted by blinded physiotherapists at baseline, week six, 12 and month six. The primary outcome was pain, measured by the Brief Pain Inventory. Additionally, participants completed an open-ended questionnaire at month six, to gain insight regarding the intervention. Analysis was by intention to treat using two-way analysis of variance and post-hoc Tukey comparisons. Answers to subjective questions were analysed according to common themes that emerged.
  
  
  
  The intervention group had significant improvements compared with the control group with moderate to large effect sizes (ES) on pain severity [week 6: p < 0.01, ES = 0.94, 95 % CI (0.45,1.41), month 6: p = 0.02. ES = 0.74, 95 % CI (0.26,1.2)] and moderate to large effects on pain interference [week 6: p < 0.01, ES = 1.2, 95 % CI (0.70,1.69), week 12: p = 0.04, ES = 0.68, 95 % CI (0.20,1.14), month 6: p < 0.01, ES = 0.98, 95 % CI (0.49,1.45)]. 53 % of participants reported that the intervention improved their pain.
  
  
  
  The intervention resulted in sustained significant improvements in pain severity and interference in patients with hip/knee osteoarthritis, awaiting arthroplasty compared with a control group. Additionally, participants' individual feedback supported observed significant improvements in pain. Such an intervention appears to be effective in managing pain in this population and should be incorporated into practice for appropriate patients. Further research is being conducted to explore long term and postoperative outcomes.
  
  
  
  Pan African Clinical Trial Registry, PACTR201409000885765 , PACTR201507001186115 .
authors.affiliation: Physiotherapy department, Tygerberg Hospital, Cape Town, South Africa.
authors.forename: M M
authors.initials: MM
authors.lastname: Saw
authors.affiliation: ICAS South Africa, Musculoskeletal Health, Johannesburg, South Africa.
authors.forename: T
authors.initials: T
authors.lastname: Kruger-Jakins
authors.affiliation: Department of Health & Rehab Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Edries
authors.affiliation: Department of Health & Rehab Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Romy.parker@uct.ac.za.
authors.forename: R
authors.initials: R
authors.lastname: Parker
mesh_terms: D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010147:Pain Measurement; D010353:Patient Education as Topic; D011300:Preoperative Care; D013019:South Africa; D011795:Surveys and Questionnaires
keywords: Arthroplasty/joint replacement; Chronic pain; Education; Exercise; Hip/knee osteoarthritis; Physiotherapy; Waiting list