1101 — STepped Exercise Program for Veterans with Knee OsteoArtritis (STEP-KOA): Results of a randomized clinical trial

Lead/Presenter: Kelli Allen,  COIN - Durham
All Authors: Allen KD (Durham VA COIN and Thurston Arthritis Research Center, University of North Carolina, Chapel HIll ), Woolson, S (Durham VA COIN), Bongiorni, D (Durham VA, Physical Medicine & Rehabilitation Service) Caves, K (Duke University, Department of Biomedical Engineering) Floegel, TA (East Carolina University, College of Nursing) Hall, K (Durham VA Geriatric Research, Education and Clinical Center; Duke University Department of Medicine) Heiderscheit, B (University of Wisconsin, Department of Orthopedics and Rehabilitation) Hoenig, H (Durham VA, Physical Medicine & Rehabilitation Service; Duke University, Department of Medicine) Huffman, K (Durham VA, Physical Medicine & Rehabilitation Service; Duke University, Department of Medicine) Morey, M (Durham VA, Durham VA Geriatric Research, Education and Clinical Center; Duke University, Department of Medicine) Ramasunder, S (Durham VA, Orthopedic Surgery Service) Severson, H (Oregon Research Institute) Van Houtven, C (Durham VA COIN; Duke University, Department of Population Health Sciences) Coffman, CJ (Durham VA COIN; Duke University, Department of Biostatistics and Bioinformatics)

Objectives:
Knee osteoarthritis (OA) is a leading cause of pain and disability among Veterans. Exercise-based interventions are first-line therapies for knee OA, and there is a need for effective and efficient models for delivering this component of knee OA care. This study examined the effects of a STepped Exercise Program for Veterans with Knee OsteoArthritis (STEP-KOA).

Methods:
This was a randomized clinical trial of 345 Veterans with knee OA [mean (standard deviation) age = 62.2 (9.8) years, 84% men] at two VA medical centers, who were randomized to the STEP-KOA program or an arthritis education (AE) control group with a 2:1 ratio, respectively. STEP-KOA began with three months of a progressive internet-based exercise program (Step 1). Participants not meeting response criteria for clinically meaningful improvement in self-reported pain and function after Step 1 progressed to Step 2, which involved bi-weekly physical activity coaching calls for 3 months. Participants not meeting response criteria after Step 2 progressed to in-person visits with a physical therapists (Step 3). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a measure of pain, stiffness and function, assessed at 9-month follow-up. Results from preliminary analysis (of the full study sample) using linear mixed models are presented.

Results:
In the STEP-KOA group (n = 230), 60% of participants progressed to Step 2 and 35% progressed to Step 3. Completion rates for 9-month assessments were 68% and 78% in the STEP-KOA and AE groups, respectively. The estimated baseline WOMAC score for the full sample was 47.5 (95% confidence interval (CI) = 45.7, 49.2). At 9-month follow-up, the estimated mean WOMAC score was 6.9 points (95% CI -10.6, -3.2) lower, indicating more improvement, in the STEP-KOA group compared to the AE group. These preliminary models indicate Veteran STEP-KOA participants had clinically relevant improvement in OA symptoms and function compared with Veterans in the AE control condition.

Implications:
These preliminary models indicate Veteran STEP-KOA participants had clinically relevant improvement in OA symptoms and function compared with Veterans in the AE control condition.

Impacts:
The STEP-KOA model of care can help to tailor exercise-based interventions to Veterans' needs and also conserve higher resource services (such as physical therapy) for Veterans who do not make clinically relevant improvements after receiving less resource intensive interventions.