Knee Pain Experiment Delivers Only Transient Relief

KEELE, England, Oct. 23 -- Two non-traditional interventional approaches produced transient improvements in knee pain in older patients, according to researchers here.

But the effects did not last, possibly because of non-compliance, Elaine Hay, M.D., of Keele University, and colleagues, reported in the online issue of BMJ.

In what they called a pragmatic randomized trial, researchers compared three interventions -- a community physiotherapy program, an enhanced pharmacy review, and a simple leaflet giving advice about dealing with knee pain.

All patients were given the leaflet, together with a follow-up phone call. Those who only got the leaflet served as a control group, said Dr. Hay and colleagues.

The researchers enrolled 325 adults ages 55 years or older (with a mean of 68) who came to 15 local generalist practices with knee pain. Of those, 297 (or 91%) were still in the study at the six-month follow-up.

They were randomized into three groups:

• 108 patients in the enhanced pharmacy group, who had up to six appointments with an experienced community pharmacist to monitor the appropriateness and effectiveness of the prescribed medication.
• 109 patients in the physiotherapy group, who received up to six sessions with a physiotherapist, which included general aerobic exercise and specific muscle strengthening and stretching exercises.
• 108 people in the control group, who received an information and advice leaflet (also issued to the other two groups), as well as a telephone call to reinforce the information and address any worries about putting the advice into practice.

The main outcome measure was change in the standard Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, which includes both pain and function scales, at three, six, and 12 months.

Compared with a mean baseline pain score of 9.1 and a mean baseline function score of 29.9:

• At three months, the mean reductions in pain scores were 0.41 in the control group, 1.59 in the pharmacy group, and 1.56 in the physiotherapy group.
• At the same time, reductions in function scores were 0.80, 2.61, and 4.79, respectively.
• The changes from baseline were statistically significant at P=0.006 for the pharmacy group and P=0.008 for the physiotherapy group.

However, by six months, the differences were no longer seen, Dr. May and colleagues reported, possibly because of lack of adherence. A weakness of the study, they said, is that there was no mechanism to track patient adherence.

The study also found that at six months the use of non-steroidal anti-inflammatory drugs was 16% lower in the pharmacy group and 15% lower in the physiotherapy group than among patients in the control group, without an increase in reported pain.