Evaluation of Cwm Taf Health Board’s knee-joint care programme a year from its completion: a professional-led dietetic and exercise intervention for obese patients with knee osteoarthritis

The National Institute for Health and Care Excellence recommends that weight loss and exercise are a core part of treatment for osteoarthritis. The delivery of these services within the National Health Service is by physiotherapists and dietitians in the secondary health-care setting. This feasibility study for obese patients with knee osteoarthritis was led by registered exercise professionals with the aim of assessing the potential for widespread use within the community.

81 patients met the inclusion criteria (body-mass index [BMI] >30 kg/m² and radiological evidence of knee osteoarthritis) and were invited to participate through various routes (National Exercise Referral Scheme exclusion criteria were used). The intervention was a 16-week programme containing 1 h of exercise twice a week and 1 h a week of dietary advice. Primary outcome measures were Oxford knee score, quality of life (EQ-5D and EQ visual analogue scale [EQ-VAS]), and function (6-min walk test and 30 s sit to stand test). Outcome data were collected at week 16 and at 1 year after completion by the same exercise professionals. Student’s t tests were used for statistical analysis.

The intervention started in January, 2013. 27 patients attended initial assessment and 18 finished the 16-week intervention. All 18 patients were white (nine men, mean age 59·7 years [SD 5·11], range 50–68), and had a starting BMI of 38·9 kg/m² (SD 8·01). 14 patients completed 1-year follow-up (seven men, mean age 62·6 years [3·74], 53–69) and had a BMI of 33·34 kg/m² (SD 5·08) at 1 year. At 1-year follow-up, significant changes were seen in the 30 s sit to stand test (mean change 3·6 repetitions, 95% CI 1·2 −5·96; p<0·0001) compared with baseline. Non-significant improvements were also seen in this time period for Oxford knee score (mean change 3·4, −4·97 to 11·7) and 6-min walk test (54·9 m, −51·4 to 161·3).

Statistically significant changes in 30 s sit to stand scores require investigation on a larger scale. Limitations include small sample size and lack of a control group. Sessions were run during working hours and no clear referral pathway was set up. Evening classes would allow working patients to participate, and incorporation of referral pathways within existing National Health Service structures would allow the programme to run at capacity. A larger study should advertise exit routes from the programme to enable long term success.

Cwm Taf Health Board.