A multi-arm cluster randomized clinical trial of the use of knee kinesiography in the management of osteoarthritis patients in a primary care setting

ABSTRACT

Objective: An important clinical gap reported by primary care physicians (PCPs) in managing knee osteoarthritis patients is the lack of validated tools to help them guide conservative treatment decision-making. This study aimed at evaluating the clinical utility of adding to current medical management (CMM) by PCPs, a dynamic knee kinesiography (KneeKG) exam assessing biomechanical risk factors linked to osteoarthritis progression.

Design: In this 6-month cluster randomized controlled trial, primary care clinics were randomized into three groups: 1-CMM by PCPs, 2-CMM+KneeKG, and 3-CMM+KneeKG+Education (a self-management education session and two follow-up group meetings). Primary outcomes were scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales and overall score.

Results: Of the 894 patients referred from 87 clinics, 515 participated, 449 (87.2%) completed the study. At 6-month follow-up, patients in both KneeKG groups reported statistically significant improvement on the KOOS overall score (Group2: +5.5; Group3: +5.0), and on the symptoms, pain, and activities of daily living subscales compared to control group (all p < 0.05). They also reported significantly higher satisfaction levels with global care (both p < 0.01). Group 3-CMM+KneeKG+Education showed statistically significant improvements in objective functional tests as well as greater global impression of change in pain, function, quality of life, and global condition (all p < 0.05).

Conclusions: Results demonstrated significant improvements in terms of pain, function, and satisfaction in KneeKG groups relative to the CMM. Adding education and supervision further improves clinical outcomes. These findings may support the added value of a KneeKG exam in assisting PCPs in the management of knee osteoarthritis patients.

KEYWORDS:

• Osteoarthrtis
• knee
• primary health care
• knee kinesiography
• mechanical markers
• KneeKG

Acknowledgments

The authors would like to acknowledge the work of Marc Dorais who independently conducted the statistical analyses, Laetitia De Polo, research assistant, who managed the database, and Marilyn Krelenbaum for manuscript editing. Our thanks are also due to all the PCPs who referred patients as well as to all the study participants.

Author contributions

All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Declaration of interest

The authors and peer reviewers have no financial interests or any conflicts of interest to disclose.

Supplementary Material

Supplemental data for this article can be accessed here.

Additional information

Funding

The study was funded by the Fonds de partenariat pour un Québec innovant et en santé (FPQIS) (government of Quebec) as well as Emovi Inc and Sanofi. Emovi Inc. deployed the KneeKG exam in the study sites in Quebec (Canada) and Sanofi contributed to the knowledge transfer and burden of disease part of the project. Neither of them had access to patient data.