A feasibility study of brain-targeted treatment for people with painful knee osteoarthritis in tertiary care

ABSTRACT

Purpose: To assess the feasibility and clinical impact of brain-targeted treatment (BT; aiming to target sensorimotor processing) in knee osteoarthritis patients attending tertiary care. Methods: Randomized replicated case series. The study involved three phases, each of 2 weeks duration: (1) no-treatment phase; (2) BT phase (left/right judgments and touch discrimination training); and (3) usual care (education, strengthening, and stretching training). Primary outcomes were: timely recruitment; number of participants completing the interventions; treatment compliance and barriers; follow-up rates; and treatment impact on pain and function. Fear-avoidance beliefs and clinical measures of cortical body representation (tactile acuity and left/right judgment performance) were secondary outcomes. Results: A total of 5% (19/355) of all assessed patients were eligible to participate and of these, 58% (11/19) agreed to participate. Ten patients completed the study, and 9 were successfully followed up, with treatment compliance varying between interventions. Compliance was poor for the touch discrimination component of BT. No significant effects were observed for pain relief or knee function after any treatment. A positive impact of treatment was found for fear-avoidance beliefs (usual care vs. washout, p = 0.007; BT vs. washout, p = 0.029) and left/right judgment accuracy (usual care vs. washout; p = 0.006). Conclusions: Clear barriers were identified to implementing BT in tertiary care for knee osteoarthritis. Access to all available services (especially the use of interpreters), and treatment options that do not require additional assistance to perform (e.g., touch discrimination training) represent the main lessons learned.

KEYWORDS:

• Feasibility study
• motor imagery
• usual care
• osteoarthritis
• patient compliance
• tactile discrimination training

Acknowledgments

We would like to acknowledge Northern Health Physiotherapy for their assistance in completing this trial. We would also like to thank Ms Caitlin Farmer for her assistance with proof reading this manuscript.

Declaration of Interest

GLM receives royalties for books on pain and rehabilitation and speaker’s fees for lectures on these topics. He has received support from Pfizer, workers’ compensation boards in Australia, Europe, and North America, Kaiser Permanente, Agile Physiotherapy and Results Physiotherapy, the International Olympic Committee, Port Adelaide Football Club, and Arsenal Football Club. TRS received travel and accommodation support from Eli Lilly Ltd. for speaking engagements; this was unrelated to the present topic. The remaining authors declare that there are no conflicts of interest.

Supplemental data

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Additional information

Funding

Funding for this work was provided by a Northern Health Small Research Grant. AMHR was partially funded by the VI Plan Propio de Investigación, Universidad de Sevilla, Spain. 875 GLM was supported by a National Health & Medical Research Council Principal Research Fellowship (ID1061279). TRS was supported by a Canadian Institute for Health Research Postdoctoral Training Fellowship (ID223354) and National Health & Medical Research 880 Council Early Career Fellowship (ID1054041).