Dose-Response Effects of Tai Chi and Physical Therapy Exercise Interventions in Symptomatic Knee Osteoarthritis.
Author: Lee AC1, Harvey WF1, Price LL2, Han X1, Driban JB1, Iversen MD3, Desai SA4, Knopp HE4, Wang C5
Affiliation:
1Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
2Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA.
3Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, and Section of Clinical Sciences, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA,USA.
4Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, MA, USA.
5Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA. Electronic address: cwang2@tuftsmedicalcenter.org.
Conference/Journal: PM R.
Date published: 2018 Jan 30
Other:
Pages: S1934-1482(17)30178-8 , Special Notes: doi: 10.1016/j.pmrj.2018.01.003. [Epub ahead of print] , Word Count: 310
BACKGROUND: Therapeutic exercise is a currently recommended non-pharmacological treatment for knee osteoarthritis (KOA). The optimal treatment dose (frequency or duration) has not been determined.
OBJECTIVE: To examine dose-response relationships, minimal effective dose, and baseline factors associated with the timing of response from two exercise interventions in KOA.
DESIGN: Secondary analysis of a single-blind, randomized trial comparing 12-week Tai Chi and Physical Therapy exercise programs (Trial Registry #NCT01258985).
SETTING: Urban tertiary care academic hospital PARTICIPANTS: 182 participants with symptomatic KOA (mean age 61 years; BMI 32kg/m2, 70% female; 55% white).
METHODS: We defined dose as cumulative attendance-weeks of intervention, and treatment response as ≥20% and ≥50% improvement in pain and function. Using log-rank tests, we compared time-to-response between interventions; and used Cox regression to examine baseline factors associated with timing of response, including physical and psychosocial health, physical performance, outcome expectations, self-efficacy, and biomechanical factors.
MAIN OUTCOME MEASURES: Weekly Western Ontario and McMasters Osteoarthritis Index (WOMAC) pain (0 to 500) and function (0 to 1700) scores.
RESULTS: Both interventions had an approximately linear dose-response effect resulting in a 9 to 11-point reduction in WOMAC pain and a 32 to 41-point improvement in function per attendance-week. There was no significant difference in overall time-to-response for pain and function between treatment groups. Median time-to-response for ≥20% improvement in pain and function was 2 attendance-weeks and 4 to 5 attendance-weeks for ≥50% improvement. On multivariable models, outcome expectations were independently associated with incident function response (Hazard Ratio: 1.47; 95% CI: 1.004 to 2.14).
CONCLUSIONS: Both interventions have approximately linear dose-dependent effects on pain and function, their minimum effective doses range from 2-5 weeks, and patient perceived benefits of exercise influence the timing of response in KOA. These results may help clinicians optimize patient-centered exercise treatments and better manage patient expectations.
LEVEL OF EVIDENCE: Level I.
Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
KEYWORDS: Dose Response; Exercise; Knee Osteoarthritis; Physical Therapy; Tai Chi
PMID: 29407226 DOI: 10.1016/j.pmrj.2018.01.003
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