Improving the Effectiveness of Exercise Therapy for Adults With Knee Osteoarthritis: A Pragmatic Randomized Controlled Trial (BEEP Trial).
Nadine E Foster, Elaine Nicholls, Melanie A Holden and 2 others
PMID 37312983WHAT IT FOUND
Adding more sessions, individual tailoring, or adherence coaching to usual knee osteoarthritis exercise care produced no better pain or function outcomes than usual care.
All three groups improved similarly, with about half meeting responder criteria. Usual care remains the effective baseline.
Key findings
01There were no significant differences in the change in WOMAC pain or function at 6 months between usual care and either individually tailored exercise or targeted exercise adherence interventions.
02Participants in all three groups showed within-group improvements in pain and function, with most improvement occurring in the first 3 months, but no significant differences between groups at any time-point.
03At 6 months, the proportion of participants meeting OMERACT-OARSI responder criteria was around 50% in all groups and remained relatively stable over longer-term follow-ups.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The interventions may not have been sufficiently different from each other to detect a treatment effect. Fidelity to the Targeted Exercise Adherence protocol was low, with only simpler educational and behavioral tools frequently used, potentially diluting the intended intervention. The number of treatment contacts delivered in the Targeted Exercise Adherence group was lower than protocolized (median 7 vs 8-10 planned), which may have been insufficient to facilitate long-term behavior change. Multiple testing was not adjusted for, though given the non-significant results, this would not change the conclusions. The study was conducted within the UK NHS, and treatment contact numbers were influenced by local service deliverability, which may limit generalizability to other healthcare systems.
Declared interests
The text does not explicitly state funding sources or conflicts of interest, though it notes the trial was approved by the North West Research Ethics Committee in the UK.
The easy way to misread this
Do not conclude that exercise therapy is ineffective for knee osteoarthritis. All groups improved similarly, with about half meeting responder criteria. The null finding is that adding more sessions, tailoring, or adherence coaching to usual care did not produce better outcomes than usual care alone.