Exercise and self-management interventions are recommended as effective treatments for chronic knee pain in the elderly. Jessep and colleaques previously described a rehabilitation program integrating exercise and self-management [Enabling Self-management and Coping with Arthritic knee Pain through Exercise (ESCAPE-knee pain)] that produced short-term improvements in pain and physical function. Sustaining these improvements, however, is difficult; moreover, the program is untried in clinical environments, where it would ultimately be delivered. The objective of the current study was to establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs in a randomized controlled trial. Sixty-four people with chronic knee pain received outpatient physiotherapy compared with ESCAPE-knee pain. The primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes included pain, objective functional performance, anxiety, depression, exercise-related health beliefs, and healthcare utilization. All outcomes were assessed at baseline and 12 months after completing the interventions (primary endpoint). ANCOVA investigated between-group differences. Both groups demonstrated similar improvements in clinical outcomes. Outpatient physiotherapy cost 130 pounds per person and the healthcare utilization costs of participants over 1 year were 583 pounds. The ESCAPE-knee pain program cost 64 pounds per person and the healthcare utilization costs of participants over one year were 320 pounds.

WHAT THE STUDY MAY MEAN TO YOU AS A HEATH CARE PROVIDER: The authors concluded that ESCAPE-knee pain can be delivered as a community-based integrated rehabilitation program for people with chronic knee pain. Both ESCAPE-knee pain and outpatient physiotherapy produced sustained physical and psychosocial benefits, but ESCAPE-knee pain cost less and was more cost-effective.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Both approaches benefited older patients with knee pain. However, the benefits of the ESCAPE-knee pain program showed greater benefit than outpatient physiotherapy.

SA Jessep et al. Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain. Physiotherapy, 2009;95:94-102.