{"id":265,"date":"2016-10-25T14:55:35","date_gmt":"2016-10-25T18:55:35","guid":{"rendered":"https:\/\/sites.temple.edu\/dptebp2016\/?p=265"},"modified":"2019-11-05T09:22:44","modified_gmt":"2019-11-05T14:22:44","slug":"booster-sessions-vs-usual-care-for-adults-with-knee-osteoarthritis","status":"publish","type":"post","link":"https:\/\/sites.temple.edu\/dptebp2016\/2016\/10\/25\/booster-sessions-vs-usual-care-for-adults-with-knee-osteoarthritis\/","title":{"rendered":"Booster Sessions vs. Usual Care for Adults with Knee Osteoarthritis"},"content":{"rendered":"

Background<\/span><\/h4>\n

Knee OA is a common diagnosis causing chronic pain, decreased physical function, and diminished quality of life. \u00a0Research has demonstrated that physical therapy is effective at improving pain and function in adults with knee OA, but long term follow ups have demonstrated that these improvements are not being maintained. \u00a0As our population ages and rates of obesity rise we expect to continue to see an increase in knee OA, and add to this that up to 42% of Americans with health insurance were considered underinsured in 2014. \u00a0Booster sessions are aimed at improving patients long term benefits from PT by allowing the therapist to monitor patients over a longer period of time and encourage more compliance with home exercises. \u00a0For the purposes of this research booster sessions are considered any physical therapy that is delivered after the initial course of consecutive treatments.<\/p>\n

Case Scenario<\/span><\/h4>\n

The patient is a 63 year old female with bilateral knee OA, BMI = 44.4, with a chief complaint of worsening knee pain that began insidiously 15 years ago. Her outcome measures were as follows; LEFI = 33\/80, 30 second sit to stand test = 3. \u00a0When observing her gait she\u00a0ambulates with a single point cane, decreased step length, decreased cadence, decreased hip flexion during swing, maintains knee flexion throughout patter. \u00a0The patients goals include walking four\u00a0blocks to go shopping and playing with her grandchildren without pain.<\/p>\n

Search Strategy<\/span><\/h4>\n

The inclusion criteria for my literature search were as follows; all articles must (1) include adult patients with knee OA, (2) include one group that receives exercise therapy in consecutive sessions followed by a home exercise program, (3) include one group that receives exercise therapy with \u201cbooster sessions\u201d of supervised therapy provided at time intervals separated from the consecutive sessions of the initial episode of care, and (4) provide outcomes including pain and\/or Western Ontario McMaster Universities Osteoarthritis Index.<\/p>\n

 <\/p>\n

\"searchstrategy_wordpress\"<\/p>\n

Results: Pain<\/span><\/p>\n

\"outcomes_pain_wordpress\"<\/p>\n

Results: Function<\/span><\/h4>\n

\"outcomes_function_wordpress\"<\/p>\n

Weaknesses\/Limitations<\/span><\/h4>\n

The two most recent randomized control trials that had identical study design found that a combination of manual therapy and Booster sessions had a negative impact outcomes, that the interactions between these two factors is not well understood. \u00a0The initial period of care was not\u00a0standardized across studies. \u00a0A number of the studies were underpowered to test group interactions. \u00a0The number of booster sessions was not standardized between groups\/studies. \u00a0None of the research provided data on a long term follow up after the conclusion of booster sessions.<\/p>\n

Clinical Bottom Line<\/span><\/h4>\n

Two of the five articles demonstrated a significant difference between groups on outcomes for pain. \u00a0One of the four articles demonstrated a significant difference between groups on the WOMAC. \u00a0I recommend that future research \u00a0explore\u00a0the possible negative interaction between manual therapy and booster sessions,\u00a0the most effective dosage of booster sessions, and include a long term follow up after cessation of PT.<\/p>\n

Clinical Application<\/span><\/h4>\n

The patients plan of care will be as follows: 8 sessions in the first 9 weeks, 2 sessions at 5 months, 1 session at 8 months, and 1 session at 11 months. \u00a0Treatment focus in the first 8 weeks will focus on\u00a0decreasing the patient’s pain and increasing\u00a0her weight bearing tolerance. \u00a0The patient will also perform aerobic exercise consisting of cycling and treadmill walking. \u00a0As her pain decreases and her weight bearing tolerance increases I will begin to progress her aerobic exercise and add weight bearing resistive training. \u00a0The patients home exercise program will be performed 3-4 times per week, and consist of 3\u00a0exercises to be performed in the home. \u00a0The patient will also be advised to begin a home walking program in which the patient will be asked to walk outside for 20 minutes 4\u00a0times per week.<\/p>\n

References<\/span><\/h4>\n

1. Abbott JH, Chapple CM, Fitzgerald GK, et al. The incremental effects of manual therapy or booster sessions in addition to exercise therapy for knee osteoarthritis: A randomized clinical trial. J Orthop Sports Phys Ther. 2015;45(12):975-983. doi: 10.2519\/jospt.2015.6015 [doi].<\/p>\n

2. Bennell KL, Kyriakides M, Hodges PW, Hinman RS. Effects of two physiotherapy booster sessions on outcomes with home exercise in people with knee osteoarthritis: A randomized controlled trial. Arthritis Care Res (Hoboken). 2014;66(11):1680-1687. doi: 10.1002\/acr.22350 [doi].<\/p>\n

3. Fitzgerald GK, Fritz JM, Childs JD, et al. Exercise, manual therapy, and use of booster sessions in physical therapy for knee osteoarthritis: A multi-center, factorial randomized clinical trial. Osteoarthritis Cartilage. 2016;24(8):1340-1349. doi: 10.1016\/j.joca.2016.03.001 [doi].<\/p>\n

4. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1:CD004376. doi: 10.1002\/14651858.CD004376.pub3 [doi].<\/p>\n

5. Mahon M. 31 million people were underinsured in 2014; many skipped needed health care and depleted savings to pay medical bills. www.commonwealthfund.org<\/a>. Updated 2015. Accessed September 28th, 2016.<\/p>\n

6. Pisters MF, Veenhof C, van Meeteren NL, et al. Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: A systematic review. Arthritis Rheum. 2007;57(7):1245-1253. doi: 10.1002\/art.23009 [doi].<\/p>\n

7. Veenhof C, Koke AJ, Dekker J, et al. Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and\/or knee: A randomized clinical trial. Arthritis Rheum. 2006;55(6):925-934.<\/p>\n","protected":false},"excerpt":{"rendered":"

Background Knee OA is a common diagnosis causing chronic pain, decreased physical function, and diminished quality of life. \u00a0Research has demonstrated that physical therapy is effective at improving pain and function in adults with knee OA, but long term follow ups have demonstrated that these improvements are not being maintained. \u00a0As our population ages and […]<\/p>\n","protected":false},"author":0,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-265","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/sites.temple.edu\/dptebp2016\/wp-json\/wp\/v2\/posts\/265","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sites.temple.edu\/dptebp2016\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sites.temple.edu\/dptebp2016\/wp-json\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/sites.temple.edu\/dptebp2016\/wp-json\/wp\/v2\/comments?post=265"}],"version-history":[{"count":0,"href":"https:\/\/sites.temple.edu\/dptebp2016\/wp-json\/wp\/v2\/posts\/265\/revisions"}],"wp:attachment":[{"href":"https:\/\/sites.temple.edu\/dptebp2016\/wp-json\/wp\/v2\/media?parent=265"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sites.temple.edu\/dptebp2016\/wp-json\/wp\/v2\/categories?post=265"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sites.temple.edu\/dptebp2016\/wp-json\/wp\/v2\/tags?post=265"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}