title: Effects of a self-management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial. Resistance training for medial compartment knee osteoarthritis and malalignment. Comparison of two methods of conducting the Fit and Strong! program. Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study. Serum levels of Cartilage Oligomeric Matrix Protein (COMP) increase temporarily after physical exercise in patients with knee osteoarthritis Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858] Impact of the fit and strong intervention on older adults with osteoarthritis. Coping self-efficacy as a mediator between catastrophizing and physical functioning: treatment target selection in an osteoarthritis sample Evaluation of group and self‐directed formats of the Arthritis Foundation's Walk With Ease Program A randomized controlled study of the Arthritis Self-Management Programme in the UK. Do OA patients gain additional benefit from care from a clinical nurse specialist?--a randomized clinical trial. Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain. Improving informed decision-making for patients with knee pain. Effects of T'ai Chi training on function and quality of life indicators in older adults with osteoarthritis. Spouse-assisted coping skills training in the management of knee pain in osteoarthritis: long-term followup results. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis. Long-term impact of Fit and Strong! on older adults with osteoarthritis. A physiotherapist-delivered, combined exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a pilot study. Self-efficacy and the progression of functional limitations and self-reported disability in older adults with knee pain. The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response Psychological determinants of problematic outcomes following Total Knee Arthroplasty
abstract: AIM This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers . BACKGROUND Osteoarthritis of the knee is a major source of loss of function in older people . Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice . METHOD A r and omized control trial was carried out from December 2002 to May 2003 and 120 participants ( 65.9 % , including 67 in intervention group and 53 in control group ) completed the 16-week postintervention assessment s. Outcome measures included arthritis self-efficacy , use of self-management techniques , pain intensity and daily activity . FINDINGS At 16 weeks , there was a ' statistically ' significant improvement in the arthritis self-efficacy level ( P < or= 0.001 ) , in most of the self-management skills , i.e. use of cold and hot compresses , in two of three joint protective practice s ( P < or= 0.001 ; P = 0.01 ) , an increase in the duration of light exercise practice ( P < or= 0.001 ) , reduction of current arthritis pain ( P < or= 0.001 ) and in the ability to perform daily activities ( P < or= 0.001 ) among the intervention group but not for the control group ( P-range from 0.04 to 0.95 ) . One joint protective practice showed a statistically significant increase in both groups ( P < or= 0.001 ) . CONCLUSION Our findings add to evidence showing short-term beneficial effects of self-efficacy theory in education programmes . Self-efficacy theory has great potential for empowering sufferers of chronic conditions to live with their illness PURPOSE S 1 ) To evaluate the effects of a 12-wk high-intensity knee extensor and flexor resistance training program on strength , pain , and adherence in patients with advanced knee osteoarthritis and varus malalignment and 2 ) to generate pilot data for change in dynamic knee joint load , patent-reported outcomes , and self-efficacy after training . METHODS Fourteen patients ( 48.35 + /- 6.51 yr ) with radiographically confirmed medial compartment knee osteoarthritis and varus malalignment of the lower limb were recruited from a surgical waiting list for high tibial osteotomy . Participants completed a high-intensity isokinetic resistance training program three times per week for 12 wk . Knee extensor and flexor strength  were assessed every third week , whereas  pain and adherence  were recorded at every training session . The external knee adduction moment during the gait , the 6-min-walk test , the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and the Arthritis Self-Efficacy Scale ( ASES ) were also evaluated before and after training . RESULTS Significant improvements in knee extensor and flexor strength were observed without increases in pain during or after training . Adherence to the high-intensity program was high . No significant changes were observed for dynamic knee joint load or the KOOS . There was a significant increase in the function subscale of the ASES only . CONCLUSIONS These findings suggest that patients with advanced knee osteoarthritis and malalignment can experience substantial gains in strength after a high-intensity resistance training program without concomitant increases in pain , adverse events , or compromised adherence . These findings provide support for future clinical trials with longer-term outcomes OBJECTIVE Fit and Strong ! is an award winning , evidence -based , multiple-component physical activity/behavior change intervention . It is a group- and facility-based program that meets for 90 minutes 3 times per week for 8 weeks ( 24 sessions total ) . We originally tested Fit and Strong ! using physical therapists ( PTs )  as instructors but have transitioned to using nationally certified exercise instructors ( CEIs ) as part of an effort to translate Fit and Strong ! into community-based setting s , and have tested the impact of this shift in instruction type on participant outcomes . METHODS We used a 2-group design . The first 161 participants to sequentially enroll received instruction from PTs . The next 190 sequential enrollees received instruction from CEIs .  All participants were assessed at baseline , at the conclusion of the 8-week Fit and Strong ! program , and at the 6-month followup . RESULTS We saw no significant differences by group on outcomes at 8 weeks or 6 months . Participants in both groups improved significantly with respect to lower-extremity strength , aerobic capacity , pain , stiffness , and physical function . Significant differences favoring the PT-led classes were seen on 2 of 5 mediators , self-efficacy for exercise and barriers adherence efficacy . Participant evaluations rated both types of instruction equally highly , attendance was identical , and no untoward health events were observed or reported under either instruction mode . CONCLUSION Outcomes under the 2 types of instruction are remarkably stable . These findings justify the use of CEIs in the future to extend the reach of the Fit and Strong ! program Background Osteoarthritis ( OA ) is a degenerative disease , considered to be one of the major public health problems . Research suggests that patient education is feasible and valuable for achieving improvements in quality of life , in function , well-being and improved coping . Since 1994 , Primary Health Care in Malmö has used a patient education programme directed towards OA . The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy , function and self-perceived health . Method The study was a single-blind , r and omized controlled trial ( RCT ) in which the  EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity . Results We found differences between the intervention group and the control group , comparing the results at baseline and after 6 months in EuroQol-5D ( p < 0.001 ) and in st and ing one leg eyes closed ( p = 0.02 ) in favour of the intervention group . No other differences between the groups were found . Conclusion This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree , but not self-efficacy . Further research to investigate the effect of exercise performance on function , as well as self-efficacy is warranted . Trial registration The trial is registered with Clinical Trials.gov . Registration number : OBJECTIVE To examine effects of activity strategy training ( AST ) , a structured rehabilitation program taught by occupational therapists and design ed to teach adaptive strategies for symptom control and engagement in physical activity ( PA ) . METHODS A r and omized controlled pilot trial was conducted at 4 sites ( 3 senior housing facilities and 1 senior center ) in southeastern , lower Michigan . Fifty-four older adults with hip or knee osteoarthritis ( mean + /- SD age 75.3+/-7.1 years ) participated . At each site , older adults were r and omly assigned to 1 of 2 programs : exercise plus AST ( Ex + AST ) or exercise plus health education ( Ex + Ed ) . The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period , and were conducted concurrently within each site . Pain , total PA and PA intensity ( measured objective ly by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors question naire ) , arthritis self-efficacy , and physical function were assessed at baseline and posttest . RESULTS At posttest , participants who received Ex + AST had significantly higher levels of objective peak PA ( P=0.02 ) compared with participants who received Ex + Ed . Although not statistically significant , participants in Ex + AST tended to have larger pain decreases , increased total objective and subjective PA , and increased physical function . No effects were found for arthritis self-efficacy . CONCLUSION Although participants were involved in identical exercise programs , participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education . Future studies will be needed to examine larger sample s and long-term effects of AST Background COMP ( Cartilage oligomeric matrix protein ) is a matrix protein , which is currently studied as a potential serum marker for cartilage processes in osteoarthritis ( OA ) . The influence of physical exercise on serum COMP is not fully eluci date d . The objective of the present study was to monitor serum levels of COMP during a r and omised controlled trial of physical exercise vs. st and ardised rest in individuals with symptomatic and radiographic knee OA . Methods Blood sample s were collected from 58 individuals at predefined time points before and after exercise or rest , one training group and one control group . The physical exercise consisted of a one-hour supervised session twice a week and daily home exercises . In a second supplementary study 7 individuals were subjected to the same exercise program and sampling of blood was performed at fixed intervals before , immediately after , 30 and 60 minutes after the exercise session and then with 60 minutes interval for another five hours after exercise to monitor the short-term changes of serum COMP . COMP was quantified with a s and wich-ELISA ( AnaMar Medical , Lund , Sweden ) . Results Before exercise or rest no significant differences in COMP levels were seen between the groups . After 60 minutes exercise serum COMP levels increased ( p < 0.001 ) . After 60 minutes of rest the serum levels decreased ( p = 0.003 ) . Median serum COMP values in sample s obtained prior to exercise or rest at baseline and after 24 weeks did not change between start and end of the study . In the second study serum COMP was increased immediately after exercise ( p = 0.018 ) and had decreased to baseline levels after 30 minutes . ConclusionS erum COMP levels increased during exercise in individuals with knee OA , whereas levels decreased during rest . The increased serum COMP levels were normalized 30 minutes after exercise session , therefore we suggest that sample s of blood for analysis of serum COMP should be drawn after at least 30 minutes rest in a seated position . No increase was seen after a six-week exercise program indicating that any effect of individualized supervised exercise on cartilage turnover is transient Background Studies on exercise in knee osteoarthritis ( OA ) have focused on elderly subjects . Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis . The aim was to test the effects of a short-term , high-intensity exercise program on self-reported pain , function and quality of life . Methods Patients aged 36–65 , with OA grade III ( Kellgren & Lawrence ) were recruited . They had been referred for radiographic examination due to knee pain and had no history of major knee injury . They were r and omized to a twice weekly supervised one hour exercise intervention for six weeks , or to a non-intervention control group . Exercise was performed at ≥ 60 % of maximum heart rate ( HR max ) . The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score ( KOOS ) . Follow-up occurred at 6 weeks and 6 months . Results Sixty-one subjects ( mean age 56 ( SD 6 ) , 51 % women , mean BMI 29.5 ( SD 4.8 ) ) were r and omly assigned to intervention ( n = 30 ) or control group ( n = 31 ) . No significant differences in the KOOS subscales assessing pain , other symptoms , or function in daily life or in sport and recreation were seen at any time point between exercisers and controls . In the exercise group , an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group ( mean change 4.0 vs. -0.7 , p = 0.05 ) . The difference between groups was still persistent at 6 months ( p = 0.02 ) . Conclusion A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA . Some effect was seen on quality of life in the exercise group compared to the control group PURPOSE This study assessed the impact of a low cost , multicomponent physical activity intervention for older adults with lower extremity osteoarthritis . DESIGN AND METHODS A r and omized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence  ( n = 80 ) to a  wait list control group ( n = 70 ) . Assessment s were conducted at baseline and at 2 and 6 months following r and omization . The training program consisted of range of motion , resistance training , aerobic walking , and education-group problem solving regarding self-efficacy for exercise and exercise adherence . All training group participants developed individualized plans for posttraining adherence . RESULTS Relative to the persons in the control group , individuals who participated in the exercise program experienced a statistically significant improvement in exercise efficacy , a 48.5 % increase in exercise adherence , and a 13.3 % increase in 6-min distance walk that were accompanied by significant decreases in lower extremity stiffness at 2 and 6 months . Program participants also experienced a significant decrease in lower extremity pain and a borderline significant improvement in efficacy to adhere to exercise over time at 6 months ( p = .052 ) . In contrast , persons in the control group deteriorated over time on the efficacy and adherence measures and showed no change on the other measures . No adverse health effects were encountered . IMPLICATION S These benefits indicate that this low-cost intervention may hold great promise as one of a growing number of public health intervention strategies for older adults in the United States with osteoarthritis The purpose of this study was to assess the relative effects of coping self-efficacy and  catastrophizing  on physical functioning . Over a 9-month period , study ing changes in self-efficacy as possible mediator between catastrophizing changes and physical functioning changes might provide evidence for the most promising treatment target . Data came from a r and omized , longitudinal controlled trial comparing exercise , self-management and the two combined to treat 254 individuals with early knee osteoarthritis . A secondary analysis using a bootstrapped linear mixed-effects mediational model produced estimates of both the direct and indirect effects . Results indicated that self-efficacy partially mediated the effect between catastrophizing and physical functioning suggesting that self-efficacy was the more direct treatment target compared to catastrophizing . Treatments targeting both  self-efficacy and catastrophizing  may have greater impact on physical functioning compared to treatments that focus on only one To evaluate the effects of a revised 6‐week walking program for adults with arthritis , Walk With Ease ( WWE ) , delivered in 2 formats , instructor‐led group or self‐directed The objective of this study was to determine whether the Arthritis Self-Management Programme ( ASMP ) improves perceptions of control , health behaviours and health status , and changes use of health care re sources . The design was a pragmatic r and omized controlled study ; participants were allocated to ASMP ( Intervention Group ) or a 4-month waiting-list Control Group . The Intervention Group completed a 12-month follow-up . In total , 544 people with arthritis were recruited from the community--311 in the Intervention Group and 233 in the Control Group . Main outcome measures included : arthritis self-efficacy , health behaviours ( exercise , cognitive symptom management , diet and relaxation ) and health status ( pain , fatigue , anxiety , depression and positive affect ) . At 4 months follow-up , the ASMP had a significant effect on arthritis self-efficacy for other symptoms and pain subscales . Performance of a range of health behaviours ( cognitive symptom management , communication with physicians , dietary habit , exercise and relaxation ) was significantly greater among the Intervention Group . The Intervention Group were significantly less depressed and had greater positive mood . In addition , trends towards decreases on fatigue and anxiety were noted . Physical functioning , pain and GP visits remained stable at 4 months . A similar pattern of findings was found at 12 months follow-up for the Intervention Group . Furthermore , a significant improvement was found on pain and visits to GPs had decreased . Apart from a small improvement on physical functioning among the Intervention Group participants with osteoarthritis 12 months , all effects were independent of the type of arthritis . The findings suggest that the ASMP is effective in promoting improvements in perception of control , health behaviours and health status , when delivered in UK setting OBJECTIVES To assess whether OA patients attending a clinical nurse specialist ( CNS ) clinic gain ' additional benefit ' compared with those attending a traditional junior hospital doctor ( JHD ) clinic . METHODS A total of 100 patients with OA attending rheumatology clinics at a UK teaching hospital were r and omly allocated to a CNS or JHD clinic and seen at 0 , 16 , 32 and 48 weeks . The study assessed ( i ) non-inferiority of the CNS with respect to clinical outcomes ( pain , morning stiffness , self-efficacy , physical function and psychological status ) and ( ii ) superiority of the CNS in terms of patient knowledge and satisfaction . RESULTS Average pain at follow-up was lower in the CNS group : unadjusted mean difference for the JHD group minus the CNS group was 5.3 ( 95 % CI -4.6 , 15.2 ) ; adjusted was 1.6 ( 95 % CI -5.7 , 8.9 ) . The corresponding effect size estimates were 0.20 ( 95 % CI -0.17 , 0.57 ) and 0.06 ( 95 % CI -0.21 , 0.33 ) , respectively . There were similar outcomes in morning stiffness , physical function and self-efficacy . Patient knowledge and satisfaction were statistically significant at the 5 % level attaining moderate to large effect sizes in favour of the CNS . CONCLUSIONS Our findings demonstrate that the clinical outcome of CNS care is not inferior to that of JHD care , and patients attending CNS  gain additional benefit in that they are better informed about their disease and significantly more satisfied with care than are their counterparts OBJECTIVE To examine the effects of aerobic and resistance exercise on self-efficacy beliefs in older adults with knee osteoarthritis ( OA ) and to determine whether self-efficacy and knee pain mediated the effects of the treatments on stair time performance and health perceptions . METHODS Measures of self-efficacy , knee pain , stair climbing performance , and health perceptions were collected prior to r and omization and again at an 18-month followup in older adults with knee OA who were assigned to 1 of 3 treatment conditions : aerobic exercise , resistance training , or health education control .  All analyses were conducted on the intention-to-treat principle . RESULTS Both exercise treatments increased self-efficacy for stair climbing in comparison to the health education control group . Both knee pain and self-efficacy mediated the effect of the treatments on stair climb time , whereas only knee pain mediated health perceptions . CONCLUSIONS The findings suggest that control beliefs and changes in physical symptoms such as knee pain are important outcomes in physical activity programs with patients who have OA of the knee . Moreover , these variables mediate the effects that such programs have on disability and health perceptions OBJECTIVE Studies have shown that patients with knee pain are not well informed of their potential treatment options and that patient preferences are often discordant with physician practice s. The objective of this pilot study was to test the efficacy of a computer tool to improve informed decision-making for patients with knee pain in an outpatient primary care clinic setting . METHODS Patients with knee pain were r and omized to receive an information pamphlet or to perform a computer task . The latter was design ed to elicit preferences based on patient tradeoffs for route of administration , benefits , and side effects of commonly used treatment options for knee pain . After performing the task , participants were given a printed h and out illustrating their preferences . RESULTS In total , 87 patients were r and omized .  Decisional self-efficacy , preparedness to participate in decision-making , and arthritis self-efficacy were greater in participants r and omized to the intervention arm compared to those receiving the information pamphlet ( p < 0.05 for all comparisons ) . CONCLUSION Participants using a tool design ed to increase patient awareness of choice and evaluate the tradeoffs related to available treatment options were more confident in their ability to obtain information about available treatment options , were better prepared to participate in their visit , and had better arthritis related self-efficacy compared to patients receiving an information pamphlet . The results of this pilot study justify future large-scale trials to determine the effectiveness of similar interventions OBJECTIVE To determine the effects of T'ai Chi training on arthritis self-efficacy , quality of life indicators , and lower extremity functional mobility in older adults with osteoarthritis . DESIGN A prospect i ve , r and omized , controlled clinical trial . Intervention length was 12 weeks , with outcomes measured before and after intervention using blinded testers . Group ( T'ai Chi vs Control ) x time ( 2 x 2 ) mixed factorial ANOVA . SETTING Allied Health Sciences Center at Springfield College , Springfield , MA PARTICIPANTS : A total of 33 community-dwelling participants ( mean age 68 ) diagnosed with lower extremity osteoarthritis and having no prior T'ai Chi training longer than 2 weeks . INTERVENTION T'ai Chi training included two 1-hour T'ai Chi classes per week for 12 weeks . MEASUREMENTS Arthritis self-efficacy ( Arthritis Self-Efficacy Scale ) , quality of life indicators ( Arthritis Impact Measurement Scale ) , functional outcomes ( one-leg st and ing balance , 50-foot walking speed , time to rise from a chair ) . RESULTS T'ai Chi participants experienced significant ( P < .05 ) improvements in self-efficacy for arthritis symptoms , total arthritis self-efficacy , level of tension , and satisfaction with general health status . CONCLUSIONS A moderate T'ai Chi intervention can enhance arthritis self-efficacy , quality of life , and functional mobility among older adults with osteoarthritis . T'ai Chi training is a safe and effective complementary therapy in the medical management of lower extremity osteoarthritis OBJECTIVE To evaluate the long-term effects of a spouse-assisted coping skills intervention in patients with osteoarthritis ( OA ) of the knees , and to evaluate how pre- to posttreatment changes in marital adjustment and self-efficacy relate to long-term improvements in pain , psychological disability , physical disability , pain coping , and pain behavior . METHODS A followup study was conducted with 88 OA patients who had been r and omly assigned to 1 of 3 treatment conditions : 1 ) spouse-assisted coping skills training ( spouse-assisted CST ) , 2 ) a conventional CST intervention with no spouse involvement , and 3 ) an arthritis education-spousal support ( AE-SS ) control condition .  To evaluate long-term outcome , comprehensive measures of self-efficacy , marital adjustment , pain , psychological disability , physical disability , pain coping , and pain behavior were collected from these individuals at 6 and 12 months posttreatment . RESULTS Data analysis revealed that , at 6-month followup , patients in the spouse-assisted CST condition scored higher on measures of coping and self-efficacy than those in the AE-SS control group . At 6-month followup , patients who received CST without spouse involvement showed a significantly higher frequency of coping attempts and reported higher levels of marital adjustment than those in the AE-SS control group . At 12-month followup , patients in the spouse-assisted CST condition had significantly higher overall self-efficacy than those in the AE-SS control condition . In addition , patients in both the spouse-assisted CST and CST only conditions tended to show improvements in physical disability at the 12-month followup . Individual differences in outcome were noted at the 12-month followup . Patients in the spouse-assisted CST condition who reported initial ( pre- to posttreatment ) increases in marital adjustment had lower levels of psychological disability , physical disability , and pain behavior at 12-month followup . However , for patients in the conventional CST and AE-SS control conditions , increases in marital adjustment occurring over the initial phase of treatment were related to increases in pain and decreases in scores on the Pain Control in Rational Thinking factor of the Coping Strategies Question naire . Finally , patients in the spouse-assisted CST condition who showed pre- to posttreatment increases in self-efficacy were more likely to show decreases in pain , psychological disability , and physical disability at 12-month followup . CONCLUSIONS These findings suggest that spouse-assisted CST can enhance self-efficacy and improve the coping abilities of OA patients in the long term . Individual differences in the long-term outcome of spouse-assisted CST were noted , with some patients ( those showing increases in marital satisfaction and self-efficacy ) showing much better outcomes than others OBJECTIVE To examine changes in mobility-related self efficacy following exercise and dietary weight loss interventions in overweight and obese older adults with knee osteoarthritis ( OA ) , and to determine if self efficacy and pain mediate the effects of the interventions on mobility task performance . METHODS The Arthritis , Diet , and Activity Promotion Trial was an 18-month , single-blind , r and omized , controlled trial comparing the effects of exercise alone , dietary weight loss alone , a combination of exercise plus dietary weight loss , and a healthy lifestyle control intervention in the treatment of 316 overweight or obese older adults with symptomatic knee OA . Participants completed measures of stair-climb time and 6-minute walk distance , self efficacy for completing each mobility task , and self-reported pain at baseline , 6 months , and 18 months during the trial . RESULTS Mixed model analyses of covariance of baseline adjusted change in the outcomes demonstrated that the exercise + dietary weight loss intervention produced greater improvements in mobility-related self efficacy ( P = 0.0035 ) , stair climb ( P = 0.0249 ) and 6-minute walk performance ( P = 0.00031 ) , and pain ( P = 0.09 ) when compared with the healthy lifestyle control intervention . Mediation analyses revealed that self efficacy and pain served as partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb time . CONCLUSION Exercise + dietary weight loss results in improved mobility-related self efficacy ; changes in these task-specific control beliefs and self-reported pain serve as independent partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb performance OBJECTIVE To determine whether gains in functioning observed immediately following participation in an 8-week program of supervised fitness walking for patients with knee osteoarthritis were sustained at 1-year followup . METHODS Twenty-nine ( 61.1 % ) of 47 original intervention program patients and 23 ( 51.1 % ) of 45 original control patients were interviewed by telephone at 1-year followup . Patients completed the Arthritis Impact Measurement Scales physical activity , arthritis impact , pain , medication use , and general health perceptions subscales , as well as a separate visual analog pain scale and measures of perceived self-efficacy to cope with arthritis pain and other symptoms . RESULTS Adherence to walking was low , and there were no statistically significant differences between intervention and control patients at one year . CONCLUSIONS The failure of intervention patients to maintain regular walking result ed in loss of functional benefits that were observed at 8 weeks in the original study . Long-term adherence to walking is critical to maintenance of initial gains in functional outcomes OBJECTIVE To evaluate the effects of moderate exercise on glycosaminoglycan ( GAG ) content in knee cartilage in subjects at high risk of knee osteoarthritis ( OA ) . METHODS Forty-five subjects ( 16 women , mean age 46 years , mean body mass index 26.6 kg/m(2 ) ) who underwent partial medial meniscus resection 3 - 5 years previously were r and omized to undergo a regimen of supervised exercise 3 times weekly for 4 months or to a nonintervention control group . Cartilage GAG content , an important aspect of the biomechanical properties of cartilage , was estimated by delayed gadolinium-enhanced magnetic resonance imaging of cartilage ( dGEMRIC ) , with results expressed as the change in the T1 relaxation time in the presence of Gd-DTPA ( T1[Gd ] ) . RESULTS Thirty of 45 patients were examined by dGEMRIC at baseline and followup . The exercise group ( n = 16 ) showed an improvement in the T1(Gd ) compared with the control group ( n = 14 ) ( 15 msec versus -15 msec ; P = 0.036 ) . To study the dose response , change in the T1(Gd ) was assessed for correlation with self-reported change in physical activity level , and a strong correlation was found in the exercise group ( n = 16 , r(S ) = 0.70 , 95 % confidence interval [ 95 % CI ] 0.31 - 0.89 ) and in the pooled group of all subjects ( n = 30 , r(S ) = 0.74 , 95 % CI 0.52 - 0.87 ) . CONCLUSION This in vivo cartilage monitoring study in patients at risk of knee OA who begin exercising indicates that adult human articular cartilage has a potential to adapt to loading change . Moderate exercise may be a good treatment not only to improve joint symptoms and function , but also to improve the knee cartilage GAG content in patients at high risk of developing OA PURPOSE We present final outcomes from the multiple-component Fit and Strong ! intervention for older adults with lower extremity osteoarthritis . DESIGN AND METHODS A r and omized controlled trial compared the effects of this exercise and behavior-change program followed by home-based reinforcement  ( n=115 ) with a wait list control  ( n=100 ) at 2 , 6 , and 12 months . Fit and Strong ! combined flexibility , aerobic walking , and resistance training with education and group problem solving to enhance self-efficacy for exercise and maintenance of physical activity . All participants developed individualized plans for long-term maintenance . RESULTS Relative to controls , treatment participants experienced statistically significant improvements in self-efficacy for exercise  ( p=.001 ) , minutes of exercise per week ( p=.000 ) , and lower extremity stiffness ( p=.018 ) at 2 months . These benefits were maintained at 6 months and were accompanied by increased self-efficacy for adherence to exercise over time ( p=.001 ) , reduced pain ( p=.040 ) , and a marginally significant increase in self-efficacy for arthritis pain management ( p=.052 ) . Despite a substantially smaller sample size at 12 months , significant treatment-group effects were maintained on self-efficacy for exercise ( p=.006 ) and minutes of exercise per week ( p=.001 ) , accompanied by marginally significant reductions in lower extremity stiffness ( p=.056 ) and pain ( p=.066 ) . No adverse health effects were seen . Effect sizes for self-efficacy for exercise and for maintenance of physical activity were 0.798 and 0.713 , and 0.905 and 0.669 , respectively , in the treatment group at 6 and 12 months . IMPLICATION S This consistent pattern of benefits indicates that this low-cost intervention is efficacious for older adults with lower extremity osteoarthritis BACKGROUND Osteoarthritis ( OA ) of the knee is associated with a number of physical and psychological impairments . Unfortunately , very few treatment strategies are capable of addressing both types of impairments concurrently . We performed a pilot , r and omized controlled , proof of principle trial investigating the feasibility and effects of an intervention combining physical exercise and pain coping skills training ( PCST ) . METHODS Twenty patients with a clinical and radiographical diagnosis of tibiofemoral OA were r and omized to receive either 10 weeks of physiotherapist supervised exercises ( lower limb strengthening and walking ) combined with non-directive counseling ( NDC ) or the same exercise program delivered concurrently with PCST . Primary outcomes included self-reported pain and pain coping , while secondary outcomes included self efficacy and self-reported physical function . RESULTS Ten participants were r and omized to each group and both groups exhibited significant improvements in isometric knee strength , self-reported knee pain and physical function , self efficacy for control of pain management and other arthritis symptoms . Only those in the exercise + PCST group reported statistically significant improvements in pain control coping and rational thinking . No between-group differences existed in any outcome ( 0.07 < p < 0.98 ) . Based on our findings , 63 participants per group would be needed for future large-scale studies using similar outcome measures and design . CONCLUSIONS Our study showed that an intervention that combines exercise and PCST within the same treatment session and delivered by specially-trained physiotherapists is feasible and can improve both physical and psychological outcomes in individuals with knee OA . LEVEL OF EVIDENCE Level II Clinical Trials Registry number : ACTRN12609000623291 OBJECTIVES The prospect i ve relationships between self-efficacy beliefs , in conjunction with measures of knee pain and knee strength , and subsequent decline in both physical performance and self-reported disability among older adults with knee pain were examined . METHODS In this prospect i ve epidemiological trial , 480 men and women aged 65 years and older who had knee pain on most days of the week and difficulty with daily activity were followed for 30 months . RESULTS There was a significant interaction of baseline self-efficacy with baseline knee strength in predicting both self-reported disability and stair climb performance . Participants who had low self-efficacy and low strength at baseline had the largest 30-month decline in these outcomes . DISCUSSION These data underscore the important role that self-efficacy beliefs play in underst and ing functional decline with chronic disease and aging . Self-efficacy beliefs appear to be most important to functional decline in older adults when they are challenged by muscular weakness in the lower extremities OBJECTIVE Evaluation of a self-management program for patients with osteoarthritis ( OA ) of the hip or knee . The program , which consisted of 6 weekly sessions of 2 hours , included health education by a peer and physical exercises taught by a physical therapist . METHODS R and omized controlled trial . Inclusion criteria were diagnosis of OA of the hip or knee according to ACR clinical and radiographic criteria and age 55 to 75 years . EXCLUSION CRITERIA on waiting list for joint replacement . There were pretest , posttest , and followup ( 6 months ) assessment s. The experimental group consisted of 56 patients , the control group 49 . Outcome variables were pain , quality of life , activity restrictions , knowledge about OA , self-efficacy , body mass index ( BMI ) , and mobility measures . Attention was also paid to effects on health care utilization and lifestyle behavior . RESULTS Significant MANOVA group x time effects ( p < 0.05 , one-sided ) were found for pain , quality of life , strength of the left M. quadriceps , knowledge , self-efficacy , BMI , physically active lifestyle , and visits to the physical therapist . Most effects were moderate at posttest assessment and smaller at followup . No effects were found for range of motion and functional tasks . CONCLUSION The program was reasonably effective , but more attention should be paid to proactive followup interventions and to the selection of participants Aims : To establish ( 1 ) the efficacy of a six-week chronic disease management programme for knee osteoarthritis and ( 2 ) whether previous physiotherapy or being wait listed for surgery moderated the outcome of the programme . Design : A pretest , posttest design with multivariate statistical modelling . Participants : One hundred and twenty-one people with severe osteoarthritis who were waiting , or being considered , for surgery . Methods and measures : Western Ontario Osteoarthritis Index ( WOMAC ) scores , arthritis self-efficacy , distress and a patient-rated global indicator of response were collected at baseline , 6 and 12 weeks . History of previous physiotherapy , waiting list status , symptom duration , New Zeal and disease severity score , radiographic changes and self-perceived need for surgery were recorded at baseline . Results : There were moderate improvements in most outcomes ; WOMAC function decreased by 0.29 , WOMAC pain by 0.27 , pain self-efficacy by 4.4 , function self-efficacy by 5.6 and visual analogue scale ( VAS ) distress by 0.2 ( effect sizes ranging from 0.3 to 0.5 at 12 weeks ) . Waiting list status was a significant modifier for function , pain , distress and self-related outcomes . Participants on the waiting list for surgery experienced lesser improvements . Previous physiotherapy was associated with greater improvements in WOMAC scores at six weeks , but not at 12 weeks . Conclusion : The chronic disease management programme could be considered for people with severe knee osteoarthritis  , but should be given prior to referral and placement on the waiting list for surgery . Previous physiotherapy should not preclude people from participating in a chronic disease management programme ABSTRACT The primary objective of the present study was to examine the role of pain‐related psychological factors in predicting pain and disability following Total Knee Arthroplasty ( TKA ) . The study sample consisted of 75 ( 46 women , 29 men ) individuals with osteoarthritis of the knee who were scheduled for TKA .  Measures of pain severity , pain catastrophizing , depression , and pain‐related fears of movement  were completed prior to surgery . Participants completed measures of pain severity and self‐reported disability 6 weeks following surgery . Consistent with previous research , cross‐sectional analyses revealed significant correlations among measures of pre‐surgical pain severity , pain catastrophizing , depression and pain‐related fears of movement . Prospect i ve analyses revealed that pre‐surgical pain severity and pain catastrophizing were unique predictors of post‐surgical pain severity ( 6‐week follow‐up ) . Pain‐related fears of movement were predictors of post‐surgical functional difficulties in univariate analyses , but not when controlling for pre‐surgical co‐morbidities ( e.g. back pain ) . The results of this study add to a growing literature highlighting the prognostic value of psychological variables in the prediction of post‐surgical health outcomes . The results support the view that the psychological determinants of post‐surgical pain severity differ from the psychological determinants of post‐surgical disability . The results suggest that interventions design ed to specifically target pain‐related psychological risk factors might improve post‐surgical outcomes
target: Small to moderate effect sizes were observed regardless of whether the intervention included exercise .
background: OBJECTIVE To evaluate studies that used arthritis self-management education alone or with exercise to improve Arthritis Self-Efficacy Scale scores of patients with knee osteoarthritis .
  BACKGROUND Increasing self-efficacy may improve patient knee osteoarthritis symptom management and function .