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Background: Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, the magnitude of clinical effect is considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While many exercise-based approaches incorporate an educational/coping component alongside muscle strengthening, there has been no previous attempt to integrate psychological techniques with muscle retraining. Building on these ideas, the aim of this study was to create a new integrated behavioural intervention for knee osteoarthritis, suitable for delivery by a physiotherapist.Methods: Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to knee muscle co-contraction. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with users.Results: The underlying framework incorporated ideas related to central sensitisation to pain, maladaptive motor responses to pain and also focused on the idea that increased knee muscle co-contraction could result from changes in postural tone. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to enable patients to visualise muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a full prototype version of the intervention. Conclusion: We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle patterns and beliefs associated with pain. Preliminary feedback and clinical indications are positive, and this motivates future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to a muscle strengthening programme. Trial Registration: ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered) |
