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Knee osteoarthritis (KOA) is a degenerative joint disorder that affects the whole of the joint unit resulting in pain and decreased function. Current evidence recommends core management strategies of exercise, education for self-management and weight reduction (as appropriate) for KOA at all levels of severity. ESCAPE pain is evidence based integrated exercise and self-management intervention for KOA. Previous work has demonstrated it is a clinical and cost-effective intervention in the United Kingdom population. In the absence of a similar intervention in Hong Kong (HK), this work aimed to establish the feasibility of this intervention for a HK Chinese population. The systematic literature review of combined programmes for Chinese populations showed a significant short-term effect in pain relief, and although self-efficacy improved long-term evidence was limited. Exercise dosage and intensity were variable. The ESCAPE programme was then adapted for cultural relevance by translating the patient information booklet that supports self-management into Chinese with pictures and text amended to fit local culture. The programme was also reduced to 10 sessions in 5 weeks to fit the local delivery context. Relevant outcome measures in Chinese were identified and local physiotherapists were trained to provide the programme. The preliminary culturally adapted ESCAPE-knee pain was tested in a proof-of-concept study (N=21). Feasibility of this programme in HK was established by recruitment rate 30.9%, retention rate 82.6% and positive change in self-reported outcomes after the intervention. Finally acceptability was determined by a focus group (n=8). The findings showed that participants learned active coping for self-management through interactive education. They set goals to facilitate continued exercise participation and expressed their willingness to stay active. Increased confidence to undertake exercise and improved function were reported. The field observation suggested adjustments to the literacy level of the patient information booklet to improve patient understanding, with further guidance on goal setting at the beginning of the programme. The findings suggest that the ESCAPE-knee pain programme is feasible and acceptable to the Chinese population in HK. This novel combined programme adds to the evidence that KOA is a chronic disease that should be targeted with lifestyle behavioural change interventions. The next steps will be to conduct a small-scale pilot study to estimate effect-size to inform a fully powered randomised controlled trial. |
