COMPARATIVE EFFICACY OF SIX-WEEK SELF-MANAGEMENT EDUCATION AND QUADRICEPS STRENGTHENING PROGRAMMES ON PAIN, PHYSICAL FUNCTION, AND QUALITY OF LIFE OF INDIVIDUALS WITH KNEE OSTEOARTHRITIS

Abstract

Osteoarthritis (OA) of the knee is a common musculoskeletal disorder accompanied by pain, functional disability and reduced quality of life. Self-Management Education (SME) and Quadriceps Strengthening Exercises (QSE) have separately been shown to be effective in the management of knee OA. However, it is not clear which of the two techniques is more effective in alleviating pain and improving physical function and Health-Related Quality of Life (HRQoL) associated with knee OA. This study was carried out to compare the efficacy of SME and QSE on pain, physical function and HRQoL of individuals with knee OA. Seventy-nine (male =13; female =66) individuals with confirmed knee OA participated in this single-blind randomised trial. Participants were consecutively recruited from the outpatient physiotherapy clinic of Barau Dikko Specialist Hospital, Kaduna,and randomly assigned into either the Self-Management Education Group (SMEG; n=42) or the Quadriceps Strengthening Exercise Group (QSEG; n=37). The SMEG had self-management education class (health education on OA, pain management strategies, coping skills for OA and weight control exercises) once weekly for six weeks and they kept a diary of adherence to exercise instructions. The QSEG had quadriceps strengthening exercises thrice weekly for six weeks. Participants‟ ages were recorded. Other variables: Physical Function (PF), Pain Intensity (PI) and Health-Related Quality of Life (HRQoL), were assessed using the Ibadan Knee/Hip Osteoarthritis Measure (IKHOAM), Visual Analogue Scale (VAS), and Arthritis Impact Measurement Scale Short Form 2 [AIMS-2 (SF)] respectively. Comfortable Pace Walking Time (CPWT) and Fast Pace Walking Time (FPWT) of participants were also measured using a stopwatch. Assessment was carried out at baseline, end of week six and at first, second and third month follow-up. Data were analysed using descriptive statistics, Student t-test and multilevel modelling at α0.05. The ages of participants in the SMEG (53.9±10.4 years) and QSEG (50.1±10.2 years) were comparable. At baseline, no significant between-group difference was observed in PF, PI and HRQoL scores but the SMEG had significantly lower CPWT (14.53±0.24s vs 13.76±0.26s) and FPWT (13.76±0.26s vs 11.52±0.27s). At end of week six, the QSEG had significantly lower PI (2.9±0.3) than the SMEG (3.9±0.3), but the groups were not significantly different in PF (84.3±1.8 vs 88.3±1.9), HRQoL (21.4±0.7 vs 20.0±0.7), CPWT (12.28±0.25s vs 12.26±0.27s) and FPWT (9.45±0.28s vs 9.08±0.30s). The two groups were not significantly different in all outcomes at first, second and third month follow-up. There was significant within group reduction in PI, increase in PF score and reduction in HRQoL between baseline and the end of the study (3rd month follow- up) for both SMEG and QSEG (PI - 3.8 (0.3) and -2.9 (0.3); PF 11.0 (1.2) and 6.8 (1.4); and HRQoL -2.1 (0.6) and -1.5 (0.7) respectively). Quadriceps strengthening exercises were more effective in alleviating osteoarthritic knee pain. Self-management education and quadriceps strengthening exercises equally improved physical function and health-related quality of life of individuals with knee osteoarthritis.