1. For patients with chronic knee pain a rehabilitation regimen delivered in the community with regular follow-up reduces pain and disability better than routine physiotherapy and these benefits are maintained over time
2. The rehabilitation regimen reduces healthcare utilisation and is ultimately less costly than routine physiotherapy
The study was approved by the Maidstone & Tunbridge Wells Local Ethics Committee on the 18th December 2003 (ref: 149/9/03).
The trial is a pragmatic, randomised, single blind study and a pilot for a potentially larger project.
Primary study design
Secondary study design
Randomised controlled trial
Quality of life
Patient information sheet
Chronic knee pain, osteoarthritis
Group one: Innovative exercise and education programme - this is a course of ten sessions each consisting of some education and some exercise
Group two: Routine physiotherapy
Outcome measures at baseline and at 12-month follow-up assessment will be summarised using appropriate descriptive statistics. Primary analyses will be by intention-to treat. The level of significance will be set at p<0.05. The effect of the intervention on the Western Ontario and McMasters Universities Osteoarthritic Index (WOMAC) functional score will be assessed, first, by investigating whether outcomes differ significantly overall by groups.
These analyses will be adjusted for baseline measures. The following additional analyses are planned. Two tests of interaction will be carried out to investigate whether the effect intervention is influenced by:
1. Depression (Hospital Anxiety and Depression [HAD] score), or
2. Self-efficacy (Arthritis Self-Efficacy Score)
For all outcomes, both unadjusted (adjusting only for the baseline measure) and adjusted analyses (adjusting for other potential confounding factors) will be carried out; the latter will be interpreted as 'sensitivity analyses' to explore the robustness of the unadjusted analyses to possible confounding. Finally, process variables characterising the success with which the intervention was delivered (e.g. compliance) will be included in analyses of WOMAC functional score only, in order to interpret better the overall effects of the intervention.
The primary economic evaluation will be a cost-effectiveness analysis comparing changes in the primary outcome (WOMAC) and total societal costs for each group. The secondary economic evaluation will be a cost-utility analysis based on utility weights associated with EuroQoL Health Survey (EQ-5D) health states. Cost-effectiveness acceptability curves will be employed for both the cost-effectiveness and cost-utility analyses in order to better inform decisions about the relative cost-effectiveness of the three treatments. Supplementary evaluation will take the form of a cost-consequences analysis, examining total and component costs alongside all outcomes.
The data analyses would be conducted in a manner consistent with those employed in the clinical evaluation (for example, on an intention-to-treat basis, and adopting the same conventions with respect to cluster randomisation, missing items scores, missing observations etc.). Cost differences between groups will be tested using the student's t-test. Cost data are often skewed, violating the normality assumption underpinning the validity of the t-test. If this is the case, bootstrap replications of the original data will be performed to check the robustness of the t-test results. Sensitivity analyses will be performed to check the assumptions made in the cost calculations and analyses. In addition, the EuroQoL will enable calculation of cost per Quality Adjusted Life Year (QALY) for the interventions.
Primary outcome measure
Western Ontario and McMasters Universities Osteoarthritic Index (WOMAC) functional score at 12 months.
Secondary outcome measures
1. Aggregate Functional Performance Test (AFPT)
2. Health-related quality of life using the Euroquol
3. Exercise self-efficacy
4. Depression using the Hospital Anxiety and Depression scale
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Over 50 years of age
2. Presented to their General Practitioner with chronic knee pain
Target number of participants
Participant exclusion criteria
1. Unstable, co-existing medical or psychological conditions
2. Those treated with physiotherapy to the knee in the previous 12 months
3. Those receiving an intra-articular injection to the knee in the previous six months
4. Other joint pain that would prevent them participating in an exercise programme
5. Taking steroids
6. Wheelchair bound
7. A poor command of English
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Physiotherapy Research Foundation (UK)
Chartered Society of Physiotherapy
14 Bedford Row
Physiotherapy Research Foundation (UK) (ref. PRF/03/3)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
2009 results in http://www.ncbi.nlm.nih.gov/pubmed/19627690
Jessep SA, Walsh NE, Ratcliffe J, Hurley MV, Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain., Physiotherapy, 2009, 95, 2, 94-102, doi: 10.1016/j.physio.2009.01.005.