Effect of Patient Education Program on Exercise Adherence and Clinical Outcomes in Individuals with Knee Osteoarthritis: A Randomized Controlled Trial

Summary

This protocol aims to evaluate the effect of a patient education program on exercise adherence and clinical outcomes in individuals with knee osteoarthritis using a randomized controlled design.

Abstract

Knee osteoarthritis (KOA) is a leading cause of disability worldwide, significantly impairing motor function and quality of life. Exercise and weight management are key components of KOA treatment, with evidence showing that exercise therapy reduces pain, improves function, and enhances well-being. Given the importance of adherence to exercise regimens, this study evaluates the effect of a structured patient education program on exercise adherence and clinical outcomes in individuals with KOA. The research objective was "To evaluate whether patient education determines a greater degree of adherence to treatment in patients with knee osteoarthritis in the short and medium term." A prospective, single-blind randomized controlled trial with non-probabilistic sampling was conducted. Participants were randomized into two groups: (1) supervised exercise therapy plus a patient education program (intervention group) and (2) supervised exercise therapy alone (control group). Outcomes included pain (VAS), functionality (WOMAC), and physical activity (GPAQ), assessed at baseline, 4 weeks, 8 weeks, and 6 months. Both groups showed significant improvements in pain and function over time. The intervention group demonstrated greater short-term pain relief and functional improvement (p < 0.05). However, no statistically significant differences were observed between groups at 6 months (p > 0.05). Patient education enhances short-term outcomes in pain and function in individuals with KOA, but its effects diminish over time without ongoing support. Sustained benefits may require continuous engagement strategies.

Introduction

Knee osteoarthritis (KOA) is one of the most common chronic diseases in the elderly population and represents a leading cause of functional limitation and disability worldwide^1,2. Exercise therapy is considered a fundamental and first-line intervention for the management of symptomatic KOA, regardless of disease severity or degree of joint involvement^3,4.

Exercise-based rehabilitation is strongly recommended by current clinical guidelines and constitutes the most widely prescribed non-pharmacological treatment for individual....

Protocol

The study was approved by the Research Bioethics Committee (reference number: 2019-169E) and was registered on ClinicalTrials.gov (Identifier: CEISH-USFQ 2019-169E). All procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki and the applicable guidelines for research involving human subjects¹⁸. All participants received detailed verbal and written information about the study and provided written informed consent prior to participation.

1. Study design

The study was designed as a randomized, single-blind, prospective, analytical cli....

Results

Baseline characteristics
A total of 49 participants with knee osteoarthritis (KOA), aged between 45-75 years, were included in the study. The majority of participants were female (77%). Participants were stratified into three age groups: 45-55 years (n = 14), 56-65 years (n = 30), and 66-75 years (n = 5).

Most participants presented with moderate (61.5%) or moderate-to-severe KOA (38.5%) according to the Kellgren and Lawrence grading system. Moderate KOA was more prevalent.......

Discussion

The present study examined the effects of combining supervised therapeutic exercise with structured patient education in individuals with knee osteoarthritis (KOA). The findings indicate that this combined intervention produced greater short-term improvements in pain and functional outcomes compared to exercise alone, with a tendency toward better maintenance of exercise adherence at six months. Although not all between-group differences reached statistical significance, the experimental group consistently demonstrated m.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Exercise mat	Marath on	https://www.marathon.store/ec/productos/deporte/h ombre/gimnasio/wod-shop-mat-de- yoga/p/bt_SU_10695473	Floor- based exercises
GPAQ questionnaire	World Health Organiz ation (WHO)	https://www.who.int/es/publications/m/item/global- physical-activity-questionnaire	Spanish version
GraphPad Prism	GraphP ad Software	v9.0	Randomization
Knee extension machine	Athletic	T1002. (Linea selection)	Resistan ce training with adjustable weight
Pressure algometer	Wagner Instruments	FPX	Pain assessment
Resistance bands (light, medium, strong)	TheraB and	https://www.ortopedicosfuturo.com.ec/banda-elstica- clx-azul-thera-band- 22402674/p?srsltid=AfmBOopFoBjb5NfdGVpF8lLh vO0 PKeJJwGzNynlB27iRPK3dP1_a bmzV	Progressive resistance during exercises
SPSS Statistics	IBM	Version 29	Statistical analysis
Stationary bicycle	Athletic	1800BVP
Visual Analog Scale (VAS)	—	https://methods.sagepub.com/ency/edvol/sage- encyclopedia-of-educational-research-measurement- evaluation/chpt/visual-analog-scales#_	Printed scale
Visual and audiovisual educational materials (My Knee Exercises program)	My Knee Exercises program	https://mykneeexercise.org.au/my-knee-education/	Patient education sessions (experimental group)
WOMAC questio nnaire	—	https://www.ser.es/wp- content/uploads/2016/07/WOMAC_cuestionario.pdf	Spanish validated version
			Used for warm-up