Clinical effectiveness of a rehabilitation program integrating exercise, self‐management, and active coping strategies for chronic knee pain: A cluster randomized trial

Hurley, M. V.; Walsh, N. E.; Mitchell, H. L.; Pimm, T. J.; Patel, A.; Williamson, E.; Jones, R. H.; Dieppe, P. A.; Reeves, B. C.

doi:10.1002/art.22995

Cited by 262Musculoskeletal pain and rehabilitationOsteoarthritis Treatment and MechanismsLower Extremity Biomechanics and Pathologies

Clinical effectiveness of a rehabilitation program integrating exercise, self‐management, and active coping strategies for chronic knee pain: A cluster randomized trial

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Hurley, M. V., Walsh, N. E., Mitchell, H. L., Pimm, T. J., Patel, A., Williamson, E., Jones, R. H., Dieppe, P. A. +1 more·2007·Arthritis Care & Research

DOI 10.1002/art.22995PMC PMC2673355

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Abstract

Objective: Chronic knee pain is a major cause of disability and health care expenditure, but there are concerns about efficacy, cost, and side effects associated with usual primary care. Conservative rehabilitation may offer a safe, effective, affordable alternative. We compared the effectiveness of a rehabilitation program integrating exercise, self‐management, and active coping strategies (Enabling Self‐management and Coping with Arthritic Knee Pain through Exercise [ESCAPE‐knee pain]) with usual primary care in improving functioning in persons with chronic knee pain. Methods: We conducted a single‐blind, pragmatic, cluster randomized controlled trial. Participants age ≥50 years, reporting knee pain for >6 months, were recruited from 54 inner‐city primary care practices. Primary care practices were randomized to continued usual primary care (i.e., whatever intervention a participant's primary care physician deemed appropriate), usual primary care plus the rehabilitation program delivered to individual participants, or usual primary care plus the rehabilitation program delivered to groups of 8 participants. The primary outcome was self‐reported functioning (Western Ontario and McMaster Universities Osteoarthritis Index physical functioning [WOMAC‐func]) 6 months after completing rehabilitation. Results: A total of 418 participants were recruited; 76 (18%) withdrew, only 5 (1%) due to adverse events. Rehabilitated participants had better functioning than participants continuing usual primary care (−3.33 difference in WOMAC‐func score; 95% confidence interval [95% CI] −5.88, −0.78; P = 0.01). Improvements were similar whether participants received individual rehabilitation (−3.53; 95% CI −6.52, −0.55) or group rehabilitation (−3.16; 95% CI −6.55, −0.12). Conclusion: ESCAPE‐knee pain provides a safe, relatively brief intervention for chronic knee pain that is equally effective whether delivered to individuals or groups of participants.

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In patients with musculoskeletal pain, higher baseline depression predicted poorer physical functioning at 6 months, according to one study in a review.
“In the review on self-management programs in musculoskeletal pain [41], one study showed that higher levels of depression at baseline predicted poorer physical functioning at 6 months [44].”
From Acceptance and commitment therapy for chronic pain: Protocol of a systematic review and individual participant data meta-Analysis (2019) · cites this paper as [44]

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[12]Porcheret M Jordan K Croft P Primary care management of knee pain in people aged 50 years and over: a survey of current practice and comparison to published recommendations Rheumatology (Oxford) 2006 45 Suppl 1 i74 [abstract]

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Musculoskeletal training: are GP trainees exposed to the right case mix for independent practice?
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Physiotherapy management of knee osteoarthritis in Nigeria—A survey of self-reported treatment preferences
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Clinical Effectiveness of a Rehabilitation Program Integrating Exercise, Self-Management, and Active Coping Strategies for Chronic Knee Pain: A Cluster Randomized
Hurley, M. V., Walsh, N. E., Mitchell, H. L., Pimm, T. J., Patel, A., Williamson, E., Jones, R. H., Dieppe, P. A., & Reeves, B. C. (2016)
Self-citation
Long‐term outcomes and costs of an integrated rehabilitation program for chronic knee pain: A pragmatic, cluster randomized, controlled trial
Hurley, M., Walsh, N. E., Mitchell, H., Nicholas, J. M., & Patel, A. K. (2011) · Arthritis Care & Research · doi:10.1002/acr.20642 · Cited by 414 · see citing works
Self-citation
Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain
Jessep, S., Walsh, N. E., Ratcliffe, J., & Hurley, M. (2009) · Physiotherapy · doi:10.1016/j.physio.2009.01.005 · Cited by 100 · see citing works
Self-citation
Economic evaluation of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain. Arthritis & Rheumatism
Hurley, M., Walsh, N. E., Mitchell, H. L., Pimm, J., Williamson, E., Jones, R., Reeves, B., Dieppe, P., & Patel, A. G. (2007) · Research Portal (King's College London)
Self-citation
Community‐based care for people with chronic knee and hip pain: Preliminary clinical outcomes and healthcare utilisation for ESCAPE‐pain
Hurley, M., & Thompson, F. (2023) · Musculoskeletal Care · doi:10.1002/msc.1847 · Cited by 6 · see citing works
Self-citation

Authors: Hurley, M. V., Walsh, N. E., Mitchell, H. L., Pimm, T. J., Patel, A., Williamson, E., Jones, R. H., Dieppe, P. A., & Reeves, B. C.
Affiliations: King's College London (GB)
University of the West of England (GB)
De Montfort University (GB)
London School of Hygiene & Tropical Medicine (GB)
University of Bristol (GB)
Corresponding author: Hurley, M. V.
ORCID: Walsh, N. E.
Mitchell, H. L.
Patel, A.
Williamson, E.
Jones, R. H.
Reeves, B. C.
Venue: Arthritis Care & Research
Publisher: Wiley
Published: 2007-09-28
Volume: 57
Issue: 7
Pages: 1211-1219
ISSN: 0893-7524 (ISSN-L)
1529-0123
DOI: 10.1002/art.22995
PMC: PMC2673355
OpenAlex: W2098653239
Cited by: 262
References: 74
Citations by year: 2026: 7 · 2025: 9 · 2024: 22 · 2023: 14 · 2022: 17 · 2021: 19 · 2020: 23 · 2019: 13 · 2018: 15 · 2017: 15 · 2016: 15 · 2015: 9 · 2014: 13 · 2013: 17 · 2012: 9
FWCI: 6.87
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Arthritis Care & Research (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
DMU Open Research Archive (De Montfort University) (submittedVersion)
Research Repository (Kingston University London) (submittedVersion)
UWE Research Repository (UWE Bristol) (submittedVersion, cc-by)
Research Portal (King's College London) (submittedVersion)
Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
Keywords: chronic knee pain, knee osteoarthritis, rehabilitation programs, exercise therapy, self-management, active coping strategies, group rehabilitation, physical function, primary care, older adults
MeSH terms: Adaptation, Psychological, Aged, Aged, 80 and over, Chronic Disease, Exercise Therapy, Female, Humans, Male, Middle Aged, Self Care, Treatment Outcome, Osteoarthritis, Knee

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Clinical effectiveness of a rehabilitation program integrating exercise, self‐management, and active coping strategies for chronic knee pain: A cluster randomized trial

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