BEhaviour change to reduce Pain in Knee Osteoarthritis (BEPKO-2) - a feasibility study
Knee osteoarthritis
Researchers have developed a new physiotherapy treatment that may help people who do not experience benefit from muscle-strengthening physiotherapy. This new treatment teaches patients how they can stop over-tightening their muscles when they walk or do other daily movements. It also teaches them to change the way they react to pain. Sensors are attached to the skin which enable patients to see their muscle patterns, both during movement and in response to pain. This muscle visualisation is supported with animated instructional videos to explain muscle and pain concepts. For more details on this new treatment see https://hub.salford.ac.uk/cognitive-muscular-therapy/. Physiotherapists: The researchers plan to recruit six band 6 physiotherapists to deliver the CMT intervention. Each physiotherapist who participates in the trial will receive training to deliver the CMT intervention via an initial online module (approximately eight hours), followed by two face-to-face one-day workshops. The physiotherapist will be expected to keep a reflective diary and to use an online platform to share experiences of the training and the intervention. Further support from the lead physiotherapist or another suitably trained physiotherapist will be offered throughout the study if required. Participants: The researchers will aim to recruit 90 participants to the study. Once recruited the participants will be randomised into one of two groups. Participants in the control arm will receive advice to continue exercise in line with the ESCAPE programme and to access usual care. Participants in the intervention arm will receive six sessions of cognitive muscular therapy by a suitably trained physiotherapist, delivered over a period of 12 weeks. In addition to these intervention sessions, intervention arm participants will attend two Electromyography (EMG) data collection sessions. In these sessions, small sensors placed on the skin will be used to measure muscle activity during a variety of
1. Above 40 years old 2. Speak and understand English sufficient to read the information sheet and sign the consent form 3. Ability to walk without an assistive device for at least 100 m (to ensure patients have sufficient mobility to be able to complete the intervention) 4. Clinical diagnosis of KOA according to American College of Rheumatology (ACR) criteria 5. Pain for at least 6 months' duration 6. Attended a minimum of six (of 10/12) ESCAPE pain classes 7. Improvement in KOOS following ESCAPE <15% from their pre-ESCAPE condition
1. Dementia or other major cognitive impairment 2. BMI >33 kg/m² (as increased subcutaneous fat prevents the collection of surface EMG signals) 3. Lower limb arthroplasty 4. Any systemic inflammatory disorders, such as rheumatoid arthritis 5. Any balance disorders which may increase the risk of a fall 6. Not fully vaccinated against COVID-19 (for the safety of the physiotherapist and research staff)