A physiotherapist-delivered, combined exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a pilot study

Knee. 2013 Mar;20(2):106-12. doi: 10.1016/j.knee.2012.07.008. Epub 2012 Aug 24.


Background: Osteoarthritis (OA) of the knee is associated with a number of physical and psychological impairments. Unfortunately, very few treatment strategies are capable of addressing both types of impairments concurrently. We performed a pilot, randomized controlled, proof of principle trial investigating the feasibility and effects of an intervention combining physical exercise and pain coping skills training (PCST).

Methods: Twenty patients with a clinical and radiographical diagnosis of tibiofemoral OA were randomized to receive either 10 weeks of physiotherapist supervised exercises (lower limb strengthening and walking) combined with non-directive counseling (NDC) or the same exercise program delivered concurrently with PCST. Primary outcomes included self-reported pain and pain coping, while secondary outcomes included self efficacy and self-reported physical function.

Results: Ten participants were randomized to each group and both groups exhibited significant improvements in isometric knee strength, self-reported knee pain and physical function, self efficacy for control of pain management and other arthritis symptoms. Only those in the exercise + PCST group reported statistically significant improvements in pain control coping and rational thinking. No between-group differences existed in any outcome (0.07 < p < 0.98). Based on our findings, 63 participants per group would be needed for future large-scale studies using similar outcome measures and design.

Conclusions: Our study showed that an intervention that combines exercise and PCST within the same treatment session and delivered by specially-trained physiotherapists is feasible and can improve both physical and psychological outcomes in individuals with knee OA.

Level of evidence: Level II Clinical Trials Registry number: ACTRN12609000623291.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological*
  • Aged
  • Arthralgia / psychology*
  • Arthralgia / therapy*
  • Counseling
  • Disability Evaluation
  • Exercise Therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / psychology*
  • Osteoarthritis, Knee / therapy*
  • Pain Measurement
  • Pilot Projects
  • Self Efficacy
  • Single-Blind Method