BEPKO-2 Feasibility study - v1
Research type
Research Study
Full title
BEhaviour change to reduce Pain in Knee Osteoarthritis (BEPKO-2) - Feasibility study
IRAS ID
306258
Contact name
SJ Preece
Contact email
ISRCTN Number
ISRCTN25291958
Duration of Study in the UK
1 years, 11 months, 30 days
Research summary
Knee osteoarthritis (KOA) is a chronic long-term condition that results in pain, disability and reduced quality of life. While current guidelines focus on the use of exercises to improve strength, there is clear evidence that people with knee osteoarthritis over-activate their muscles during functional tasks. Through a previously NIHR project (BEPKO-1), we developed a new behavioural intervention for people with KOA. This intervention was developed from concepts to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from postural compensation. Given the integration of cognitive and muscular techniques and the target of reducing muscle overactivity, we refer to this new intervention as cognitive muscular therapy (CMT). Preliminary clinical data showed a 69% reduction in pain with very positive user feedback, following six individual sessions of CMT. Given these encouraging findings, further clinical research is required to investigate the clinical efficacy of the CMT intervention.
Current NHS guidelines for the physiotherapy management of KOA recommend a group-delivered physiotherapy exercise programme, known as ESCAPE (Enabling Self-Management and Coping of Arthritic Knee Pain Through Exercise). While highly cost-effective, research demonstrates that approximately 40% of patients with KOA fail to experience any clinically meaningful benefit from ESCAPE. Therefore, the proposed feasibility trial will provide insight into whether the CMT intervention can provide benefit to people who do not respond to the ESCAPE programme. This will also inform the feasibility of running a future large scale RCT.
Summary of results
Background:
We have developed a new physiotherapy for knee osteoarthritis (KOA) treatment called Cognitive Muscular Therapy (CMT). In contrast to current physiotherapy which focuses on muscle strengthening, CMT teaches patients to improve the way they use their knee muscles during different activities and to change the way they respond to pain.
Aims and objectives
We aimed to develop a CMT training course for NHS physiotherapists. We also ran a small study, called a feasibility study. This was designed to understand the possibility of running a large trial designed to compare CMT with usual care for patients with KOA who fail to benefit from muscle strengthening.
Methods and findings:
Learning from the first study was used to refine a training course which was used to train the physiotherapists for the feasibility study. A total of 82 patients were enrolled onto the feasibility study and were randomly put into a CMT or usual care group. Of the 42 patients in the CMT group, 32 completed treatment and showed a 49% reduction in knee pain/function after the treatment. Other data showed that it is possible to identify KOA patients from an NHS triage service and that both patients and physiotherapists are positive about the new treatment. However, there were problems with dropout which need to be addressed in a future trial.
PPI:We involved patients in research design and sought patient feedback on our intervention through focus groups and individual consultation.
Outputs, dissemination and future plans
We will publish two scientific papers describing our study and communicate with patient groups through online magazines. We have applied for funding for a larger, follow-on trial. If this trial shows that CMT is effective, it will lead to a change in NHS management of KOA, potentially reducing the numbers of people who proceed to orthopaedic referral.
REC name
West Midlands - Solihull Research Ethics Committee
REC reference
21/WM/0255
Date of REC Opinion
6 Jan 2022
REC opinion
Further Information Favourable Opinion