Christian John Barton

Chronic knee symptoms and early-onset osteoarthritis are common after anterior cruciate ligament reconstruction (ACLR). Evidence to inform management is needed. To evaluate whether physiotherapist-supervised exercise therapy with education is superior to a single education session and self-directed exercise resource for young adults with persistent knee problems after ACLR. Parallel-group randomized trial. (Australian New Zealand Clinical Trials Registry: ACTRN12620001164987). Community. 184 young adults (aged 18 to 40 years) with persistent knee problems 9 to 36 months after ACLR. A 4-month twice-weekly physiotherapist-supervised exercise therapy program with education (SUPER [SUpervised exercise-therapy and Patient Education Rehabilitation]; n = 92) and a single physiotherapist-delivered education session and self-directed exercise resource (control; n = 92). Primary outcome was 4-month change in the composite Knee injury and Osteoarthritis Outcome Score (KOOS₄; 0= worst, 100= best). Secondary outcomes included KOOS₄ at 12 months and thigh muscle strength, patient-perceived global rating of change, and cartilage thickness and composition on magnetic resonance imaging at 4 and 12 months. 184 participants were randomly assigned (mean age, 30 years [SD, 6]; 2.2 years [SD, 0.7] after ACLR); 178 (97%) and 174 (95%) completed 4-month and 12-month follow-up, respectively. At 4 months, KOOS₄ scores improved more in the SUPER group than in the control group (14.1 vs. 9.4; adjusted mean difference, 4.8 [95% CI, 1.4 to 8.2]). At 4 months, SUPER resulted in greater muscle strength gains and higher rates of success on global rating of change (for example, pain 73% vs. 40%). Between-group differences narrowed at 12 months as the control group continued to improve, whereas SUPER gains were sustained. There were no between-group differences seen in cartilage thickness or composition. Unblinded participants. For young adults with persistent knee problems after ACLR, physiotherapist-supervised exercise therapy with education improved patient-reported outcomes compared with a single education session and self-directed exercise resource, but these between-group differences may not be sustained over time. National Health and Medical Research Council.

Objective: Few people with knee osteoarthritis meet the World Health Organization (WHO) physical activity guidelines, and knowledge of guidelines in this population is not well known. We examined (i) baseline knowledge of physical activity guidelines in people with knee osteoarthritis; (ii) change in knowledge following participation in an education and exercise therapy programme; and (iii) its association with programme adherence and physical activity participation. Design: An observational cohort pre‐post study including 1470 participants with knee osteoarthritis (72% female) from the Good Life with osteoArthritis from Denmark (GLA:D) Australia registry. Five multiple‐choice questions assessed knowledge of the WHO physical activity guidelines at baseline and at 3 months post baseline. Programme adherence was self‐reported and physical activity participation was assessed using the University of California, Los Angeles (UCLA) physical activity scale. Changes in overall knowledge score were assessed through the Wilcoxon test and changes within individual questions were assessed with McNemar's tests. Associations between variables were assessed using Spearman's correlations. Results: The median physical activity knowledge score was 2/5 [IQR 1, 2] correct responses at both baseline and follow‐up without change between time points ( p = 0.080). Follow‐up physical activity knowledge score was not associated with physical activity participation ( r _s = 0.020) or programme adherence ( r _s = 0.060). 61% of participants attended a minimum of 10 exercise and 2 education sessions. Conclusions: Knowledge of physical activity guidelines is limited among people with knee osteoarthritis and does not appear to change following participation in an education and exercise therapy programme. This large study indicates that physical activity knowledge may not drive physical activity behaviour in people with knee osteoarthritis.