Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trial

doi:10.1136/bmj.38977.590752.0B

BMJ 2006;333:995 (11 November), doi:10.1136/bmj.38977.590752.0B (published 20 October 2006)

Research

Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trial

Elaine M Hay, professor/consultant in community rheumatology¹, Nadine E Foster, DoH primary care career scientist and senior lecturer in therapies¹, Elaine Thomas, senior lecturer in biostatistics¹, George Peat, senior lecturer in clinical epidemiology¹, Mike Phelan, medication review pharmacist¹, Hannah E Yates, research nurse¹, Alison Blenkinsopp, professor of the practice of pharmacy², Julius Sim, professor of health care research¹

¹ Primary Care Musculoskeletal Research Centre, Keele University, Keele, ² Medicines Management, Keele University

Correspondence to: E M Hay e.m.hay{at}cphc.keele.ac.uk

Objectives To evaluate the effectivenessof two primary care strategies for delivering evidence basedcare to people aged 55 or over with knee pain: enhanced pharmacyreview and community physiotherapy.

Design Pragmatic multicentrerandomised clinical trial.

Setting 15 general practicesin North Staffordshire.

Participants 325 adults aged55 years or over (mean 68 years) consulting with knee pain;297 (91%) reached six month follow-up.

Interventions Enhanced pharmacyreview (pharmacological management in accordance with an algorithm);community physiotherapy (advice about activity and pacing andan individualised exercise programme); control (advice leafletreinforced by telephone call).

Main outcome measure Changein Western Ontario and McMaster Universities osteoarthritisindex (WOMAC) at 3, 6, and 12 months.

Results Mean baseline WOMACpain score was 9.1 (SD 3.7), and mean baseline function scorewas 29.9 (SD 12.8). At three months, the mean reductions inpain scores were 0.41 (SD 2.8) for control, 1.59 (3.2) for pharmacy,and 1.56 (3.4) for physiotherapy; reductions in function scoreswere 0.80 (8.5), 2.61 (9.8), and 4.79 (10.8). Compared withcontrol, mean differences in change scores for physiotherapywere 1.15 (95% confidence interval 0.2 to 2.1) for pain and3.99 (1.2 to 6.8) for function; those for pharmacy were 1.18(0.3 to 2.1) for pain and 1.80 (–0.8 to 4.5) for function.These differences were not sustained to six or 12 months. Significantlyfewer participants in the physiotherapy group reported consultingtheir general practitioner for knee pain in the follow-up period,and use of non-steroidal anti-inflammatory drugs was lower inthe physiotherapy and pharmacy groups than in the control group.

Conclusions Evidence based carefor older adults with knee pain, delivered by primary care physiotherapistsand pharmacists, resulted in short term improvements in healthoutcomes, reduced use of non-steroidal anti-inflammatory drugs,and high patient satisfaction. Physiotherapy seemed to producea shift in consultation behaviour away from the traditionalgeneral practitioner led model of care.

Trial registration UK NationalResearch Register N0286046917; Current Controlled Trials ISRCTN55376150 [controlled-trials.com] .

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