Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for XXXX : a cluster randomized trial.

@entity1 @entity1118 @entity571 @entity158
OBJECTIVE: @entity1118 is a major cause of disability and health care expenditure, but there are concerns about efficacy, cost, and side effects associated with usual primary care. Conservative rehabilitation may offer a safe, effective, affordable alternative. We compared the effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies (Enabling Self-management and Coping with Arthritic Knee Pain through Exercise [ESCAPE- @entity158 ]) with usual primary care in improving functioning in @entity1 with @entity1118 . METHODS: We conducted a single-blind, pragmatic, cluster randomized controlled trial. @entity1 age >/=50 years, reporting @entity158 for >6 months, were recruited from 54 inner-city primary care practices. Primary care practices were randomized to continued usual primary care (i.e., whatever intervention a @entity1 's primary care physician deemed appropriate), usual primary care plus the rehabilitation program delivered to individual @entity1 , or usual primary care plus the rehabilitation program delivered to groups of 8 @entity1 . The primary outcome was self-reported functioning (Western Ontario and McMaster Universities @entity571 Index physical functioning [WOMAC-func]) 6 months after completing rehabilitation. RESULTS: A total of 418 @entity1 were recruited; 76 (18%) withdrew, only 5 (1%) due to adverse events. Rehabilitated @entity1 had better functioning than @entity1 continuing usual primary care (-3.33 difference in WOMAC-func score; 95% confidence interval [95% CI] -5.88, -0.78; P = 0.01). Improvements were similar whether @entity1 received individual rehabilitation (-3.53; 95% CI -6.52, -0.55) or group rehabilitation (-3.16; 95% CI -6.55, -0.12). CONCLUSION: ESCAPE- @entity158 provides a safe, relatively brief intervention for @entity1118 that is equally effective whether delivered to individuals or groups of @entity1 .
