Testing a non-surgical physiotherapy-led alternative (Cognitive Functional Therapy) for people with knee osteoarthritis .

Cognitive Functional Therapy (CFT): All participants in the treatment group will receive CFT. CFT is best briefly described as a personalised, cognitive and behavioural approach to the identification and management of modifiable multidimensional factors underlying a person’s pain and disability. CFT comprehensively operationalises and integrates a self-management program, targeting psychological (cognitive and emotional factors), physical (e.g. movement) and lifestyle (e.g. obesity) factors. The intervention is delivered by specially trained physiotherapists with at least 100 hours of experience in this approach. CFT will be delivered face-to-face in a clinical setting and will address these targets using a tailored cognitive and behavioural self-management plan, depending on which factors are dominant for each individual. The CFT intervention treatment has three components: (1) Cognitive: Education focused on the reconceptualization of pain within a biopsychosocial context related to the person’s story and valued daily life goals. Negative pain beliefs related to radiological imaging and tissue damage are specifically addressed in this process. The role of unhealthy lifestyle factors on pain and disability will be explained. (2) Functional training: Pain controllability is enhanced through normalization of postures and movements, discouraging pain behaviours, while building confidence to gradually engage in feared and / or painful movements and activities. These new learned movement behaviors are gradually incorporated into daily tasks. The movements and behaviours targeted will be tailored to the specific functional goals of the individual. Examples of common movements or behaviours include walking, moving from sitting to standing and negotiating stairs. (3) Lifestyle training: Increasing physical activity levels in a relaxed, confident, mindful manner while developing skills to enhance stress coping and healthy sleep habits. Treatment dosage for all participants will be up to 10 sessions in total including, 7 sessions over the 12-week intervention, and 3 booster sessions. The boosters sessions can be triggered by the patient in case of a flare up or need of assistance. If the patient does not make contact, the booster sessions will occur at 2, 4 and 6 months after the end of the 12-week intervention period. Patients will be offered to come in or have an online video consult with the Physiotherapist for these three sessions. This will be based on the participant’s preference. The initial session will be 1hr and follow-ups of 30–45 min. Participants will be seen weekly for 2-3 sessions and progressed to one session every 2–3 weeks. Participants will be requested to practice the strategies at home, and to become increasingly aware of both physical and psychosocial dimensions to their pain, both during and after the intervention period. Participants are requested to practice the strategies at home (the patient is encouraged to practice the strategies whenever they perform the movement/postural task throughout the day). This is usually on a daily basis. Adherence to the at-home practice will be monitored by a single question (“Over the past week, how many days have you engaged in your management plan?”) asked weekly during the intervention and follow up periods. To integrate care with members of other health disciplines, the CFT physiotherapist will liaise with the participant’s GP, and refer on to a psychologist and or a dietician as indicated by the presence of health co-morbidities such as mental health disorders and obesity.