Why does Good Living with Arthritis Denmark ( GLA:D®) work? A pilot study investigating the link between biomechanical factors and a successful outcome following a movement retraining program for knee osteoarthritis.

This study will assess the biomechanical effects of a neuromuscular exercise program, GLA:D® (Good Life with Osteoarthritis in Denmark). The GLA:D® program is a multicomponent intervention consisting of the core recommended non-surgical treatments of exercise and education for those who have been diagnosed with hip or knee osteoarthritis. GLA:D® is delivered by certified GLA:D® physiotherapists and consists of 2 education sessions and 12 individual or group-based exercise sessions over a 6–8-week period. The patient education sessions consist of 2 (60-90 minute) education sessions about osteoarthritis management delivered by a certified physiotherapist. The aim is to have Education 1 completed prior to the first exercise session and Education 2 completed within the first 2 weeks of commencing the exercise sessions. The feasibility of this will be assessed as part of this study. All participants will be provided with a GLA:D Education booklet which summarises key aspects of both education sessions. The exercise program is delivered over 12 (60 minute) sessions with a focus on a neuromuscular exercise program. Patients are encouraged to complete the program preferably in a small physiotherapy supervised group of approximately 4-6 people, however, may be completed as a home program or via telehealth. The exercise component consists of : • 10 minute warmup on exercise bike or other suitable method • lower limb circuit program (10 exercises in total) • Cool down Exercises include: • 2 abdominal/core exercises using a gym ball • 2 dynamic alignment exercises using an exercise slider • 4 lower limb strengthening exercises using TheraBand • 2 functional exercises consisting of a sit to stand and a step up requiring a sturdy chair and a step. Participants aim to perform 2-3 sets of 10-15 repetitions of each exercise. Each participant is monitored individually according to their pain intensity and progression of exercise difficulty occurs if good quality of the exercise can be maintained. Exercises are performed on both legs, with focus on the affected leg using mirror provided visual feedback (1). Participants will be provided with the GLA:D specific exercise booklet which allows recording of each session completed, pain levels pre-post session and recording of the sets/repetitions and level of exercise difficulty completed. A study specific form will be provided to each participant prior to commencing the study that allows for recording of all upcoming class and education appointments and study appointments related to their assessment in the biomechanics lab. (1) Skou ST and Roos EM. Good Life with osteoArthritis in Denmark (GLA:D): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disorders, 2017. 18(1): p. 72.