Knee Osteoarthritis, Older Women, Pain, Disability
Conditions
Keywords
Pain Neuroscience Education, Knee Osteoarthritis, Older Women, Disability, Exercise, Pilot randomized controlled trial
Brief summary
This pilot trial aimed to estimate preliminary clinical effects and to assess the feasibility of adding group-based pain neuroscience education (PNE) to exercise in women aged ≥60 years with medically diagnosed knee osteoarthritis and current knee pain. Participants were randomized to either 10 weeks of community-based exercise plus PNE or exercise alone. All participants attended weekly group exercise sessions, and those in the intervention group also participated in five in-person group-based PNE sessions lasting 30 minutes each. Physical fitness tests were administered, and participants completed questionnaires assessing disability, pain intensity, and pain neurophysiology knowledge.
Detailed description
Knee osteoarthritis (OA) is a highly prevalent and disabling condition in older adults, with the knee being the most commonly affected joint. In Chile, OA represents a substantial clinical and public health burden, particularly among women aged 60 years and older, who experience high rates of pain, disability, and loss of functional independence. Disability and pain are hallmark symptoms of knee OA and are strongly associated with reduced physical function and poorer quality of life in older women. Current clinical guidelines recommend education, self-management, and exercise as first-line treatments. Exercise therapy can improve pain and physical function in people with knee OA, but average effects are modest and individual responses vary. Pain in knee OA is increasingly understood within a biopsychosocial framework, suggesting that maladaptive pain beliefs contribute to persistent symptoms. Pain Neuroscience Education (PNE) may complement exercise by improving pain-related knowledge and psychological outcomes, although evidence-particularly for group-based delivery and disability outcomes in older women-remains limited. This study was implemented in the context of a training program called "Camina 60+KineUC", a community-based program jointly delivered by the UC Older Adults Program and the Department of Physical Therapy from Pontificia Universidad Católica de Chile. The program provides weekly group sessions focused on strength, aerobic, balance, and flexibility exercises for adults aged 60 years and older and is designed to promote healthy aging. The study was designed to assess feasibility and estimate preliminary between-group effect sizes rather than to make definitive efficacy conclusions.
Interventions
The intervention group received five group-based PNE sessions of 30 min each ((total dose = 150 min) delivered in person across the 10-week intervention period using digital presentations. The selected dose was informed by dose-response syntheses suggesting that 150-200 min of PNE may be associated with clinically relevant changes in psychosocial outcomes when combined with exercise. Sessions were delivered by four fourth-year physical therapy students trained in PNE and were based on The Knee Osteoarthritis Handbook (Noigroup©) and Dolor Crónico, una guía de ayuda para pacientes (Equipo DolorUC book). To support intervention fidelity, the student facilitators completed 5 days of 2hrs of training in PNE and communications skills before delivering the intervention, used a standardized slide deck and session script, and followed a prespecified checklist for each session.
OTHERExercise program
The "Camina 60+KineUC" is a community-based program jointly delivered by the UC Older Adults Program and the Department of Physical Therapy of the Pontificia Universidad Católica de Chile. The program provides weekly group in-person sessions focused on strength, aerobic, balance, and flexibility exercises for adults aged 60 years and older, guided by monitors (physiotherapists and trained physiotherapy students), considering progression in movement complexity, or balance challenge according to tolerance, throughout the 10 weeks of the program.
Sponsors
Pontificia Universidad Catolica de Chile
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Two-arm, parallel-group randomized controlled trial conducted between August and November 2024 at the San Joaquín Campus of Pontificia Universidad Católica de Chile, Santiago, Chile. Potentially eligible participants were identified during the initial Camina 60+KineUC sessions using the program questionnaire and functional assessment battery that included the Senior Fitness Test and the Four-Stage Balance Test. Participants who met the eligibility criteria and provided written informed consent were randomized in a 1:1 ratio to exercise plus pain neuroscience education (PNE) or exercise only. The allocation sequence was computer generated with OxMaR software, and age was used as the balancing factor. Allocation concealment was preserved by password-protected OxMaR access managed by GT.
Eligibility
Sex/Gender
FEMALE
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
\- Medical diagnosis of knee osteoarthritis with current knee pain.
Exclusion criteria
* Inability to understand study procedures during baseline assessment. Mini-Mental State Examination (MMSE) cutoff used to define adequate comprehension for study participation was ≥24/30). * Severe neurological disease. * Anticipated inability to attend all educational sessions or attendance less than 80% at the end of the program.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| KOOS - Activities of Daily Living (KOOS-ADL) | Baseline and immediately after the 10-week intervention period. | Self-reported disability during activities of daily living, measured using the Activities of Daily Living subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The KOOS is a knee-specific, self-administered questionnaire. The ADL subscale is scored from 0 to 100, with higher scores indicating better knee-related function. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| KOOS - Pain Subscale | Baseline and immediately after the 10-week intervention period. | Knee pain measured using the Pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS). Scores range from 0 to 100, with higher scores indicating less pain and better knee status. |
| KOOS - Symptoms Subscale | Baseline and immediately after the 10-week intervention period. | Knee-related symptoms measured using the Symptoms subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS). Scores range from 0 to 100, with higher scores indicating fewer symptoms. |
| KOOS - Sport and Recreation Function Subscale | Baseline and immediately after the 10-week intervention period. | Self-reported difficulty with sport and recreational activities measured using the Sport and Recreation Function subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS). Scores range from 0 to 100, with higher scores indicating better function. |
| KOOS - Knee-related Quality of Life Subscale | Baseline and immediately after the 10-week intervention period. | Knee-related quality of life measured using the Quality of Life subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS). Scores range from 0 to 100, with higher scores indicating better knee-related quality of life. |
| Pain intensity | Baseline and immediately after the 10-week intervention period. | Pain intensity was assessed with a 10-cm visual analog scale, with higher scores indicating greater pain intensity. |
| Lower-body functional performance | Baseline and immediately after the 10-week intervention period. | Lower-body functional performance was assessed with the 30-s Sit-to-Stand Test, scored as the number of repetitions completed in 30 seconds. |
| Pain neurophysiology knowledge | Baseline and immediately after the 10-week intervention period. | Pain neurophysiology knowledge was assessed with the Spanish version of the Revised Neurophysiology of Pain Questionnaire (R-NPQ), with higher scores indicating greater knowledge. |
Countries
Chile
Contacts
PRINCIPAL_INVESTIGATORGustavo Torres
Pontificia Universidad Catolica de Chile
Outcome results
None listed