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Facilitating activity and self-management for people with arthritic knee, hip or lower back pain (FASA): A cluster randomised controlled trial

Walsh, Nicola; Jones, Louise; Phillips, Sonia; Thomas, Rachel; Odondi, Lang’o; Palmer, Shea; Cramp, Fiona; Pollock, Jon; Hurley, Mike

Facilitating activity and self-management for people with arthritic knee, hip or lower back pain (FASA): A cluster randomised controlled trial Thumbnail


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Nicola Walsh
Professor in Knowledge Mobilisation & Muscul

Louise Jones

Sonia Phillips
Occasional Associate Lecturer - CHSS - SHSW

Lang’o Odondi

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Shea Palmer
Occasional Associate Lecturer - CHSS - HSW

Fiona Cramp
Professor in Long Term Conditions

Jon Pollock
Associate Professor in Epidemiology

Mike Hurley


Chronic musculoskeletal pain including osteoarthritis (OA) can significantly limit the functional independence of individuals. The spine and hip and knee are predominantly affected; management guidelines for each recommend exercise and education to support self-management.

Objectives: This study investigated the effectiveness of a generic exercise and self-management intervention for people over-50 with hip/knee OA and/or lower back pain compared to continued GP management.

Design: Single blind, cluster randomised controlled trial.

Method: Participants who had previously consulted with hip/knee OA and/or chronic lower back pain were recruited from 45 GP practices in SW England. Practices were randomly allocated to receive continued GP care (control) or continued GP care and a 6-week group exercise and self-management intervention facilitated by a physiotherapist and located in a community-based physiotherapy department. The primary outcome measure was the Dysfunction Index of the Short Musculoskeletal Functional Assessment (DI-SMFA) measured at six month post-rehabilitation.

Results: 349 participants were recruited and allocated to the intervention (n = 170) or control (n = 179) arms; the attrition rate was 13% at the 6 month primary end-point. One minor adverse event in the intervention group that required no medical input was reported. Intervention arm participants reported better function at 6 months compared with continued GP management alone (−3.01 difference in DI-SMFA [95%CI -5.25, −0.76], p = 0.01).

Conclusions: A generic exercise and self-management intervention resulted in statistically significant changes in function after six-months compared with GP management alone, but clinical significance of these findings is less clear. This may be an effective way of managing group interventions for lower limb OA and chronic lower back pain.

Journal Article Type Article
Acceptance Date Oct 5, 2020
Online Publication Date Oct 10, 2020
Publication Date Dec 1, 2020
Deposit Date Oct 12, 2020
Publicly Available Date Oct 11, 2021
Journal Musculoskeletal Science and Practice
Print ISSN 2468-8630
Electronic ISSN 2468-7812
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 50
Article Number 102271
Keywords OA; exercise; self-management
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