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  • Alternative models to support weight loss in chronic musculoskeletal conditions: effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, the POWER randomised controlled trial

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Original research
Alternative models to support weight loss in chronic musculoskeletal conditions: effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, the POWER randomised controlled trial
  1. Kim Allison1,
  2. Sarah Jones1,
  3. Rana S Hinman1,
  4. Jesse Pardo1,
  5. Peixuan Li2,3,
  6. Anurika DeSilva2,3,
  7. Jonathan George Quicke4,5,
  8. Priya Sumithran6,7,
  9. Jodie Prendergast8,
  10. Elena George9,
  11. Melanie A Holden4,
  12. Nadine E Foster4,10,
  13. Kim L Bennell1
  1. 1 Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
  3. 3 Methods and Implementation Support for Clinical and Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Primary Care and Health Sciences, School of Medicine, Keele University, Keele, UK
  5. 5 Chartered Society of Physiotherapy, Chancery Exchange, London, UK
  6. 6 Department of Surgery, Division of Clinical Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
  7. 7 Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
  8. 8 Medibank Private, Melbourne, Victoria, Australia
  9. 9 Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
  10. 10 STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, St Lucia, Queensland, Australia
  1. Correspondence to Dr Kim Allison, The University of Melbourne Centre for Health Exercise and Sports Medicine, Melbourne, VIC 3010, Australia; kim.allison{at}unimelb.edu.au

Abstract

Objectives To determine if physiotherapists can deliver a clinically effective very low energy diet (VLED) supplementary to exercise in people with knee osteoarthritis (OA) and overweight or obesity.

Methods 88 participants with knee OA and body mass index (BMI) >27 kg/m2 were randomised to either intervention (n=42: VLED including two daily meal replacement products supplementary to control) or control (n=46: exercise). Both interventions were delivered by unblinded physiotherapists via six videoconference sessions over 6 months. The primary outcome was the percentage change in body weight at 6 months, measured by a blinded assessor. Secondary outcomes included BMI, waist circumference, waist-to-hip ratio, self-reported measures of pain, function, satisfaction and perceived global change, and physical performance tests.

Results The intervention group lost a mean (SD) of 8.1% (5.2) body weight compared with 1.0% (3.2) in the control group (mean (95% CI) between-group difference 7.2% (95% CI 5.1 to 9.3), p<0.001), with significantly lower BMI and waist circumference compared with control group at follow-up. 76% of participants in the intervention group achieved ≥5% body weight loss and 37% acheived ≥10%, compared with 12% and 0%, respectively, in the control group. More participants in the intervention group (27/38 (71.1%)) reported global knee improvement than in the control group (20/42 (47.6%)) (p=0.02). There were no between-group differences in any other secondary outcomes. No serious adverse events were reported.

Conclusion A VLED delivered by physiotherapists achieved clinically relevant weight loss and was safe for people with knee OA who were overweight or obese. The results have potential implications for future service models of care for OA and obesity.

Trial registration number NIH, US National Library of Medicine, Clinicaltrials.gov NCT04733053 (1 February 2021).

  • Osteoarthritis
  • Weight loss
  • Randomized Controlled Trial
  • Physical Therapy

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The datasets used and/or analysed during the current trial will be made available from the corresponding author on reasonable request.

https://doi.org/10.1136/bjsports-2023-107793

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The datasets used and/or analysed during the current trial will be made available from the corresponding author on reasonable request.

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    Footnotes

    • X @HinmanRana

    • Contributors KLB and KA obtained funding for the trial; KA, KLB and RSH designed the trial with input from SJ, PS, JGQ, JPr, MAH, NEF and EG. SJ, KA and KLB developed the training modules, and SJ conducted the mock patient training, audited the practice patient training and provided training feedback to physiotherapists. SJ and JP coordinated the trial. PL, ADS and KLB prepared the statistical analysis plan blinded, and PL performed statistical analyses with guidance from ADS. KA and KLB wrote the draft of this paper and all authors edited and approved the final version. KB is the guarantor and accepts full responsibility for the finished work and/or the conduct of the study, had access to the data and controlled the decision to publish.

    • Funding National Health and Medical Research Council (NHMRC) Program Grant #1091302 and Investigator Grant (#1174431), Physiotherapy Research Fund Project Grant PG18-004 and University of Melbourne Early Career Researcher Grant 2019. RSH is supported by a National Health & Medical Research Council Senior Research Fellowship (#1154217). KLB is supported by a National Health and Medical Research Council Investigator Grant (#1174431). NEF is supported by a National Health and Medical Research Council Investigator Grant (#2018182).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.