PARQVE: PROJECT ARTHRITIS RECOVERING QUALITY OF LIFE THROUGH EDUCATION: TWO-YEAR RESULTS

REZENDE, MÁRCIA UCHOA DE; FRUCCHI, RENATO; PAILO, ALEXANDRE FELÍCIO; CAMPOS, GUSTAVO CONSTANTINO DE; PASQUALIN, THIAGO; HISSADOMI, MARCELO ISSAO

doi:10.1590/1413-785220172501165604

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Acta Ortopédica Brasileira

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Original Articles • Acta ortop. bras. 25 (1) • Jan-Feb 2017 • https://doi.org/10.1590/1413-785220172501165604 copy

PARQVE: PROJECT ARTHRITIS RECOVERING QUALITY OF LIFE THROUGH EDUCATION: TWO-YEAR RESULTS

PARQVE, PROJETO ARTROSE RECUPERANDO QUALIDADE DE VIDA PELA EDUCAÇÃO: RESULTADOS EM DOIS ANOS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the effects of a multi-professional educational program in patients with knee osteoarthritis (KOA).

Methods:

Prospective randomized controlled trial with 195 KOA patients. One group was submitted to two-day lectures and received educational material about KOA (Class group), and the control group received the educational material only. Patients were evaluated at baseline, twelve and 24 months. At evaluation, patients answered pain and functional questionnaires (WOMAC, Lequesne, VAS and SF-36); reported the intensity of exercise per week; measured the body fat percentage, weight and height to estimate body mass index (BMI); and performed Timed Up & Go (TUG) and Five-Times-Sit-to-Stand (FTSST) tests.

Results:

The groups presented similar results in all time points with respect to pain (VAS and WOMAC pain), WOMAC, BMI and body fat percentage (p>0.05). The Class group exhibited improved function according to the Lequesne questionnaire, whereas the control group worsened (p=0.02) during follow-up (p<0.02). TUG (p=0.01) and FTSST (p<0.001) improved in the Class group. A higher percentage of patients in the Class group performed regular physical activity (p=0.045).

Conclusions:

The educational program with classes improved the consistency of physical activity and the subjective and objective function of patients with KOA.Level of evidence IA, Prospective Randomized Controlled Trial.

Keywords:
Osteoarthritis; Knee; Quality of life; Patient education as topic; Treatment outcome

	Subgroup
Variable	1		2		3		4		p
	n	%	n	%	n	%	n	%
K&L Right									0.149*
0	0	0.0	0	0.0	2	4.1	0	0.0
1	4	8.2	1	2.0	6	12.2	1	2.3
2	20	40.8	17	34.0	12	24.5	13	29.5
3	15	30.6	21	42.0	19	38.8	14	31.8
4	10	20.4	11	22.0	10	20.4	16	36.4
K&L Left									0.361*
0	0	0.0	0	0.0	0	0.0	3	6.4
1	5	10.2	3	6.1	5	10.2	1	2.1
2	21	42.9	14	28.6	14	28.6	15	31.9
3	16	32.7	25	51.0	16	32.7	20	42.6
4	7	14.3	7	14.3	14	28.6	8	17.0
Gender									0.893
Male	13	26.5	10	20.0	12	24.5	11	23.4
Female	36	73.5	40	80.0	37	75.5	36	76.6
Race									0.616#
White	27	56.2	31	63.3	32	66.7	33	70.2
Mulatto/Mestizo	12	25.0	11	22.4	10	20.8	8	17.0
Black	9	18.8	5	10.2	5	10.4	4	8.5
Asian	0	0.0	2	4.1	1	2.1	2	4.3
Knee									0.745
Right	39	79.6	43	86.0	41	83.7	41	87.2
Left	10	20.4	7	14.0	8	16.3	6	12.8
Bilateral									0.866
No	15	30.6	14	28.0	17	34.7	13	27.7
Yes	34	69.4	36	72.0	32	65.3	34	72.3

Variable	Subgroup	Mean	SD	95% CI		n	p
Variable	Subgroup	Mean	SD	Lower	Upper
Age (years)	Subgroup 1	64.4	9.7	61.7	67.1	49	0.108
	Subgroup 2	62.1	8.3	59.8	64.4	50
	Subgroup 3	66.6	9.8	63.9	69.4	49
	Subgroup 4	64.3	8.7	61.8	66.8	47
Time of study (years)	Subgroup 1	7.4	2.7	6.6	8.1	49	0.556
	Subgroup 2	7.8	3.3	6.9	8.7	49
	Subgroup 3	8.0	3.5	7.0	8.9	49
	Subgroup 4	8.2	2.2	7.6	8.8	47
BMI (kg/m²⁾	Subgroup 1	31.3	5.2	29.9	32.8	49	0.049
	Subgroup 2	32.8	6.0	31.2	34.5	50
	Subgroup 3	29.8	4.7	28.5	31.1	49
	Subgroup 4	31.3	5.2	29.8	32.8	46
BFP	Subgroup 1	35.8	9.4	33.2	38.4	49	0.421
	Subgroup 2	37.8	7.6	35.7	40.0	50
	Subgroup 3	35.1	8.2	32.8	37.4	49
	Subgroup 4	36.3	8.4	33.8	38.7	47
ANOVA

Subgroup	Calling in the first year		WOMAC			WOMAC Pain			Lequesne
Subgroup	Calling in the first year		Baseline	1 year	2 years	Baseline	1 year	2 years	Baseline	1 year	2 years
1	Yes (A)	Mean (SD)	44 (20.2)	39.1 (15)	35.8 (15.9)	8.8 (4.3)	7.5 (3.3)	7.6 (2.9)	11.2 (4.1)	10.6 (3.4)	10.1 (3.8)
	Yes (A)	95% CI	(35.3 - 52.6)	(32.7 - 45.5)	(28.8 - 42.8)	(6.9 - 10.6)	(6.1 - 8.9)	(6.3 - 8.9)	(9.5 - 13)	(9.1 - 12.1)	(8.4 - 11.7)
	No (B)	Mean (SD)	48.8 (15.8)	44.3 (14)	45.3 (16.8)	9.1 (4.3)	8.3 (3.6)	9.4 (3.8)	11.9 (4)	12.4 (3.1)	11.7 (4.7)
	No (B)	95% CI	(43 - 54.7)	(39.1 - 49.5)	(39.1 - 51.5)	(7.5 - 10.7)	(7 - 9.7)	(8 - 10.8)	(10.4 - 13.4)	(11.3 - 13.6)	(10 - 13.4)
2	Yes (A)	Mean (SD)	49 (17.2)	42 (19.5)	43.2 (21)	9.6 (3.2)	7.7 (3.8)	8.5 (4.6)	12.3 (3.4)	11.6 (4.8)	12.4 (4.7)
	Yes (A)	95% CI	(42.2 - 55.7)	(34.4 - 49.6)	(34.8 - 51.6)	(8.4 - 10.9)	(6.2 - 9.2)	(6.7 - 10.4)	(10.9 - 13.6)	(9.7 - 13.5)	(10.5 - 14.3)
	No (B)	Mean (SD)	47.2 (19.3)	44.8 (20.4)	39.4 (16.7)	9.9 (4.4)	8.5 (4.2)	7.8 (3.7)	12.5 (4.3)	11.8 (4.7)	11.4 (3.8)
	No (B)	95% CI	(39.6 - 54.8)	(36.8 - 52.8)	(32.4 - 46.4)	(8.2 - 11.6)	(6.9 - 10.2)	(6.2 - 9.3)	(10.8 - 14.2)	(9.9 - 13.6)	(9.8 - 13)
3	Yes (A)	Mean (SD)	42.8 (19.5)	43.6 (20)	47.3 (21.2)	8.9 (4)	8.5 (3.9)	9.9 (4.3)	11.6 (4.6)	11.8 (4.5)	12.4 (4.4)
	Yes (A)	95% CI	(35 - 50.6)	(35.6 - 51.6)	(38.6 - 56)	(7.3 - 10.5)	(7 - 10.1)	(8.2 - 11.6)	(9.7 - 13.4)	(10 - 13.6)	(10.6 - 14.1)
	No (B)	Mean (SD)	43.8 (19)	42.6 (14.5)	39.4 (16.8)	8.3 (4.3)	8.7 (3.2)	7.3 (3.5)	11.2 (3.8)	12.1 (3.5)	10.9 (4.8)
	No (B)	95% CI	(36.4 - 51.3)	(36.9 - 48.3)	(32.5 - 46.3)	(6.6 - 10)	(7.5 - 10)	(5.8 - 8.7)	(9.7 - 12.7)	(10.7 - 13.4)	(8.9 - 12.8)
4	Yes (A)	Mean (SD)	44.4 (13.8)	47.5 (19)	45.8 (14.9)	9.4 (4.1)	9.6 (4.7)	9.6 (3.4)	11.9 (4.6)	12.2 (4)	12.6 (4.2)
	Yes (A)	95% CI	(38.8 - 50.1)	(39.7 - 55.3)	(39.6 - 52)	(7.7 - 11.1)	(7.7 - 11.5)	(8.1 - 11)	(10 - 13.8)	(10.5 - 13.9)	(10.9 - 14.3)
	No (B)	Mean (SD)	42.6 (21.8)	44.9 (20.1)	42 (15.3)	8 (4.2)	9.1 (3.7)	8.6 (3.2)	12.5 (4.4)	12.3 (4.2)	11.7 (4.2)
95% CI	(33.9 - 51.3)	(36.8 - 52.9)	(35.4 - 48.5)	(6.4 - 9.7)	(7.6 - 10.6)	(7.2 - 10)	(10.7 - 14.2)	(10.7 - 14)	(9.9 - 13.5)

Subgroup	Calling in the first		VAS			SF-36 PCS			SF-36 MCS
Subgroup	Calling in the first		Baseline	1 year	2 years	Baseline	1 year	2 years	Baseline	1 year	2 years
1	Yes (A)	Mean (SD)	52.3 (25.3)	49.4 (22.2)	48.9 (15.2)	32.3 (8.2)	32.2 (9.1)	36.9 (8.6)	44.4 (12.3)	48.3 (13.1)	49.7 (12.9)
	Yes (A)	95% CI	(41.5 - 63.1)	(39.9 - 58.9)	(42.2 - 55.6)	(28.8 - 35.9)	(28.3 - 36)	(33.1 - 40.7)	(39.2 - 49.7)	(42.7 - 53.9)	(44.1 - 55.3)
	No (B)	Mean (SD)	60.6 (24.8)	54.4 (23.2)	53.4 (26.2)	32.6 (8.1)	34.2 (7.3)	34.7 (7.2)	46.6 (14.1)	49.5 (10)	49.2 (13.4)
	No (B)	95% CI	(51.5 - 69.8)	(45.8 - 63)	(43.6 - 63.1)	(29.6 - 35.6)	(31.5 - 36.9)	(32 - 37.4)	(41.4 - 51.8)	(45.8 - 53.2)	(44.2 - 54.2)
2	Yes (A)	Mean (SD)	67.8 (24.1)	53.4 (23.9)	58.2 (23)	30.3 (6.5)	32 (8.4)	32.5 (6.1)	44 (12.6)	45.8 (14.2)	44.4 (13.6)
	Yes (A)	95% CI	(58.3 - 77.2)	(44 - 62.8)	(49 - 67.4)	(27.8 - 32.9)	(28.8 - 35.3)	(30.1 - 35)	(39.1 - 49)	(40.2 - 51.4)	(39 - 49.8)
	No (B)	Mean (SD)	60.8 (28.7)	52.7 (27.5)	53.5 (24.5)	33 (9.1)	33.9 (9.6)	34.4 (7.7)	43.5 (13.1)	47 (13.7)	47.3 (10.6)
	No (B)	95% CI	(49.6 - 72.1)	(41.9 - 63.4)	(43.3 - 63.7)	(29.4 - 36.5)	(30.2 - 37.7)	(31.2 - 37.7)	(38.4 - 48.7)	(41.6 - 52.4)	(42.9 - 51.7)
3	Yes (A)	Mean (SD)	61.9 (25.2)	56.2 (21)	65.8 (19)	31.9 (9)	33.1 (7.9)	31.8 (9.3)	48.9 (11.2)	49 (11)	44 (12.7)
	Yes (A)	95% CI	(51.8 - 72)	(47.8 - 64.6)	(58 - 73.5)	(28.3 - 35.5)	(30 - 36.3)	(27.9 - 35.6)	(44.4 - 53.4)	(44.6 - 53.3)	(38.8 - 49.2)
	No (B)	Mean (SD)	46.8 (28.3)	53.7 (24.1)	51.5 (13.8)	34.7 (7.7)	36.1 (10.3)	37.7 (9.2)	46.8 (9.9)	49.7 (10)	49.7 (9.1)
	No (B)	95% CI	(35.7 - 57.8)	(44.2 - 63.1)	(45.9 - 57.1)	(31.7 - 37.7)	(32.1 - 40.2)	(33.9 - 41.5)	(42.9 - 50.6)	(45.7 - 53.6)	(45.9 - 53.4)
4	Yes (A)	Mean (SD)	53 (25.8)	59.8 (26.7)	63.5 (18)	33.6 (7.7)	32.7 (8.1)	32.8 (7.3)	45.4 (12.1)	48.6 (17)	45.5 (11.1)
	Yes (A)	95% CI	(42.4 - 63.5)	(48.9 - 70.7)	(55.9 - 71)	(30.4 - 36.7)	(29.4 - 36)	(29.8 - 35.9)	(40.5 - 50.4)	(41.7 - 55.6)	(40.9 - 50.2)
	No (B)	Mean (SD)	61.7 (28.7)	62 (21.5)	61.2 (19.2)	33.7 (7.5)	34.6 (8.6)	34.5 (8.1)	43.3 (13.3)	43.6 (13.9)	41.4 (13.1)
95% CI	(50.2 - 73.1)	(53.4 - 70.6)	(53 - 69.4)	(30.7 - 36.7)	(31.2 - 38)	(31.1 - 38)	(38 - 48.7)	(38 - 49.1)	(35.7 - 47)

		Group Class			Group Control			Significance
		Baseline	1 year	2 years	Baseline	1 year	2 years	Between Groups	Time
		Baseline	1 year	2 years	Baseline	1 year	2 years	p	p
BMI	Mean (SD)	31.29 (5.41)	31.14 (5.37)	31.44 (5.33)	31.30 (5.19)	31.15 (5.79)	31.44 (6.18)	0.52	0.46
BMI	CI	30.14 - 32.37	30.11 - 32.30	30.26 - 32.35	29.48 - 33.96	29.00 - 34.04	28.51 - 33.64	0.52	0.46
BFP	Mean (SD)	36.26 (8.46)	35.75 (8.56)	38.34 (8.39)	36.26 (8.45)	35.96 (8.11)	37.73 (8.49)	0.46	0.001*
BFP	CI	34.32 - 37.87	33.94 - 37.56	36.37 - 40.06	33.92 - 41.05	33.80 - 40.68	33.40 - 42.64	0.46	0.001*
Womac	Mean (SD)	46.07 - (18.31)	42.85 (17.22)	42.01 (18.32)	43.51 (18.14)	46.15 (19.42)	43.91 (15.02)	0.74	0.47
Womac	CI	40.42 - 48.80	38.85 - 46.27	35.57 - 43.26	36.61 - 48.49	34.05 - 50.85	34.62 - 48.18	0.74	0.47
Womac Pain	Mean (SD)	9.11 (4.06)	8.23 (3.67)	8.47 (3.91)	8.00 (4.12)	9.00 (4.17)	9.00 (3.33)	0.40	0.68
Womac Pain	CI	8.09 - 9.88	7.44 - 9.04	7.15 - 8.77	7.32 - 10.68	6.81 - 9.99	6.56 - 9.74	0.40	0.68
VAS	Mean (SD)	58.55 (26.58)	53.39 (23.47)	55.31 (21.42)	57.4 (27.36)	60.89 (23.96)	62.35 (18.45)	0.14	0.88
VAS	CI	51.44 - 62.75	47.01 - 56.98	46.27 - 55.20	45.84 - 69.76	41.05 - 65.45	50.32 - 68.28	0.14	0.88
Lequesne	Mean (SD)	11.81 (4.09)	11.76 (4.02)	11.51 (4.39)	11.97 (3.71)	12.26 (4.06)	12.16 (4.13)	0.02	<0.001*
Lequesne	CI	10.61 - 12.48	10.46 - 12.18	9.81 - 11.72	9.61 - 13.34	9.98 - 13.37	9.45 - 13.25	0.02	<0.001*
Time-Up-and-Go	Mean (SD)	12.2 (4.42)	12.08 (4.37)	11.79 (4.87)	13.71 (6.00)	12.6 (4.73)	12.6 (5.20)	0.31	0.01*
Time-Up-and-Go	CI	11.11 - 13.23	10.95 - 12.83	10.29 - 12.09	11.63 - 16.40	10.92 - 15.66	9.89 - 15.15	0.31	0.01*
Five-Times-Sit-to-Stand	Mean (SD)	23.23 (8.26)	18.17 (5.96)	19.43 (6.65)	22.79 (11.08)	19.66 (10.26)	23.24 (10.49)	0.13	<0.001*
CI		21.26 - 25.13	16.71 - 19.13	18.13 - 20.84	18.10 - 29.69	15.42 - 26.53	18.08 - 29.76

	Baseline				2 years
	Group Class		Group Control		Group Class		Group Control
Intensity of physical activity	n	%	n	%	n	%	n	%
Does not perform	118	84.9%	40	90.9%	38	27.3%	22	50.0%
Light activity	7	5.0%	4	9.1%	60	43.2%	14	31.8%
Moderate activity	12	8.6%	0	0.0%	33	23.7%	7	15.9%
Vigorous activity	2	1.4%	0	0.0%	8	5.8%	1	2.3%
	p = 0.139				p = 0.045

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[1] Correspondence: Rua Dr. Ovídio Pires de Campos, 333. Cerqueira César, São Paulo, SP. 05403-010. murezende@uol.com.br