Effectiveness of Pain Science Education in People With Symptomatic Knee Osteoarthritis
Condition: Osteo Arthritis Knee
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      The aim of this study is to determine the effectiveness of the program integrated with pain
      science education for people with painful knee osteoarthritis (OA). Another purpose of the
      study is to evaluate whether the program integrated with pain science education is more
      effective than the program integrated with biomedical education.
    

Detailed description: 
      Contemporary pain science education provides a scientific basis for the increased sensitivity
      produced in chronic pain due to adaptations in the central nervous system. In the literature,
      pain science education has been shown to reduce unhelpful pain beliefs and improve pain,
      function, and disability in several chronic musculoskeletal pain states, but data specific to
      knee OA are lacking.

      Patients with knee osteoarthritis who meet the inclusion criteria and agree to participate in
      the study will be included. The participants will be randomly divided into two groups. These
      groups are: a) intervention group, where the program integrated with pain science education
      and b)control group, where the program integrated with biomedical education.

      Three weeks of face-to-face sessions in both groups will be followed by three weeks of
      telerehabilitation sessions. Telerehabilitation sessions will be applied as phone calls or
      video conference sessions, according to the participant's request. All sessions will be
      conducted one-on-one.

      Face-to-face sessions for both groups:

        -  3 sessions in total,

        -  1 day a week for 3 weeks,

        -  Each session will last approximately 60 minutes for the control group and the
           intervention group.

        -  Each face-to-face session will include education and physiotherapy program. Biomedical
           education for the control group and pain science education for the intervention group
           will be applied. Visuals and presentations will be used in the education of both groups.
           The presentations and visuals that will be used in pain science education and biomedical
           education will be different. The physiotherapy program will be the same for both groups.
           Physiotherapy program will be applied after education in both groups. In the
           physiotherapy program, all participants will be given knee exercises and will be asked
           to take a walk twice a week as homework and suggestions will be made to reduce their
           sedentary behavior. The exercises given to both groups will be the same.

      Telerehabilitation sessions for both groups:

        -  3 sessions in total,

        -  1 day a week for 3 weeks,

        -  Each session is approximately 15-20 minutes,

        -  Each session will include education, recommendations (especially about increasing
           physical activity and reducing sedentary behaviour), answering questions if any, and
           discussion.

      The homework and suggestions to be given to the participants in the intervention group will
      be integrated with the pain science education, while the homework and suggestions to be given
      to the participants in the control group will be integrated with the biomedical education.
      For example, it will be explained to a participant in the intervention group that walking
      will regulate increased sensitivity in the central nervous system and ensure plasticity
      (using stories, examples in a way that the participant can understand). It will be explained
      to the participant in the control group that walking will strengthen their muscles and will
      be beneficial for general health and joint health.
    

Intervention name(s): Pain science education driven physiotherapy program; Biomedical education driven physiotherapy program
Intervention type(s): Other; Other
Intervention description(s): Pain science training will be carried out as described by Moseley and Butler. Topics covered within the scope of pain science education are planned to include: neurophysiology of pain, synapses, peripheral sensitization, central sensitization, plasticity of the nervous system. The aim of the training will be to teach participants that pain is a multifactorial experience rather than just tissue injury. Participants in this group will be told about the importance of physical activity integrated with pain science education (i.e., explaining that physical activity is the key to bioplasticity and causing changes in our system) and why sedentary behaviors should be reduced (reducing sedentary behaviors reduces the overprotectiveness of the pain system).; Participants in this group will be planned to increase their knowledge of knee anatomy, knowledge of knee OA and knee OA risk factors, and the importance of increasing physical activity and reducing sedentary behavior in reducing osteoarthritic pain and improving overall health. The importance of physical activity by integrating it with biomedical education (as physical activity can help strengthen muscles, protect joint function, and improve sleep and general health) and the necessity of reducing sedentary behaviors will be discussed within the framework of biomedical education.The main difference of standard education from pain science education will be that it does not contain information about pain mechanisms mentioned in pain science education.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Osteoarthritis; pain; knee; education