Evidence map›Paper›PMID 34454458›Full record

ArticleBMC musculoskeletal disorders2021

The EPIPHA-KNEE trial: Explaining Pain to target unhelpful pain beliefs to Increase PHysical Activity in KNEE osteoarthritis - a protocol for a multicentre, randomised controlled trial with clinical- and cost-effectiveness analysis.

Tasha R Stanton, Felicity A Braithwaite, David Butler, G Lorimer Moseley, Catherine Hill, Rachel Milte, Julie Ratcliffe, Carol Maher, Christy Tomkins-Lane, Brian W Pulling and 8 more

3 registry-linked trialsAbstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC musculoskeletal disorders, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05860816 active not recruitingnot on this mapstarted 2023, after this paper: background citation

Facilitators and Barriers to Implementing Pain Neuroscience Education Programmes for the Treatment of Patients With Chronic Pain in Primary Care Physiotherapy Units: the Physiotherapist's Perspective

TypeobservationalSponsorCastilla-León Health ServiceRan2023 to 2025Enrolled123ConditionsChronic Primary Pain, Musculoskeletal Pain, FibromyalgiaArmsSurvey
NCT05955430 naunknown statusnot on this mapstarted 2023, after this paper: background citation

Efficacy of Percutaneous Electrical Stimulation Compared to Transcutaneous Electrical Stimulation in Combination With an Education and Exercise Program in Patients With Knee Osteoarthritis

TypeinterventionalSponsorJosue Fernandez CarneroRan2023 to 2024Enrolled30ConditionsKnee OsteoarthritisArmsTherapeutic exercise, Pain education, Percutaneous electrical stimulation, Transcutaneous electrical stimulation, Placebo stimulation
NCT06400329 nacompletednot on this mapstarted 2024, after this paper: background citation

Evaluating the Physiological Impact of Pain Neuroscience Education Versus Standard Education for Older Adults With Osteoarthritis

TypeinterventionalSponsorLisa CarlessoRan2024 to 2025Enrolled37ConditionsOsteoarthritis, Chronic PainArmsPain Neuroscience Education, Standard Pain Education
3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Canadian journal of pain = Revue canadienne de la douleur · 2026
    Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Tasha R StantonIIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia. tasha.stanton@unisa.edu.au.ORCID http://orcid.org/0000-0001-7106-4456
Felicity A BraithwaiteIIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.
David ButlerIIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.
G Lorimer MoseleyIIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.
Catherine HillRheumatology Department, The Queen Elizabeth Hospital, Adelaide, Australia.
Rachel MilteCaring Futures Institute, Flinders University, Adelaide, Australia.
Julie RatcliffeCaring Futures Institute, Flinders University, Adelaide, Australia.
Carol MaherAlliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
Christy Tomkins-LaneDepartment of Health and Physical Education, Mount Royal University, Calgary, Canada.
Brian W PullingIIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.
Erin MacIntyreIIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.
Adrian EstermanClinical & Health Sciences, University of South Australia, Adelaide, Australia.
Ty StanfordClinical & Health Sciences, University of South Australia, Adelaide, Australia.
Hopin LeeCentre for Statistics in Medicine, Rehabilitation Research in Oxford (RRIO), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
Francois FraysseAlliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
Ben MetcalfCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia.
Brendan MouattIIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.
Kim BennellCentre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia.

Funding

medical research future fund 1193862national health and medical research council 1141735national health and medical research council 1161634national health and medical research council 1178444university of south australia USAPA scholarship
6 · The paper itself

Abstract

backgroundDespite well-established benefits of physical activity for knee osteoarthritis (OA), nine of ten people with knee OA are inactive. People with knee OA who are inactive often believe that physical activity is dangerous, fearing that it will further damage their joint(s). Such unhelpful beliefs can negatively influence physical activity levels. We aim to evaluate the clinical- and cost-effectiveness of integrating physiotherapist-delivered pain science education (PSE), an evidence-based conceptual change intervention targeting unhelpful pain beliefs by increasing pain knowledge, with an individualised walking, strengthening, and general education program.

methodsTwo-arm, parallel-design, multicentre randomised controlled trial involving 198 people aged ≥50 years with painful knee OA who do not meet physical activity guideline recommendations or walk regularly for exercise. Both groups receive an individualised physiotherapist-led walking, strengthening, and OA/activity education program via 4x weekly in-person treatment sessions, followed by 4 weeks of at-home activities (weekly check-in via telehealth), with follow-up sessions at 3 months (telehealth) and 5 and 9 months (in-person). The EPIPHA-KNEE group also receives contemporary PSE about OA/pain and activity, embedded into all aspects of the intervention. Outcomes are assessed at baseline, 12 weeks, 6 and 12 months. Primary outcomes are physical activity level (step count; wrist-based accelerometry) and self-reported knee symptoms (WOMAC Total score) at 12 months. Secondary outcomes are quality of life, pain intensity, global rating of change, self-efficacy, pain catastrophising, depression, anxiety, stress, fear of movement, knee awareness, OA/activity conceptualisation, and self-regulated learning ability. Additional measures include adherence, adverse events, blinding success, COVID-19 impact on activity, intention to exercise, treatment expectancy/perceived credibility, implicit movement/environmental bias, implicit motor imagery, two-point discrimination, and pain sensitivity to activity. Cost-utility analysis of the EPIPHA-KNEE intervention will be undertaken, in addition to evaluation of cost-effectiveness in the context of primary trial outcomes. DISCUSSION: We will determine whether the integration of PSE into an individualised OA education, walking, and strengthening program is more effective than receiving the individualised program alone. Findings will inform the development and implementation of future delivery of PSE as part of best practice for people with knee OA.

trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12620001041943 (13/10/2020).

Indexed as

COVID-19Osteoarthritis, KneeAustraliaCost-Benefit AnalysisExerciseExercise TherapyHumansMulticenter Studies as TopicPainQuality of LifeRandomized Controlled Trials as TopicSARS-CoV-2ExerciseOsteoarthritisPain science educationPhysical activityPhysiotherapyRCTStrengthening programWalking program

Identifiers

PMID34454458
PMCPMC8401372

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.