Does targeting pain-related beliefs in people with knee osteoarthritis increase physical activity? A randomised, sham-controlled, feasibility trial.

ine of ten people with knee osteoarthritis are inactive. Unhelpful pain beliefs may negatively influence physical activity levels. Targeting these unhelpful pain beliefs, via contemporary pain science education (PSE), may provide benefit. Here we aimed to evaluate the feasibility of conducting a clinical trial to determine the effect of adding PSE (vs adding sham ultrasound) to an individualised, physiotherapist-led education and walking program in people with painful knee osteoarthritis. Twenty participants were randomised (1:1) into the PSE or Control group, with clinical outcomes and physical activity (7 days of wrist-worn accelerometry) assessed at baseline, 4 (clinical outcomes only), 8, and 26 weeks. Feasibility criteria for recruitment, intervention adherence, viability of wrist-based accelerometry, and follow-up retention were set. Perceived intervention credibility, acceptability, usefulness from participants and clinicians were assessed. Our results showed that most feasibility criteria were met. We had sufficient recruitment, treatment compliance was high, and wrist-based accelerometry had >75% valid wear-time. However, Sufficient follow-up rates were not achieved (26 weeks: 65%). Participant and clinician feedback highlighted that PSE was too complex. Together this suggests that progression to a full trial is warranted. Strategies to increase participant retention and refine the PSE content/delivery are required.