Cognitive Muscular TherapyTM for knee osteoarthritis: a feasibility randomised controlled trial

Objective: People with knee osteoarthritis exhibit overactivity of the knee muscles during functional tasks. This will increase mechanical loads and may exacerbate pain. Cognitive Muscular TherapyTM (CMT) is a new conservative intervention that aims to reduce muscle overactivity and change habitual responses to pain. This study was designed to assess the feasibility of a future randomised controlled trial, designed to compare CMT with usual care. Methods: Patients with knee osteoarthritis, who had failed to benefit from previous therapeutic exercise, were randomised to receive CMT or usual care. Participants in the CMT arm were offered seven individual sessions, delivered by an NHS physiotherapist trained to deliver the intervention. Trial feasibility was assessed by monitoring recruitment, adherence, retention, treatment fidelity and acceptability through an embedded process evaluation. Secondary outcome measures included WOMAC and the Pain Catastrophizing Scale. Results: 82 patients were recruited from 164 screened. Of the 42 allocated to the CMT arm, 32 completed the treatment. Retention was acceptable in the CMT arm but higher than anticipated in the usual care arm. Both patients and physiotherapists found the treatment to be acceptable, and the mean intervention fidelity score was 91%. Composite WOMAC score reduced by 17.1 points in the CMT arm from baseline to 20-weeks, and 2.8 points in the control arm over the same period. Conclusions: CMT is an acceptable intervention for people with knee osteoarthritis. Future large-scale trials are now required to quantify the clinical effectiveness of this promising new treatment. Keywords: knee osteoarthritis; physiotherapy; rehabilitation; EMG; biofeedback; behavioural intervention Trial registration: ISRCTN25291958