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Type: Journal article
Title: Effect of a low-intensity, self-management lifestyle intervention on knee pain in community-based young to middle-aged rural women: a cluster randomised controlled trial
Author: Wang, Y.
Lombard, C.
Hussain, S.
Harrison, C.
Kozica, S.
Brady, S.
Teede, H.
Cicuttini, F.
Citation: Arthritis Research and Therapy, 2018; 20(1):74
Publisher: BMC
Issue Date: 2018
ISSN: 1478-6354
Statement of
Yuanyuan Wang, Catherine Lombard, Sultana Monira Hussain, Cheryce Harrison, Samantha Kozica, Sharmayne R. E. Brady, Helena Teede and Flavia M. Cicuttini
Abstract: BACKGROUND:Knee pain is common with obesity and weight gain being important risk factors. Previous clinical trials have focused on overweight or obese adults with knee pain and osteoarthritis and demonstrated modest effects of intense weight loss programs on reducing knee pain despite very significant weight loss. There has been no lifestyle intervention that targets community-based adults to test its effect on prevention of knee pain. We aimed to determine the effect of a simple low-intensity self-management lifestyle intervention (HeLP-her), proven in randomised controlled trials to improve lifestyle and prevent weight gain, on knee pain in community-based young to middle-aged rural women. METHODS:A 1-year pragmatic, cluster randomised controlled trial was conducted in 649 community-based women (aged 18-50 years) to receive either the HeLP-her program (consisting of one group session, monthly SMS text messages, one phone coaching session, and a program manual) or one general women's health education session. Secondary analyses were performed in 390 women who had knee pain measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and 12-month follow-up. "Any knee pain" was defined as a WOMAC pain score ≥ 1. Knee pain worsening was defined as an increase in WOMAC pain score over 12 months. RESULTS:Thirty-five percent of women had "any knee pain" at baseline. The risk of knee pain worsening did not differ between the intervention and control groups over 12 months. For women with any knee pain at baseline, those in the intervention arm had a lower risk of knee pain worsening compared with those in the control arm (OR 0.37, 95% CI 0.14-1.01, p = 0.05), with a stronger effect observed in women with body mass index ≥ 25 kg/m2 (OR 0.28, 95% CI 0.09-0.87, p = 0.03). CONCLUSIONS:In community-based young to middle-aged women, a simple low-intensity lifestyle program reduced the risk of knee pain worsening in those with any knee pain at baseline, particularly in those overweight or obese. Pragmatic lifestyle programs such as HeLP-her may represent a feasible lifestyle intervention to reduce the burden of knee pain in the community. TRIAL REGISTRATION:ACTRN12612000115831 , registered 24 January 2012.
Keywords: Knee Joint; Humans; Arthralgia; Obesity; Life Style; Telemedicine; Adolescent; Adult; Middle Aged; Rural Population; Australia; Female; Overweight; Patient Education as Topic; Young Adult; Text Messaging; Self-Management
Rights: © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated
RMID: 0030113635
DOI: 10.1186/s13075-018-1572-5
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