Group Physical Therapy Program for Veterans With Knee Osteoarthritis

Knee osteoarthritis is a common and often painful condition affecting many Veterans, causing joint stiffness, discomfort, and reduced mobility that can significantly impact daily life. Physical therapy is a well-established, effective treatment approach that helps manage these symptoms through targeted exercises and education. However, access to physical therapy services has been challenging within the VA system due to high demand and limited availability, leading to long wait times or costly referrals to community providers. This research addresses these barriers by implementing and comparing two different approaches to delivering group physical therapy programs across multiple VA sites.

The study builds on previous successful research showing that group physical therapy for knee osteoarthritis provides comparable benefits to individual therapy while being more efficient and accessible. In earlier work involving 19 VA sites, 366 Veterans participated in group physical therapy and experienced meaningful improvements in pain and physical function. This new phase of research will expand and refine these approaches to ensure they reach as many Veterans as possible, particularly those who might otherwise face barriers to care.

This implementation study will involve 20 VA medical sites across the country, randomly assigned to one of two support approaches. The first approach, called Foundational Support, provides comprehensive resources including a detailed Group PT toolkit, training materials, data tracking systems, and opportunities for staff to share experiences and solutions. The second approach, called Reach+Equity Bundle, includes all the foundational support elements plus additional strategies specifically designed to enhance equitable access. These additional strategies include external facilitation to help sites overcome implementation barriers, equity-focused toolkits to ensure consideration of all patients' needs, and data monitoring to track progress toward equitable participation goals.

The group physical therapy program itself consists of six sessions that combine exercise and education components. Participants learn exercises to strengthen the muscles around the knee, improve flexibility, and reduce pain, while also receiving education about managing their condition long-term. The sessions can be delivered either in-person or via telehealth, depending on the site's capabilities and patient preferences. To participate in the group therapy, Veterans need a clinician's diagnosis of symptomatic knee osteoarthritis and must not have conditions that would make group exercise unsafe, such as significant fall risk or other health concerns that could be aggravated by physical activity.

The research team will measure several important outcomes over 18 months, with additional assessments at 6 and 12 months. The primary focus is on reach – how many Veterans actually begin the group therapy program. Secondary measures include fidelity (how consistently participants attend sessions), adoption (whether sites successfully establish and maintain the program), and clinical outcomes including pain levels, physical function, and satisfaction with care. The study will use standardized measures like the PROMIS pain interference and physical function scales, along with practical tests like the 30-second chair stand test, which measures how many times a person can stand up from a seated position in 30 seconds – an important indicator of lower body strength and functional mobility.

This research is particularly important because it addresses both the clinical needs of Veterans with knee osteoarthritis and the systemic challenges of delivering effective care within the VA system. By testing different implementation strategies, the study aims to identify the most effective ways to expand access to evidence-based care while ensuring that all Veterans, regardless of background or circumstances, have opportunities to benefit. The findings will help inform how group physical therapy programs can be successfully implemented across the VA healthcare system and potentially other healthcare settings.

For Veterans living with knee osteoarthritis, this research represents an important step toward more accessible and effective pain management and functional improvement. The group format not only provides clinical benefits but also offers social support and shared learning experiences that many patients find valuable. The emphasis on equitable reach means that the program is designed to serve diverse Veteran populations, including those who might traditionally face barriers to accessing specialized care.

The broader importance of this type of implementation research cannot be overstated. While many effective treatments exist for common conditions like osteoarthritis, getting these treatments to the patients who need them remains a significant challenge in healthcare systems worldwide. Implementation science – the study of how to effectively integrate research findings into routine clinical practice – plays a crucial role in bridging this gap. By systematically testing different approaches to delivering proven treatments, studies like this one help ensure that scientific advances actually translate into better patient care and outcomes.

For caregivers and family members of Veterans with knee osteoarthritis, this research offers hope for more accessible and comprehensive care options. The group therapy model may reduce wait times and provide more consistent support than individual therapy appointments, while the focus on education empowers patients to better manage their condition over the long term. As the population ages and the prevalence of osteoarthritis increases, developing efficient, effective, and equitable delivery models for proven interventions becomes increasingly important for maintaining quality of life and functional independence.

The study is led by researchers at the Durham VA Medical Center and is scheduled to run from October 2026 through September 2030, with results expected to inform VA physical therapy services and potentially influence care models for osteoarthritis management in other healthcare systems. The comprehensive nature of this research – examining not just clinical outcomes but also implementation processes and equitable access – makes it particularly valuable for advancing both patient care and healthcare delivery science.