A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program

Clare E Safran-Norton, James K Sullivan, James J Irrgang, Hannah M Kerman, Kim L Bennell, Gary Calabrese, Leigh Dechaves, Brian Deluca, Alexandra B Gil, Madhuri Kale, Brittney Luc-Harkey, Faith Selzer, Derek Sople, Peter Tonsoline, Elena Losina, Jeffrey N Katz, Clare E Safran-Norton, James K Sullivan, James J Irrgang, Hannah M Kerman, Kim L Bennell, Gary Calabrese, Leigh Dechaves, Brian Deluca, Alexandra B Gil, Madhuri Kale, Brittney Luc-Harkey, Faith Selzer, Derek Sople, Peter Tonsoline, Elena Losina, Jeffrey N Katz

Abstract

Background: Knee osteoarthritis (OA) is prevalent and often associated with meniscal tear. Physical therapy (PT) and exercise regimens are often used to treat OA or meniscal tear, but, to date, few programs have been designed specifically for conservative treatment of meniscal tear with concomitant knee OA. Clinical care and research would be enhanced by a standardized, evidence-based, conservative treatment program and the ability to study the effects of the contextual factors associated with interventions for patients with painful, degenerative meniscal tears in the setting of OA. This paper describes the process of developing both a PT intervention and a home exercise program for a randomized controlled clinical trial that will compare the effectiveness of these interventions for patients with knee pain, meniscal tear and concomitant OA.

Methods: This paper describes the process utilized by an interdisciplinary team of physical therapists, physicians, and researchers to develop and refine a standardized in-clinic PT intervention, and a standardized home exercise program to be carried out without PT supervision. The process was guided in part by Medical Research Council guidance on intervention development.

Results: The investigators achieved agreement on an in-clinic PT intervention that included manual therapy, stretching, strengthening, and neuromuscular functional training addressing major impairments in range of motion, musculotendinous length, muscle strength and neuromotor control in the major muscle groups associated with improving knee function. The investigators additionally achieved agreement on a progressive, protocol-based home exercise program (HEP) that addressed the same major muscle groups. The HEP was designed to allow patients to perform and progress the exercises without PT supervision, utilizing minimal equipment and a variety of methods for instruction.

Discussion: This multi-faceted in-clinic PT program and standardized HEP provide templates for in-clinic and home-based care for patients with symptomatic degenerative meniscal tear and concomitant OA. These interventions will be tested as part of the Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial.

Trial registration: The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004 on February 14, 2017. TeMPO was also approved by the Institutional Review Board at Partners HealthCare/Brigham and Women's Hospital.

Keywords: Home exercise program; Meniscal tear; Osteoarthritis; Physical therapy; Randomized trial.

Conflict of interest statement

The authors declare that they have no competing interests.

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