The EPIPHA-KNEE trial: Explaining Pain to target unhelpful pain beliefs to Increase PHysical Activity in KNEE osteoarthritis - a protocol for a multicentre, randomised controlled trial with clinical- and cost-effectiveness analysis

Tasha R Stanton, Felicity A Braithwaite, David Butler, G Lorimer Moseley, Catherine Hill, Rachel Milte, Julie Ratcliffe, Carol Maher, Christy Tomkins-Lane, Brian W Pulling, Erin MacIntyre, Adrian Esterman, Ty Stanford, Hopin Lee, Francois Fraysse, Ben Metcalf, Brendan Mouatt, Kim Bennell, Tasha R Stanton, Felicity A Braithwaite, David Butler, G Lorimer Moseley, Catherine Hill, Rachel Milte, Julie Ratcliffe, Carol Maher, Christy Tomkins-Lane, Brian W Pulling, Erin MacIntyre, Adrian Esterman, Ty Stanford, Hopin Lee, Francois Fraysse, Ben Metcalf, Brendan Mouatt, Kim Bennell

Abstract

Background: Despite well-established benefits of physical activity for knee osteoarthritis (OA), nine of ten people with knee OA are inactive. People with knee OA who are inactive often believe that physical activity is dangerous, fearing that it will further damage their joint(s). Such unhelpful beliefs can negatively influence physical activity levels. We aim to evaluate the clinical- and cost-effectiveness of integrating physiotherapist-delivered pain science education (PSE), an evidence-based conceptual change intervention targeting unhelpful pain beliefs by increasing pain knowledge, with an individualised walking, strengthening, and general education program.

Methods: Two-arm, parallel-design, multicentre randomised controlled trial involving 198 people aged ≥50 years with painful knee OA who do not meet physical activity guideline recommendations or walk regularly for exercise. Both groups receive an individualised physiotherapist-led walking, strengthening, and OA/activity education program via 4x weekly in-person treatment sessions, followed by 4 weeks of at-home activities (weekly check-in via telehealth), with follow-up sessions at 3 months (telehealth) and 5 and 9 months (in-person). The EPIPHA-KNEE group also receives contemporary PSE about OA/pain and activity, embedded into all aspects of the intervention. Outcomes are assessed at baseline, 12 weeks, 6 and 12 months. Primary outcomes are physical activity level (step count; wrist-based accelerometry) and self-reported knee symptoms (WOMAC Total score) at 12 months. Secondary outcomes are quality of life, pain intensity, global rating of change, self-efficacy, pain catastrophising, depression, anxiety, stress, fear of movement, knee awareness, OA/activity conceptualisation, and self-regulated learning ability. Additional measures include adherence, adverse events, blinding success, COVID-19 impact on activity, intention to exercise, treatment expectancy/perceived credibility, implicit movement/environmental bias, implicit motor imagery, two-point discrimination, and pain sensitivity to activity. Cost-utility analysis of the EPIPHA-KNEE intervention will be undertaken, in addition to evaluation of cost-effectiveness in the context of primary trial outcomes.

Discussion: We will determine whether the integration of PSE into an individualised OA education, walking, and strengthening program is more effective than receiving the individualised program alone. Findings will inform the development and implementation of future delivery of PSE as part of best practice for people with knee OA.

Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12620001041943 (13/10/2020).

Keywords: Exercise; Osteoarthritis; Pain science education; Physical activity; Physiotherapy; RCT; Strengthening program; Walking program.

Conflict of interest statement

TRS receives payment for lectures on pain and rehabilitation. TRS, DB, and GLM are authors of the Explain Pain Osteoarthritis Handbook and will receive royalties from sales should it progress to market. GLM and DB receive author royalties for other related books on pain and rehabilitation. GLM has received support from Reality Health, ConnectHealth, sporting organisations and various workers’ compensation and income protection insurers for work related to pain education and rehabilitation and has received payment for lectures on pain and rehabilitation. FAB has received speaker fees for providing lectures related to pain and blinding in clinical trials. BWP has received honoraria from Elsevier for contributing to a textbook on geriatric physical therapy. BM receives remuneration from The Knowledge Exchange for provision of continuing professional development workshops related to pain and exercise rehabilitation. KB received payments from Wolters Kluwer for UpToDate clinical OA guidelines.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Participant flow through the randomised controlled trial
Fig. 2
Fig. 2
Study procedures and timing of outcome assessments. NRS = Numeric Rating Scale; Rx = in-person treatment session; TH = Telehealth (Telephone call or videoconferencing); Wk = Week; PSE = Pain Science Education; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index

References

    1. March LM, Bagga H. Epidemiology of osteoarthritis in Australia. Med J Aust. 2004;180(S5):S6–10. doi: 10.5694/j.1326-5377.2004.tb05906.x.
    1. Access Economics. Painful realities: the economic impact of arthritis in Australia 2007. Arthritis Australia. Available from:.
    1. Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011;14(1):4–9. doi: 10.1016/j.jsams.2010.08.002.
    1. Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews.2015, Issue 1. Art. No.: CD004376. 10.1002/14651858.CD004376.pub3.
    1. Wallis JA, Taylor NF. Pre-operative interventions (non-surgical and non-pharmacological) for patients with hip or knee OA awaiting joint replacement surgery - a systematic review and meta-analysis. Osteoarthr Cartilage. 2011;19(12):1381–1395. doi: 10.1016/j.joca.2011.09.001.
    1. Dunlop DD, Song J, Lee J, Gilbert AL, Semanik PA, Ehrlich-Jones L, Pellegrini CA, Pinto D, Ainsworth B, Chang RW. Physical activity minimum threshold predicting improved function in adults with lower limb symptoms. Arthritis Care Res. 2017;69(4):475–483. doi: 10.1002/acr.23181.
    1. Song J, Gilbert AL, Chang RW, Pellegrini CA, Ehrlich-Jones LS, Lee J, Pinto D, Semanik PA, Sharma L, Kwoh CK, Jackson RD, Dunlop DD. Do inactive older adults who increase physical activity experience less disability: evidence from the osteoarthritis initiative. J Clin Rhematol. 2017;23(1):26–32. doi: 10.1097/RHU.0000000000000473.
    1. Wallis JA, Webster KE, Levinger P, Taylor NF. What proportion of people with hip and knee OA meet physical activity guidelines? A systematic review and meta-analysis. Osteoarthr Cartilage. 2013;21(11):1648–1659. doi: 10.1016/j.joca.2013.08.003.
    1. Neusch E, Dieppe P, Reichenbach S, et al. All cause and disease specific mortality in people with osteoarthritis of the knee or hip: population based cohort study. BMJ. 2011;342(mar08 2):d1165. doi: 10.1136/bmj.d1165.
    1. Dobson F, Bennell KL, French SD, Nicolson PJA, Klaasman RN, Holden MA, Atkins L, Hinman RS. Barriers and facilitators to exercise participation in people with hip and/or knee OA: synthesis of the literature using behavior change theory. Am J Phys Med Rehabil. 2016;95(5):372–389. doi: 10.1097/PHM.0000000000000448.
    1. Wilcox S, Der Ananian C, Abbott J, et al. Perceived exercise barriers, enablers and benefits among exercising and nonexercising adults with arthritis: results from a qualitative study. Arthritis & Rheum. 2006;55(4):616–627. doi: 10.1002/art.22098.
    1. Bunzli S, O'Brien P, Ayton D, et al. Misconceptions and the acceptance of evidence-based nonsurgical interventions for knee osteoarthritis. A qualitative study. Clin Orthop Relat Res. 2019;477(9):1975–1983. doi: 10.1097/CORR.0000000000000784.
    1. Pouli N, Nair RD, Lincoln NB, et al. The experience of living with knee OA: exploring illness and treatment beliefs through thematic analysis. Disabil Rehabil. 2014;36(7):600–607. doi: 10.3109/09638288.2013.805257.
    1. Edwards RR, Dolman AJ, Martel MO, et al. Variability in conditioned pain modulation predicts response to NSAIDtreatment in patients with knee osteoarthritis. BMC Musculoskelet Disord. 2016;17:284. 10.1186/s12891-016-1124-6.
    1. Helmark IC, Mikkelsen UR, Børglum J, et al. Exercise increases interleukin-10 levels both intraarticularly and perisynoviallyin patients with knee osteoarthritis: a randomized controlled trial. Arthritis Res Ther. 2010;12(4):R126.10.1186/ar3064.
    1. Liu Y, Ding W, Wang HL, Dai LL, Zong WH, Wang YZ, Bi J, Han W, Dong GJ. Gut microbiota and obesity-associated osteoarthritis. Osteoarthr Cartil. 2019;27(9):1257–1265. doi: 10.1016/j.joca.2019.05.009.
    1. Morris JL, Letson HL, Gillman R, Hazratwala K, Wilkinson M, McEwen P, Dobson GP. The CNS theory of osteoarthritis: opportunities beyond the joint. Semin Arthritis Rheum. 2019;49(3):331–336. doi: 10.1016/j.semarthrit.2019.03.008.
    1. Roos EM, Dahlberg L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis Rheum. 2005;52(11):3507–3514. doi: 10.1002/art.21415.
    1. Shelby RA, Somers TJ, Keefe FJ, DeVellis BM, Patterson C, Renner JB, Jordan JM. Brief fear of movement scale for OA. Arthritis Care Res. 2012;64(6):862–871. doi: 10.1002/acr.21626.
    1. Somers TJ, Keefe FJ, Pells JJ, Dixon KE, Waters SJ, Riordan PA, Blumenthal JA, McKee DC, LaCaille L, Tucker JM, Schmitt D, Caldwell DS, Kraus VB, Sims EL, Shelby RA, Rice JR. Pain catastrophizing and pain-related fear in osteoarthritis patients: relationships to pain and disability. J Pain Symptom Manag. 2009;37(5):863–872. doi: 10.1016/j.jpainsymman.2008.05.009.
    1. Holden MA, Nicholls EE, Young J, Hay EM, Foster NE. Role of exercise for knee pain: what do older adults in the community think? Arthritis Care Res. 2012;64(10):1554–1564. doi: 10.1002/acr.21700.
    1. Holden MA, Nicholls EE, Hay EM, Foster NE. Physical therapists' use of therapeutic exercise for patients with clinical knee OA in the UK: in line with current recommendations? Phys Ther. 2008;88(10):1109–1121. doi: 10.2522/ptj.20080077.
    1. Quicke JG, Foster NE, Thomas MJ, Holden MA. Is long-term physical activity safe for older adults with knee pain? A systematic review. Osteoarthr Cartil. 2015;23(9):1445–1456. doi: 10.1016/j.joca.2015.05.002.
    1. Larsson C, Ekvall Hansoon E, Sundquist K, et al. Impact of pain characteristics and fear-avoidance beliefs on physical activity levels among older adults with chronic pain: a population-based, longitudinal study. BMC Geriatr. 2016;16(1):50. doi: 10.1186/s12877-016-0224-3.
    1. Quicke JG, Foster NE, Ogollah RO, Croft PR, Holden MA. The relationship between attitudes, beliefs and physical activity in older adults with knee pain: secondary analysis of a randomised controlled trial. Arthritis Care Res. 2017;69(8):1192–2000. doi: 10.1002/acr.23104.
    1. Pisters MF, Veenhof C, van Meeteren NL, et al. Long-term effectiveness of exercise therapy in patients with OA of the hip or knee: a systematic review. Arthritis Rheum. 2007;57(7):1245–1253. doi: 10.1002/art.23009.
    1. Williamson W, Kluzek S, Roberts N, Richards J, Arden N, Leeson P, Newton J, Foster C. Behavioural physical activity interventions in participants with lower-limb OA: a systematic review and meta-analysis. BMJ Open. 2015;5(8):e007642. doi: 10.1136/bmjopen-2015-007642.
    1. Mazieres B, Thevenon A, Coudeyre E, et al. Adherence to, and results of, physical therapy programs in patients with hip or knee OA. Development of French clinical practice guidelines. Joint Bone Spine. 2008;75(5):589–596. doi: 10.1016/j.jbspin.2008.02.016.
    1. Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain. 2015;16(9):807–813. doi: 10.1016/j.jpain.2015.05.005.
    1. Smith BE, Moffatt F, Hendrick P, Bateman M, Selfe J, Rathleff MS, Smith TO, Logan P. Barriers and facilitators of loaded self-managed exercises and physical activity in people with patellofemoral pain: understanding the feasibility of delivering a multicentred randomised controlled trial, a UK qualitative study. BMJ Open. 2019;9(6):e023805. doi: 10.1136/bmjopen-2018-023805.
    1. National Institute for Health and Care Excellence (NICE). Osteoarthritis: care and management. Clinical Guideline [CG177].Published: 12 Feb 2014. Updated: 11 Dec 2020. Available from: .
    1. Gay C, Chabaud A, Guilley E, Coudeyre E. Education patients about the benefits of physical activity and exercise for their hip and knee osteoarthritis. Systematic literature review. Ann Phys Rehabil Med. 2016;59(3):174–183. doi: 10.1016/j.rehab.2016.02.005.
    1. Focht BC. Effectiveness of exercise interventions in reducing pain symptoms among older adults with knee osteoarthritis: a review. J Aging Phys Act. 2006;14(2):212–235. doi: 10.1123/japa.14.2.212.
    1. Kroon FP, van der Burg LR, Buchbinder R, et al. Self-management education programmes for OA. Cochrane Database SystRev. 2014;(1):CD008963. 10.1002/14651858.CD008963.pub2.
    1. Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention inpeople with chronic low back pain. Eur J Pain. 2004;8:39–45. 10.1016/S1090-3801(03)00063-6.
    1. Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20(5):324–330. doi: 10.1097/00002508-200409000-00007.
    1. Moseley GL. Combined physiotherapy and education is efficacious for chronic low back pain. Physiother. 2002;48:297–302.
    1. Moseley GL. Joining forces - combining cognition-targeted motor control training with group or individual pain physiology education: a successful treatment for chronic low back pain. J Man Manip Therapeutics. 2003;11(2):88–94. doi: 10.1179/106698103790826383.
    1. Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial. Man Ther. 2010;15(4):382–387. doi: 10.1016/j.math.2010.03.003.
    1. Tegner H, Frederiksen P, Esbensen BA, Juhl C. Neurophysiological pain education for patients with chronic low Back pain: a systematic review and Meta-analysis. Clin J Pain. 2018;34(8):778–786. doi: 10.1097/AJP.0000000000000594.
    1. Wood L, Hendrick PA. A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: short-and long-term outcomes of pain and disability. Eur J Pain. 2019;23(2):234–249. doi: 10.1002/ejp.1314.
    1. Stanton TR, Karran EL, Butler DS, Hull MJ, Schwetlik SN, Braithwaite FA, Jones HG, Moseley GL, Hill CL, Tomkins-Lane C, Maher C, Bennell K. A pain science education and walking program to increase physical activity in people with symptomatic knee osteoarthritis: a feasibility study. Pain Rep. 2020;5(5):e830. doi: 10.1097/PR9.0000000000000830.
    1. Runhaar J, Beavers DP, Miller GD, Nicklas BJ, Loeser RF, Bierma-Zeinstra S, Messier SP. Inflammatory cytokines mediate the effects of diet and exercise on pain and function in knee osteoarthritis independent of BMI. Osteoarthr Cartil. 2019;27(8):1118–1123. doi: 10.1016/j.joca.2019.04.009.
    1. Voinier D, Neogi T, Stefanik JJ, Guermazi A, Roemer FW, Thoma LM, Master H, Nevitt MC, Lewis CE, Torner J, White DK. Using cumulative load to explain how body mass index and daily walking relate to worsening knee cartilage damage over two years: the MOST study. Arthritis Rheumatol. 2020;72(6):957–965. doi: 10.1002/art.41181.
    1. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, Hróbjartsson A, Mann H, Dickersin K, Berlin JA, Doré CJ, Parulekar WR, Summerskill WSM, Groves T, Schulz KF, Sox HC, Rockhold FW, Rennie D, Moher D. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE, Dixon-Woods M, McCulloch P, Wyatt JC, Chan AW, Michie S. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Brit Med J. 2014;348(mar07 3):g1687. doi: 10.1136/bmj.g1687.
    1. Farrar JT, Young JP, Jr, LaMoreaux L, et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–158. doi: 10.1016/S0304-3959(01)00349-9.
    1. Bennell KL, Egerton T, Martin J, Abbott JH, Metcalf B, McManus F, Sims K, Pua YH, Wrigley TV, Forbes A, Smith C, Harris A, Buchbinder R. Effect of physical therapy on pain and function in patients with hip osteoarthritis: a randomized clinical trial. JAMA. 2014;311(19):1987–1997. doi: 10.1001/jama.2014.4591.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. doi: 10.1016/j.jbi.2008.08.010.
    1. Urbaniak GC, Plous S. Research Randomizer (Version 4.0) [Computer software] 2013. Available from:.
    1. Chi MTH, Wylie R. The ICAP framework: linking cognitive engagement to active learning outcomes. Educ Psychol. 2014;49(4):219–243. doi: 10.1080/00461520.2014.965823.
    1. Gadgil S, Nokes-Malach TJ, Chi MTH. Effectiveness of holistic mental model confrontation in driving conceptual change. Learn Instr. 2012;22(1):47–61. doi: 10.1016/j.learninstruc.2011.06.002.
    1. Zimmerman BJ. Becoming a self-regulated learner: an overview. Theory Pract. 2002;41(2):64–70. doi: 10.1207/s15430421tip4102_2.
    1. Moseley GL. Do training diaries affect and reflect adherence to home programs? Arthritis Care Res. 2006;55(4):662–664. doi: 10.1002/art.22086.
    1. Foster ED, Deardorff A. Open Science Framework (OSF) J Med Libr Assoc. 2017;105(2):203–206.
    1. Butler DS, Moseley GL, Stanton TR. The Explain Pain Handbook: Knee osteoarthritis. Adelaide, South Australia: NOIgrouppublications; NOIgroup Australasia Pty Ltd.; In press.
    1. Arthritis Australia. Taking control of your osteoarthritis: A practical guide to treatments, services and lifestyle choices. 2009,reviewed Nov 2016. p. 1–31. Available from: .
    1. World Health Organization. WHO guidelines on physical activity and sedentary behaviour, Nov 2020. Available from: .
    1. Antcliff D, Keeley P, Campbell M, Woby S, Keenan AM, McGowan L. Activity pacing: moving beyond taking breaks and slowing down. Qual Life Res. 2018;27(7):1933–1935. doi: 10.1007/s11136-018-1794-7.
    1. Bennell KL, Kyriakides M, Metcalf B, Egerton T, Wrigley TV, Hodges PW, Hunt MA, Roos EM, Forbes A, Ageberg E, Hinman RS. Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment: a randomized controlled trial. Arthritis Rheumatol. 2014;66(4):950–959. doi: 10.1002/art.38317.
    1. McDermott MM, Newman AB. Preserving clinical trial integrity during the coronavirus pandemic. JAMA. 2020;323(21):2135–2136. doi: 10.1001/jama.2020.4689.
    1. Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–1840.
    1. Troiano RP, Berrigan D, Dodd KW, et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–188. doi: 10.1249/mss.0b013e31815a51b3.
    1. Troiano RP, McClain JJ, Brychta RJ, et al. Evolution of accelerometer methods for physical activity research. Br J Sports Med. 2014;48(13):1019–1023. doi: 10.1136/bjsports-2014-093546.
    1. Kovar PA, Allengrante JP, MacKenzie CR, et al. Supervised fitness walking in patients with OA of the knee: a randomized, controlled trial. Ann Intern Med. 1992;116(7):529–534. doi: 10.7326/0003-4819-116-7-529.
    1. White DK, Tudor-Locke C, Zhang Y, Fielding R, LaValley M, Felson DT, Gross KD, Nevitt MC, Lewis CE, Torner J, Neogi T. Daily walking the risk of incident functional limitation in knee OA: an observational study. Arthritis Care Res. 2014;66(9):1328–1336. doi: 10.1002/acr.22362.
    1. Gardiner PA, Clark BK, Healy GN, et al. Measuring older adults' sedentary time: reliability, validity and responsiveness. Med Sci Sports Exerc. 2011;43(11):2127–2133. doi: 10.1249/MSS.0b013e31821b94f7.
    1. McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster universities osteoarthritis index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum. 2001;45(5):453–61. 10.1002/1529-0131(200110)45:5<453::AID-ART365>;2-W.
    1. Cella D, Choi SW, Condon DM, Schalet B, Hays RD, Rothrock NE, Yount S, Cook KF, Gershon RC, Amtmann D, DeWalt DA, Pilkonis PA, Stone AA, Weinfurt K, Reeve BB. PROMIS(®) adult health profiles: efficient short-form measures of seven health domains. Value Health. 2019;22(5):537–544. doi: 10.1016/j.jval.2019.02.004.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–396. doi: 10.2307/2136404.
    1. Warttig SL, Forshaw MJ, South J, White AK. New, normative, English-sample data for the short form perceived stress scale (PSS-4) J Health Psychol. 2013;18(12):1617–1628. doi: 10.1177/1359105313508346.
    1. McWilliams LA, Kowal J, Wilson KG. Development and evaluation of short forms of the pain catastrophizing scale and the pain self-efficacy questionnaire. Eur J Pain. 2015;19(9):1342–1349. doi: 10.1002/ejp.665.
    1. Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res. 2011;20(10):1727–1736. doi: 10.1007/s11136-011-9903-x.
    1. Nishigami T, Mibu A, Tanaka K, Yamashita Y, Yamada E, Wand BM, Catley MJ, Stanton TR, Moseley GL. Development and psychometric properties of knee-specific body-perception questionnaire in people with knee osteoarthritis: the Fremantle knee awareness questionnaire. PLoS One. 2017;12(6):e0179225. doi: 10.1371/journal.pone.0179225.
    1. ten Klooster PM, Drossaers-Bakker KW, Taal E, et al. Patient-perceived satisfactory improvement (PPSI): interpreting meaningful change in pain from the patient's perspective. Pain. 2006;121(1–2):151–157. doi: 10.1016/j.pain.2005.12.021.
    1. Matthews CE, Chen KY, Freedson PS, Buchowski MS, Beech BM, Pate RR, Troiano RP. Amount of time spent in sedentary behaviors in the United States, 2003-2004. Am J Epidemiol. 2008;167(7):875–881. doi: 10.1093/aje/kwm390.
    1. Smuck M, Tomkins-Lane C, Ith MA, Jarosz R, Kao MCJ. Physical performance analysis: a new approach to assessing free-living physical activity in musculoskeletal pain and mobility-limited populations. PLoS One. 2017;12(2):e0172804. doi: 10.1371/journal.pone.0172804.
    1. Groll DL, To T. Bombardier C, et al. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol. 2005;58(6):595–602. doi: 10.1016/j.jclinepi.2004.10.018.
    1. Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain. 2007;11(2):153–163. doi: 10.1016/j.ejpain.2005.12.008.
    1. Greenwald AG, McGhee DE, Schwartz JLK. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464–1480. doi: 10.1037/0022-3514.74.6.1464.
    1. Witt JK, Linkenauger SA, Bakdash JZ, Augustyn JS, Cook A, Proffitt DR. The long road of pain: chronic pain increases perceived distance. Exp Brain Res. 2009;192(1):145–148. doi: 10.1007/s00221-008-1594-3.
    1. Stefanucci JK, Proffitt DR, Clore GL, Parekh N. Skating down a steeper slope: fear influences the perception of geographical slant. Perception. 2008;37(2):321–323. doi: 10.1068/p5796.
    1. Wideman TH, Finan PH, Edwards RR, Quartana PJ, Buenaver LF, Haythornthwaite JA, Smith MT. Increased sensitivity to physical activity among individuals with knee osteoarthritis: relation to pain outcomes, psychological factors, and responses to quantitative sensory testing. Pain. 2014;155(4):703–711. doi: 10.1016/j.pain.2013.12.028.
    1. Stanton TR, Lin C-WC, Smeets RJEM, Taylor D, Law R, Lorimer Moseley G. Spatially defined disruption of motor imagery performance in people with osteoarthritis. Rheumatology (Oxford) 2012;51(8):1455–1464. doi: 10.1093/rheumatology/kes048.
    1. Stanton TR, Lin CW, Bray H, et al. Tactile acuity is disrupted in osteoarthritis but is unrelated to disruptions in motor imagery performance. Rheumatology (Oxford) 2013;52(8):1509–1519. doi: 10.1093/rheumatology/ket139.
    1. Pintrich PR, Smith DAF, Duncan T, et al. A manual for the use of the Motivated Strategies for Learning Questionnaire(MSLQ), 1991. Ann Arbor, Mich: National Center for Research to Improve Postsecondary Teaching and Learning
    1. Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73–86. doi: 10.1016/S0005-7916(00)00012-4.
    1. Rhodes RE, Hunt Matheson D, Mark R. Evaluation of social cognitive scaling response options in the physical activity domain. Meas Phys Educ Exerc Sci. 2010;14(3):137–150. doi: 10.1080/1091367X.2010.495539.
    1. Australian Government Department of Health. Manual of resource items and their associated unit costs Canberra, Australia,2016. Available from:
    1. Australian Government Department of Health. MBS Online Medicare Benefits Schedule 2018. Available from:.
    1. Australian Government Department of Health. The Pharmaceutical Benefits Scheme. 2018. Available from:.
    1. Independent Hospital Pricing Authority. National Hospital Cost Data Collection. Sydney, Australia 2019. Available from:
    1. Bang H, Flaherty SP, Kolahi J, Park J. Blinding assessment in clinical trials: a review of statistical methods and a proposal of blinding assessment protocol. Clin Res Regul Aff. 2010;27(2):42–51. doi: 10.3109/10601331003777444.
    1. Cottrell E, Foster NE, Porcheret M, Rathod T, Roddy E. GPs' attitudes, beliefs and behaviours regarding exercise for chronic knee pain: a questionnaire survey. BMJ Open. 2017;7(6):e014999. doi: 10.1136/bmjopen-2016-014999.
    1. Houben RM, Ostelo RW, Vlaeyen JW, et al. Health care providers' orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity. Eur J Pain. 2005;9(2):173–183. doi: 10.1016/j.ejpain.2004.05.002.
    1. Catley MJ, O'Connell NE, Moseley GL. How good is the neurophysiology of pain questionnaire? A Rasch analysis of psychometric properties. J Pain. 2013;14(8):818–827. doi: 10.1016/j.jpain.2013.02.008.
    1. Messier SP, Callahan LF, Golightly YM, Keefe FJ. OARSI clinical trials recommendations: design and conduct of clinical trials of lifestyle diet and exercise interventions for OA. Osteoarthr Cartilage. 2015;23(5):787–797. doi: 10.1016/j.joca.2015.03.008.
    1. Talbot LA, Gaines JM, Huynh TN, Metter EJ. A home-based pedometer-drive walking program to increase physical activity in older adults with OA of the knee: a preliminary study. JAGS. 2003;51(3):387–392. doi: 10.1046/j.1532-5415.2003.51113.x.
    1. Bennell KL, Campbell PK, Egerton T, Metcalf B, Kasza J, Forbes A, Bills C, Gale J, Harris A, Kolt GS, Bunker SJ, Hunter DJ, Brand CA, Hinman RS. Telephone coaching to enhance a home-based physical activity program for knee osteoarthritis: a randomized clinical trial. Arthritis Care Res. 2017;69(1):84–94. doi: 10.1002/acr.22915.
    1. Fitzgerald GK, Piva SR, Gil AB, Wisniewski SR, Oddis CV, Irrgang JJ. Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial. Phys Ther. 2011;91(4):452–469. doi: 10.2522/ptj.20100188.
    1. Williams VJ, Piva SR, Irrgang JJ, Crossley C, Fitzgerald GK. Comparison of reliability and responsiveness of patient-reported clinical outcome measures in knee osteoarthritis rehabilitation. J Orthop Sports Phys Ther. 2012;42(8):716–723. doi: 10.2519/jospt.2012.4038.
    1. Madley-Dowd P, Hughes R, Tilling K, Heron J. The proportion of missing data should not be used to guide decisions on multiple imputation. J Clin Epidemiol. 2019;110:63–73. doi: 10.1016/j.jclinepi.2019.02.016.
    1. Feise RJ. Do multiple outcome measures require p-value adjustment? BMC Med Res Methodol. 2002;2(1):8. doi: 10.1186/1471-2288-2-8.
    1. Perneger TV. What's wrong with Bonferroni adjustments. BMJ. 1998;316(7139):1236–1238. doi: 10.1136/bmj.316.7139.1236.
    1. Brazier J, Ratcliffe J, Salomon J, et al. Measuring and valuing health benefits for economic evaluation. 2nd edition ed. Oxford: Oxford University Press; 2016.
    1. Drummond M, Sculpher M, Claxton K, et al. Methods for the economic evaluation of health care programmes. 2nd edition ed. Oxford: Oxford University Press; 2015.
    1. Imai K, Keele L, Tingley D. A general approach to causal mediation analysis. Psychol Methods. 2010;15(4):309–334. doi: 10.1037/a0020761.
    1. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ (Clinical research ed) 2006;332(7555):1430–1434. doi: 10.1136/bmj.332.7555.1430.
    1. Traeger AC, Lee H, Hübscher M, Skinner IW, Moseley GL, Nicholas MK, Henschke N, Refshauge KM, Blyth FM, Main CJ, Hush JM, Lo S, McAuley JH. Effect of intensive patient education vs placebo patient education on outcomes in patients with acute low Back pain: a randomized clinical trial. JAMA Neurol. 2019;76(2):161–169. doi: 10.1001/jamaneurol.2018.3376.
    1. Moore AJ, Holden MA, Foster NE, et al. Therapeutic alliance facilitates adherence to physiotherapy-led exercise and physical activity for older adults with knee pain: a longitudinal qualitative study. J Phys. 2020;66(1):45–53.
    1. Lawford BJ, Bennell KL, Campbell PK, Kasza J, Hinman RS. Association between therapeutic Alliance and outcomes following telephone-delivered exercise by a physical therapist for people with knee osteoarthritis: secondary analyses from a randomized controlled trial. JMIR Rehabil Assist Technol. 2021;8(1):e23386. doi: 10.2196/23386.
    1. Kelley JM, Lembo AJ, Ablon JS, Villanueva JJ, Conboy LA, Levy R, Marci CD, Kerr CE, Kirsch I, Jacobson EE, Riess H, Kaptchuk TJ. Patient and practitioner influences on the placebo effect in irritable bowel syndrome. Psychosom Med. 2009;71(7):789–797. doi: 10.1097/PSY.0b013e3181acee12.

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