{"doi":"10.7326/m20-4447","title":"Stepped Exercise Program for Patients With Knee Osteoarthritis","abstract":"BACKGROUND: Evidence-based models are needed to deliver exercise-related services for knee osteoarthritis efficiently and according to patient needs OBJECTIVE: To examine a stepped exercise program for patients with knee osteoarthritis (STEP-KOA). DESIGN: Randomized controlled trial. (ClinicalTrials.gov: NCT02653768). SETTING: 2 U.S. Department of Veterans Affairs sites. PARTICIPANTS: 345 patients (mean age, 60 years; 15% female; 67% people of color) with symptomatic knee osteoarthritis. INTERVENTION: Participants were randomly assigned in a 2:1 ratio to STEP-KOA or an arthritis education (AE) control group, respectively. The STEP-KOA intervention began with 3 months of an internet-based exercise program (step 1). Participants who did not meet response criteria for improvement in pain and function after step 1 progressed to step 2, which involved 3 months of biweekly physical activity coaching calls. Participants who did not meet response criteria after step 2 went on to in-person physical therapy visits (step 3). The AE group received educational materials via mail every 2 weeks. MEASUREMENTS: Primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Scores for the STEP-KOA and AE groups at 9 months were compared by using linear mixed models. RESULTS: In the STEP-KOA group, 65% of participants (150 of 230) progressed to step 2 and 35% (81 of 230) to step 3. The estimated baseline WOMAC score for the full sample was 47.5 (95% CI, 45.7 to 49.2). At 9-month follow-up, the estimated mean WOMAC score was 6.8 points (CI, -10.5 to -3.2 points) lower in the STEP-KOA than the AE group, indicating greater improvement. LIMITATION: Participants were mostly male veterans, and follow-up was limited. CONCLUSION: Veterans in STEP-KOA reported modest improvements in knee osteoarthritis symptoms compared with the control group. The STEP-KOA strategy may be efficient for delivering exercise therapies for knee osteoarthritis. 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Byrd","orcid":null,"position":4,"is_corresponding":false},{"id":292207,"name":"Kevin Caves","orcid":"0000-0001-6630-9615","position":5,"is_corresponding":false},{"id":231461,"name":"Katherine S. Hall","orcid":"0000-0002-9834-2011","position":6,"is_corresponding":false},{"id":292208,"name":"Bryan C. Heiderscheit","orcid":"0000-0003-4956-1776","position":7,"is_corresponding":false},{"id":293659,"name":"Nancy Jo Hodges","orcid":null,"position":8,"is_corresponding":false},{"id":235342,"name":"Kim M. Huffman","orcid":"0000-0003-4708-4734","position":9,"is_corresponding":false},{"id":292209,"name":"Miriam C. Morey","orcid":"0000-0002-1230-7590","position":10,"is_corresponding":false},{"id":293660,"name":"Shalini Ramasunder","orcid":null,"position":11,"is_corresponding":false},{"id":292210,"name":"Herbert H. Severson","orcid":"0000-0002-0911-5395","position":12,"is_corresponding":false},{"id":292211,"name":"Courtney H. Van Houtven","orcid":"0000-0002-0783-1611","position":13,"is_corresponding":false},{"id":293661,"name":"Lauren M. Abbate","orcid":null,"position":14,"is_corresponding":false},{"id":292212,"name":"Cynthia J. Coffman","orcid":"0000-0002-4554-1463","position":15,"is_corresponding":false},{"id":292204,"name":"Kelli D. Allen","orcid":"0000-0002-3886-0677","position":0,"is_corresponding":true}],"reference_count":42,"raw_metadata":null,"created_at":"2026-07-18T21:05:49.581291Z","pmid":"33370174","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}