Background: Osteoarthritis (OA) has a major impact on mobility and the loss of productivity of patients, especially knee OA (KOA). Obesity is one of the main risk factors for the incidence and prevalence of KOA. Weight loss alone decreases pain and improves quality of life and functional scores. Objective: To use BMI, body fat, and calorie intake to measure the effect of a multi-professional educational program on patients with KOA and correlate these measurements with subjective questionnaire results. Methods: A total of 198 patients undergoing standard treatment for KOA were randomized to 4 groups. All groups received written and video information regarding KOA. Three groups (1, 2 and 3) also attended two days of lectures 1, 2 and 3 months apart, respectively, whereas group 4 did not. Each group was divided into subgroups A (bimonthly telephone calls) and B (no telephone calls). All patients were evaluated at baseline and at one year for BMI, waist-hip ratio (WHR), percentage of body fat, and calorie intake and with the WOMAC, LEQUESNE, VAS and SF-36 questionnaires. Results: The WHR showed 89.4% of android obesity at baseline and 87.9% at one year without improvement (p = 0.38). Body fat decreased by 0.44% regardless of group or subgroup. Calorie intake was different between groups (p = 0.019) according to phone calls and follow-up (p = 0.03). BMI and body fat percentage were correlated with the WOMAC, WOMAC pain, VAS and LEQUESNE scores at baseline and at reassessment. Weight was correlated with the baseline results of the WOMAC pain (r = 0.175, p = 0.014), VAS (r = 0.155, p = 0.029), LEQUESNE (r = 0.161, p = 0.023), SF-36-PCS (r = ?0.186, p = 0.009) and SF-36-MCS (r = 0.155, p = 0.029) scores and with the one-year results of the WOMAC (r = 0.155, p = 0.029) and WOMAC pain (r = 0.151, p = 0.034) scores. Conclusion: The multi-professional treatment program had very little impacts on the percentage of body fat. This improvement was independent of classes, telephone calls, or improvements in pain, function and quality of life. Calorie intake improvement was influenced by telephone calls and classes but was not associated with objective measurements of/or changes in weight, BMI, or body fat percentage or with subjective improvements.
Osteoarthritis (OA) is the most frequent form of arthritis and the main cause of chronic disability [
In Brazil, according to information from the National Household Sample Survey (PNAD) 2008, the prevalence of arthritis or rheumatism corresponds to 5.7% of Brazil’s population [
Currently, OA is irreversible [
Accumulation of metabolic syndrome (MetS) components appears to be associated with a higher intensity of knee pain independent of weight; therefore, appropriate treatment of MetS may be helpful for subjects with KOA [
The aim of this study is to evaluate the effects of multi-professional education in patients with knee osteoarthritis (KOA) by anthropometric measurements, including variations of the percentage of body fat, calorie intake, and waist-hip ratio, and by pain, functional and quality of life questionnaires and to correlate the obtained results.
This prospective, randomized controlled trial followed the guidelines of the CONSORT statements for randomized controlled trials and non-drug treatments [
Care providers included one nutritionist, seven orthopedic surgeons, four psychologists, three social workers, five occupational therapists, three physical therapists and two physical educators, all of whom were volunteers or staff at the Orthopedic Institute, Hospital das Clínicas, University of São Paulo.
Patients had to meet the following criteria: outpatient of 45 years of age or older with KOA according to the American College of Rheumatology clinical and radiological definition [
Participants were undergoing standard care for the treatment of KOA at the Osteometabolic Diseases Group, Department of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo. By November 2011, 306 patients were receiving standard care for KOA, which included being followed by orthopedic surgeons and submitting to blood tests for metabolic syndrome (with a referral to a general practitioner for clinical control) and calcium metabolism, X-rays, densitometry and more specific images (ultrasound and magnetic resonance image (MRI)) depending on symptoms. All patients were prescribed diacerhein. Paracetamol and codeine were offered for pain. Muscle relaxants and magnesium were prescribed if patients complained of cramps. Non-steroidal anti-inflammatory drugs (NSAIDs) were used for short periods of time for severe pain. Vitamin D3 and calcium supplements were prescribed according to blood levels and bone densitometry results. When present, osteoporosis was treated with alendronate. Based on X-rays, orthotics, such as custom-made hand orthotics and valgus or varus insoles, canes, and walkers were prescribed. Patients were referred to physical therapy and acupuncture when they suffered impaired mobility and pain. Of these 306 patients, 228 met the inclusion criteria and were interested in participating in the study.
At enrollment, patients were evaluated for anthropometric data, BMI and waist-hip ratio; had seven skin folds measured to obtain the percentage of body fat; and were asked for details on their diet over the previous last 24 hours to estimate calorie intake. Patients were also asked to respond to the VAS (Visual Analogue Scale), WOMACTM, Lequesne and SF-36 questionnaires [
Participants were randomly allocated in four groups (1 to 4, according to days of lectures) and 2 subgroups (A and B, according to telephone calls) of 28 or 29 participants each. Three groups had two days of lectures on OA. All groups received printed material to read and a video with all the lectures. Groups 1, 2, and 3 attended lectures one, two and three months apart, respectively. Group 4 received the educational material only. Subgroup A received bimonthly telephone calls, and subgroup B did not receive telephone calls. Patients in each group were asked to come to the hospital on two specific Saturdays according to the intervals of their group.
The program, explained partially in the short-term results [
Both days of lectures had 30- to 60-minute intervals at 9:30 (30 minutes), 13:00 (1 hour) and 16:00 (30 minutes) for meals with the diet suggested by the nutritionist. Patients followed the recommendations of eating every 3 hours and of consuming colorful foods, 3 to 5 fruits a day (exceptions when restricted by clinicians), whole wheat grains, and 8 glasses of water/tea or juice (one fruit/glass only) a day with the exception of patients with fluid restrictions.
The physicians called patients in subgroup A two months after the lecture and then every other month until the 1-year reassessment. Patients were asked about pain, medication, diet, occupational therapy, and social and/or physical activity and frequency. They were reminded to read the booklet or watch the DVD as well as to exercise at least three times a week (preferably daily) and to follow correct diet, social and occupational habits.
Twelve months after the final lecture or after receiving the educational material, patients returned for an evaluation. Again, patients were evaluated for anthropometric data; seven skin folds; previous 24-hour diet for calorie intake estimation; and LEQUESNE, WOMACTM, VAS, and SF-36 questionnaires. The evaluators were blinded to the allocation.
This is a pilot study to evaluate the best (time-wise) intervention to add multi-professional education to KOA clinical treatment. The authors aimed to have 30 patients in each group.
Randomization was performed by a computer-generated program (available at http://www.randmization.com/). Patients were randomly allocated in one of the 4 groups.
There was no difference in demographics between groups. Groups 1, and 3 had classroom instructions from professionals as well as audio-visual and written instructions, which group 4 also received. Patients knew when signing the informed consent that groups would differ according to time between classes or lack of classes and telephone calls or lack thereof. Evaluators did not know the group to which each patient belonged. Two secretaries scheduled appointments, classes, and material retrieval and plotted the questionnaire results in Excel.
Anthropometric and dietary measures have been described by groups, telephone calls and evaluation moments using summary measures (mean, standard deviation and 95% confidence interval). The values between groups, the presence or lack of telephone calls, and moments of evaluation were compared using analysis of variance with repeated measures with three factors, followed by Bonferroni multiple comparisons to compare the groups, telephone calls and evaluation moments as needed.
Pearson correlations were made between functional scales and anthropometric measurements and calorie intake at baseline and at the one-year reassessment.
The existence of a marginal association between the type of obesity at baseline and at reassessment was verified using the McNemar test.
Changes in pain, function and quality of life scores were compared according to the type of obesity at baseline and at reassessment using Student’s t-test (Kirkwood and Sterne, 2006).
The tests were conducted at a 5% significance level.
Of the 306 patients assessed for eligibility, 246 met the inclusion criteria. However, only 228 agreed to participate (
Variable | Source | df num. | df den. | F. Value | p |
---|---|---|---|---|---|
Waist/Hip Ratio | Moment | 1 | 190 | 1.35 | 0.247 |
Moment * Group | 3 | 190 | 3.14 | 0.027 | |
Moment * Calling | 1 | 190 | 1.82 | 0.178 | |
Moment * Group * Calling | 3 | 190 | 0.49 | 0.690 | |
Group | 3 | 190 | 0.57 | 0.639 | |
Calling | 1 | 190 | 0.72 | 0.398 | |
Group * Calling | 3 | 190 | 0.93 | 0.426 | |
Weight (Kg) | Moment | 1 | 190 | 1.22 | 0.270 |
Moment * Group | 3 | 190 | 0.14 | 0.936 | |
Moment * Calling | 1 | 190 | 0.80 | 0.372 | |
Moment * Group * Calling | 3 | 190 | 0.38 | 0.764 | |
Group | 3 | 190 | 2.54 | 0.058 | |
Calling | 1 | 190 | 0.35 | 0.555 | |
Group * Calling | 3 | 190 | 1.17 | 0.321 | |
BMI (Kg/m2) | Moment | 1 | 190 | 0.10 | 0.748 |
Moment * Group | 3 | 190 | 1.18 | 0.318 | |
Moment * Calling | 1 | 190 | 1.98 | 0.161 | |
Moment * Group * Calling | 3 | 190 | 0.97 | 0.410 | |
Group | 3 | 190 | 1.45 | 0.231 | |
Calling | 1 | 190 | 0.84 | 0.360 | |
Group * Calling | 3 | 190 | 0.47 | 0.704 | |
Percentage of Body Fat | Moment | 1 | 190 | 8.55 | 0.004 |
Moment * Group | 3 | 190 | 0.39 | 0.758 | |
Moment * Calling | 1 | 190 | 0.15 | 0.698 | |
Moment * Group * Calling | 3 | 190 | 1.77 | 0.155 | |
Group | 3 | 190 | 0.91 | 0.436 | |
Calling | 1 | 190 | 0.70 | 0.405 | |
Group * Calling | 3 | 190 | 0.60 | 0.616 | |
Calorie Intake (Kcal consumed) | Moment | 1 | 189 | 1.01 | 0.315 |
Moment * Group | 3 | 189 | 2.58 | 0.055 | |
Moment * Calling | 1 | 189 | 4.03 | 0.046 | |
Moment * Group * Calling | 3 | 189 | 3.04 | 0.030 | |
Group | 3 | 189 | 3.41 | 0.019 | |
Calling | 1 | 189 | 3.74 | 0.055 | |
Group * Calling | 3 | 189 | 6.05 | 0.001 |
identified between any two groups (
The average body fat percentage differed between moments of evaluation regardless of group or subgroup (p = 0.004,
Caloric intake was influenced by group, subgroup, and moment of evaluation (
Type of obesity did not change significantly from baseline to the one-year reassessment, as shown in
Change in caloric intake was inversely correlated with the change in WOMAC pain (r = −0.141, p = 0.048). Again, the correlation value was very close to zero, although it was statistically significant (
Group/Moment | Comparisons | Mean Difference | S.E. | df | p | 95% CI | |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
2 days of lectures 1 month apart | Baseline - 12 months | −0.003 | 0.004 | 1 | >0.999 | −0.017 | 0.010 |
2 days of lectures 2 months apart | Baseline - 12 months | −0.008 | 0.004 | 1 | >0.999 | −0.021 | 0.005 |
2 days of lectures 3 months apart | Baseline - 12 months | 0.011 | 0.004 | 1 | 0.339 | −0.003 | 0.024 |
No classroom intervention | Baseline - 12 months | −0.012 | 0.004 | 1 | 0.163 | −0.025 | 0.002 |
Baseline | Lectures 1 month apart - Lectures 2 months apart | −0.011 | 0.018 | 1 | >0.999 | −0.066 | 0.045 |
Lectures 1 month apart - Lectures 3 months apart | −0.027 | 0.018 | 1 | >0.999 | −0.082 | 0.029 | |
Lectures 1 month apart - no classroom intervention | −0.015 | 0.018 | 1 | >0.999 | −0.071 | 0.041 | |
Lectures 2 months apart - Lectures 3 months apart | −0.016 | 0.018 | 1 | >0.999 | −0.072 | 0.040 | |
Lectures 2 months apart - no classroom intervention | −0.005 | 0.018 | 1 | >0.999 | −0.061 | 0.051 | |
Lectures 3 months apart - no classroom intervention | 0.011 | 0.018 | 1 | >0.999 | −0.045 | 0.068 | |
12 Months | Lectures 1 month apart - Lectures 2 months apart | −0.015 | 0.018 | 1 | >0.999 | −0.071 | 0.040 |
Lectures 1 month apart - Lectures 3 months apart | −0.013 | 0.018 | 1 | >0.999 | −0.068 | 0.043 | |
Lectures 1 month apart - no classroom intervention | −0.024 | 0.018 | 1 | >0.999 | −0.080 | 0.032 | |
Lectures 2 months apart - Lectures 3 months apart | 0.003 | 0.018 | 1 | >0.999 | −0.053 | 0.058 | |
Lectures 2 months apart - no classroom intervention | −0.008 | 0.018 | 1 | >0.999 | −0.064 | 0.048 | |
Lectures 3 months apart - no classroom intervention | −0.011 | 0.018 | 1 | >0.999 | −0.067 | 0.045 |
Group/Moment/Calling | Comparisons | Mean Difference | S.E. | df | p | 95% IC | |
---|---|---|---|---|---|---|---|
Lower | Upper | ||||||
Lectures 1 month apart - w/o telephone calls | Baseline - 12 months | −339.2 | 160.9 | 1 | >0.999 | −907.2 | 228.8 |
Lectures 1 month apart - with telephone calls | Baseline - 12 months | 285.9 | 163.1 | 1 | >0.999 | −289.8 | 861.6 |
Lectures 2 months apart - w/o telephone calls | Baseline - 12 months | −526.2 | 160.9 | 1 | 0.129 | −1094.1 | 41.8 |
Lectures 2 months apart - with telephone calls | Baseline - 12 months | −130.8 | 160.9 | 1 | >0.999 | −698.7 | 437.2 |
Lectures 3 months apart - w/o telephone calls | Baseline - 12 months | 186.1 | 152.1 | 1 | >0.999 | −350.6 | 722.8 |
Lectures 3 months apart - with telephone calls | Baseline - 12 months | −131.5 | 171.6 | 1 | >0.999 | −736.9 | 474.0 |
Educational material only - w/o telephone calls | Baseline - 12 months | −21.2 | 160.9 | 1 | >0.999 | −589.1 | 546.8 |
Educational material only - with telephone calls | Baseline - 12 months | 200.2 | 167.8 | 1 | >0.999 | −392.0 | 792.3 |
Lectures 1 month apart - Baseline | w/o telephone calls - with telephone calls | 380.4 | 193.9 | 1 | >0.999 | −304.1 | 1064.8 |
Lectures 1 month apart - 12 months | w/o telephone calls - with telephone calls | 1005.4 | 195.7 | 1 | <0.001 | 314.6 | 1696.3 |
Lectures 2 month apart - Baseline | w/o telephone calls - with telephone calls | −3.9 | 193.9 | 1 | >0.999 | −688.3 | 680.5 |
Lectures 2 month apart - 12 months | w/o telephone calls - with telephone calls | 391.5 | 193.9 | 1 | >0.999 | −292.9 | 1075.9 |
Lectures 3 month apart - Baseline | w/o telephone calls - with telephone calls | 81.4 | 195.3 | 1 | >0.999 | −608.0 | 770.8 |
Lectures 3 month apart - 12 months | w/o telephone calls - with telephone calls | −236.1 | 195.3 | 1 | >0.999 | −925.5 | 453.3 |
Educational material only - Baseline | w/o telephone calls - with telephone calls | −300.9 | 198.1 | 1 | >0.999 | −1000.1 | 398.2 |
Educational material only - 12 months | w/o telephone calls - with telephone calls | −79.6 | 198.1 | 1 | >0.999 | −778.7 | 619.6 |
Without telephone calls - Baseline | Lectures 1 month apart - Lectures 2 months apart | 19.1 | 193.9 | 1 | >0.999 | −665.3 | 703.5 |
Lectures 1 month apart - Lectures 3 months apart | −169.5 | 188.7 | 1 | >0.999 | −835.3 | 496.4 | |
Lectures 1 month apart - Educational material only | 118.6 | 193.9 | 1 | >0.999 | −565.8 | 803.0 | |
Lectures 2 months apart - Lectures 3 months apart | −188.6 | 188.7 | 1 | >0.999 | −854.4 | 477.3 | |
Lectures 2 months apart - Educational material only | 99.5 | 193.9 | 1 | >0.999 | −584.9 | 783.9 | |
Lectures 3 months apart - Educational material only | 288.1 | 188.7 | 1 | >0.999 | −377.8 | 953.9 |
Type of Obesity | Baseline | 12 Months | p | ||
---|---|---|---|---|---|
n | % | n | % | ||
Android | 177 | 89.4 | 174 | 87.9 | 0.375 |
Gynecoid | 21 | 10.6 | 24 | 12.1 | |
Total | 198 | 100 | 198 | 100 |
McNemar test.
Variable | Type of obesity | Baseline | 12 Months | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Median | Minimum | Maximum | N | p | Mean | SD | Median | Minimum | Maximum | N | p | |||
WOMAC | Android | 1.57 | 17.80 | 2 | −35 | 60 | 177 | 0.963 | 1.62 | 17.67 | 2 | −34 | 60 | 174 | 0.879 | |
Gynecoid | 1.38 | 14.42 | 2 | −23 | 33 | 21 | 1.04 | 16.05 | 2 | −35 | 33 | 24 | ||||
WOMAC Pain | Android | 0.52 | 4.43 | 1 | −15 | 13 | 177 | 0.816 | 0.59 | 4.29 | 1 | −13 | 13 | 174 | 0.428 | |
Gynecoid | 0.29 | 3.65 | 0 | −5 | 9 | 21 | −0.17 | 4.80 | 0 | −15 | 9 | 24 | ||||
VAS | Android | 3.37 | 30.05 | 2 | −84 | 80 | 177 | 0.612 | 3.53 | 29.34 | 1.5 | −73 | 80 | 174 | 0.499 | |
Gynecoid | −0.10 | 24.98 | 0 | −41 | 59 | 21 | −0.83 | 31.17 | 2 | −84 | 59 | 24 | ||||
Lequesne | Android | −0.02 | 4.21 | 0 | −15 | 15 | 177 | 0.588 | −0.08 | 4.15 | 0 | −15 | 15 | 174 | 0.300 | |
Gynecoid | 0.50 | 3.07 | 0.5 | −4 | 8 | 21 | 0.85 | 3.74 | 0.25 | −4 | 11 | 24 | ||||
SF-36 PCS | Android | 0.86 | 9.09 | 0.8 | −27.6 | 28.5 | 177 | 0.563 | 1.07 | 8.87 | 0.95 | −27.6 | 28.5 | 174 | 0.156 | |
Gynecoid | −0.36 | 9.64 | −1.1 | −15 | 16.4 | 21 | −1.75 | 10.73 | −1.2 | −23.7 | 16.4 | 24 | ||||
SF-36 MCS | Android | 2.43 | 13.19 | 1.5 | −33 | 53 | 177 | 0.726 | 2.31 | 13.30 | 1.35 | −33 | 53 | 174 | 0.983 | |
Gynecoid | 1.38 | 10.45 | 1.8 | −15 | 28 | 21 | 2.37 | 9.80 | 2.3 | -15 | 28 | 24 | ||||
t-Student test.
Correlation | Baseline | 12 Months | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
WOMAC | WOMAC Pain | VAS | Lequesne | SF-36 PCS | SF-36 MCS | WOMAC | WOMAC Pain | VAS | Lequesne | SF-36 PCS | SF-36 MCS | |||
Waist/Hip Ratio | r | 0.068 | −0.024 | 0.064 | 0.028 | 0.018 | 0.026 | 0.089 | 0.022 | 0.086 | 0.121 | −0.102 | 0.029 | |
p | 0.343 | 0.740 | 0.367 | 0.694 | 0.801 | 0.714 | 0.213 | 0.757 | 0.229 | 0.090 | 0.152 | 0.688 | ||
N | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | ||
Weight | r | 0.137 | 0.175 | 0.155 | 0.161 | −0.186 | 0.155 | 0.155 | 0.151 | 0.104 | 0.174 | −0.118 | 0.058 | |
p | 0.054 | 0.014 | 0.029 | 0.023 | 0.009 | 0.029 | 0.029 | 0.034 | 0.144 | 0.014 | 0.097 | 0.416 | ||
N | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | ||
BMI | r | 0.164 | 0.199 | 0.154 | 0.158 | −0.204 | 0.034 | 0.174 | 0.200 | 0.15 | 0.181 | −0.110 | −0.042 | |
p | 0.021 | 0.005 | 0.031 | 0.027 | 0.004 | 0.633 | 0.014 | 0.005 | 0.035 | 0.011 | 0.124 | 0.553 | ||
N | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | ||
Percentage of body fat | r | 0.177 | 0.191 | 0.193 | 0.161 | −0.232 | −0.077 | 0.240 | 0.249 | 0.217 | 0.228 | −0.108 | −0.085 | |
p | 0.013 | 0.007 | 0.006 | 0.023 | 0.001 | 0.279 | 0.001 | <0.001 | 0.002 | 0.001 | 0.132 | 0.236 | ||
N | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | 198 | ||
Calorie intake (Kcal consumed) | r | −0.096 | −0.127 | −0.136 | −0.050 | 0.020 | 0.074 | −0.034 | −0.070 | −0.088 | −0.068 | 0.037 | 0.005 | |
p | 0.177 | 0.073 | 0.056 | 0.485 | 0.783 | 0.299 | 0.634 | 0.328 | 0.218 | 0.340 | 0.608 | 0.943 | ||
N | 198 | 198 | 198 | 198 | 198 | 198 | 197 | 197 | 197 | 197 | 197 | 197 | ||
Correlations | WOMAC | WOMAC Pain | VAS | Lequesne | SF-36 PCS | SF-36 MCS | |
---|---|---|---|---|---|---|---|
Waist/Hip Ratio (baseline - 12 months) | r | 0.139 | 0.062 | 0.062 | 0.046 | 0.099 | 0.089 |
p | 0.051 | 0.386 | 0.388 | 0.516 | 0.166 | 0.212 | |
N | 198 | 198 | 198 | 198 | 198 | 198 | |
Weight (baseline - 12 months) | r | 0.123 | 0.077 | 0.067 | 0.061 | 0.017 | 0.098 |
p | 0.083 | 0.282 | 0.346 | 0.394 | 0.812 | 0.169 | |
N | 198 | 198 | 198 | 198 | 198 | 198 | |
BMI (baseline - 12 months) | r | −0.034 | 0.022 | 0.000 | −0.037 | 0.009 | 0.018 |
p | 0.634 | 0.761 | 0.995 | 0.601 | 0.896 | 0.798 | |
N | 198 | 198 | 198 | 198 | 198 | 198 | |
Percentage of body Fat (baseline - 12 months) | r | 0.135 | 0.131 | 0.116 | 0.061 | 0.066 | 0.063 |
p | 0.059 | 0.067 | 0.103 | 0.395 | 0.353 | 0.378 | |
N | 198 | 198 | 198 | 198 | 198 | 198 | |
Calorie Intake (baseline - 12 months) | r | −0.110 | −0.141 | −0.055 | 0.009 | −0.102 | −0.036 |
p | 0.124 | 0.048 | 0.444 | 0.895 | 0.152 | 0.614 | |
N | 197 | 197 | 197 | 197 | 197 | 197 |
The purpose of this study was to objectively measure the effects of a multi-professional educational program for patients with knee OA by comparing weight, BMI, body fat percentage and calorie intake with subjective scores. The waist-hip ratio has been shown to correlate with KOA and WOMAC scores [
It has been said that weight loss alone decreases pain and improves quality of life and functional scores [
The percentage of body fat improved in all patients regardless of group or subgroup. The body fat percentage improvement shows that patients gained lean body mass even if they did not lose weight, which may reflect increased physical activity, a reduced calorie intake and/or improved diet quality. The percentage of body fat also correlated with the WOMAC, WOMAC pain and Lequesne scores at baseline and at reassessment. Changes in calorie intake correlated inversely with changes in the WOMAC pain score, suggesting that the greater the reduction in calorie consumption, the less improvement in pain the patient had. Because this information is contrary to all published studies [
Patients were initially unaware of the relationship between their diet habits, their body composition and their symptoms. Their diets had excessive carbohydrates and saturated fat and very little fiber, i.e., their diet quality and quantity were poor. Changes in calorie intake at the one-year reassessment were influenced by group and subgroup. The group with classes one month apart showed a lower caloric intake than the other groups at the one-year reassessment. Those in group 1 who received bimonthly telephone calls also had a lower caloric intake than those in group 1 without telephone calls. Because this lower caloric intake was not reflected in weight loss or in a lower BMI or percentage of body fat, one must question the accuracy of their answers. Patients might have responded based on what the investigators taught but did not actually apply what they learned.
Our study has limitations. First, it is a pilot study. Almost 200 patients were distributed among 8 groups. Second, our patients were of a low socio-economic level. This implies difficulties in actually acquiring good- quality food, because carbohydrates are less expensive and more easily acquired, as well as difficulties in comprehension, but at the same time indicates that this population is our target. We must be able to help them based on this reality. Third, we did not monitor lipid and sugar levels. Blood testing was performed to verify metabolism disorders, but it was not the aim of the study to correlate anthropometric data with sugar and lipid blood levels. This could be performed in future studies. Fourth, we did not control physical activity levels to correlate our results. These data exist and can be analyzed on future studies. Roughly 2/3 did not change or even increased BMI after the educational program. The program must be improved to reach a significant number of patients with clinically relevant improvements.
The multi-professional treatment program had very little impacts on the percentage of body fat. This improvement was independent of classes, telephone calls, or improvements in pain, function and quality of life. Calorie intake improvement was influenced by telephone calls and classes but was not associated with objective measurements of weight, BMI, or body fat percentage or with subjective improvements.
Ethical ApprovalThis prospective, randomized controlled trial was conducted under the principles of the Helsinki Declaration and approved by the Ethics Committee for the Analysis of Research Projects (CAPPesq) under protocol number 0622/11. Clinical Trials registration number: NCT01572051.
This study could not been performed without the voluntary help of Heloísa Ungaro, Paulo Dallari, Miriam Damaris Di Maio, Alípio Jose Gusmão dos Santos, and Pérola Grinberg Plapler; the secretaries (especially Suellen Lima, Natalia Borges, Rosilane Zaranelli Castro Dutra and Mercedes Alves Coutinho); the occupational therapist team; the social workers; the physical therapists; the psychologists; the physical educators; and the security staff of Hospital das Clínicas, Department of Orthopedics, Faculdade de Medicina Universidade de São Paulo.
This study was funded by both TRB Pharma TM-Brazil and the Department of Orthopedics and Traumatology, Hospital das Clínicas, University of São Paulo, neither of which had any role in the project design and implementation, data collection, analysis and interpretation, or manuscript writing.
Nádia Lucila RochaBrito,Marcia Uchoade Rezende,ThiagoPasqualin,Gustavo Constantinode Campos,RenatoFrucchi,Marcelo IssaoHissadomi,Alexandre FelicioPailo,Olavo Piresde Camargo, (2016) Analysis of Anthropometric Measurements and Dietary Intake in Patients Undergoing a Multi-Professional Osteoarthritis Education Program (PARQVE-Project Arthritis Recovering Quality of Life by Means of Education). Open Journal of Orthopedics,06,32-45. doi: 10.4236/ojo.2016.62006