The use of booster sessions in physical therapy management of individuals with knee OA is an emerging field of research. Bennell and colleagues found that the addition of two booster sessions to a course of physical therapy did not impact pain, function or adherence to a home exercise program at 24 weeks.19 However, all participants were provided with an exercise log book to motivate them to continue their home exercise program. It’s possible that the provision of the log book served as a type of booster by reminding patients to continue their exercise program. This may have confounded the results, because it may be argued that both groups received some form of booster.
In contrast, the aforementioned 2015 study by Abbott found that exercise therapy with booster sessions over one year provided greater benefits in self-reported pain and physical function (using the WOMAC) compared with exercise therapy alone.14 In the larger 2016 study by Fitzgerald, the use of booster sessions did not result in additive improvement in WOMAC scores, but secondary analyses showed that use of booster sessions improved knee pain and odds of being a responder at one year (substantial patient-rated improvement using OARSI-OMERACT responder criteria).15,20 Taken together, these studies suggest using booster sessions may be a promising way to sustain treatment effects over time; however, further research is necessary to clarify the role of booster sessions in sustaining positive effects of exercise and manual therapy for individuals with knee OA.
Physical activity promotion: Optimal self-management of knee OA requires a commitment to regular physical activity. However, the best method for encouraging those with OA to meet physical activity recommendations is not clear. A recent review of physical activity programs for overweight individuals with OA noted that, “evidence for long-term maintenance of physical activity behaviors is limited and needs further investigation.”9 Among articles included in that review, most did not find a benefit to various self-management or walking promotion programs.21-23
Pisters compared a “behavioral graded activity” program with standard physical therapy for individuals with hip or knee OA.24 The behavioral graded activity intervention slowly increases the dose of physical activity over time and uses principles of operant conditioning and self-regulation to promote a more physically active lifestyle. They found that the behavioral graded activity program significantly increased the odds of adhering to the prescribed exercises (OR 3.0, 95% CI 1.5–6.0) and meeting physical activity recommendations (OR 2.9, 95% CI 1.2–6.7) at 65 weeks.24 In this study, only the individuals receiving behavioral graded activity intervention received booster sessions. Therefore, it is not possible to state whether the benefits for the experimental group are due to differences in the components of the two interventions, differences in the time over which the face-to-face interventions were delivered or a combination of both.
