Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and/or knee: A randomized clinical trial

Cindy Veenhof, Albère J.A. Köke, Joost Dekker, Rob A. Oostendorp, Johannes W.J. Bijlsma, Maurits W. Van Tulder, Cornelia H.M. Van Den Ende, A.J.A. Koke, CH Van den Ende

Research output: Contribution to JournalArticleAcademicpeer-review

83 Citations (Scopus)


Objective. To determine the effectiveness of a behavioral graded activity program (BGA) compared with usual care (UC; exercise therapy and advice) according to the Dutch guidelines for physiotherapy in patients with osteoarthritis (OA) of the hip and/or knee. The BGA intervention is intended to increase activity in the long term and consists of an exercise program with booster sessions, using operant treatment principles. Methods. We conducted a cluster randomized trial involving 200 patients with hip and/or knee OA. Primary outcome measures were pain (visual analog scale [VAS] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), physical function (WOMAC), and patient global assessment, assessed at weeks 0,13, 39, and 65. Secondary outcome measures comprised tiredness (VAS), patient-oriented physical function (McMaster Toronto Arthritis Patient Preference Disability Questionnaire [MACTAR]), 5-meter walking time, muscle strength, and range of motion. Data were analyzed according to intent-to-treat principle. Results. Both treatments showed short-term and long-term beneficial within-group effects. The mean differences between the 2 groups for pain and functional status were not statistically significant. Significant differences in favor of BGA were found for the MACTAR functional scale and 5-meter walking test at week 65. Conclusion. Because both interventions resulted in beneficial long-term effects, the superiority of BGA over UC has not been demonstrated. Therefore, BGA seems to be an acceptable method to treat patients with hip and/or knee OA, with equivalent results compared with UC.

Original languageEnglish
Pages (from-to)925-934
Number of pages10
JournalArthritis Care and Research
Issue number6
Publication statusPublished - 15 Dec 2006


  • Behavioral treatment
  • Booster sessions
  • Exercise therapy
  • Graded activity
  • Osteoarthritis
  • Physiotherapy
  • Randomized controlled trial

Cite this