Implementation of Group Physical Therapy for Knee Osteoarthritis: A Cluster Randomized Clinical Trial

Allen, KD; Webb, S; Coffman, CJ; Anderson, L; Cummin, G; Drake, C; Tucker, M; Webster, A; Sperber, N; Zullig, LL; Hughes, JM; Ballengee, LA; Abbate, LM; Hoenig, H; Fullenkamp, N; Van Houtven, CH; Hastings, SN

doi:10.1001/jamanetworkopen.2025.35038

Implementation of Group Physical Therapy for Knee Osteoarthritis: A Cluster Randomized Clinical Trial

JAMA Netw OpenPublished 1 Oct 2025Cluster randomised controlled trial

Primary result · Penetration, patients enrolled per monthResultMean difference −0.1 patients enrolled 95% CI −1.1 to 1.0

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Authors' conclusion

In this cluster randomized clinical trial, an enhanced implementation support approach for delivering group PT did not outperform foundational support.

Study context

Population: Outpatient physical therapy (PT) departments at Veterans Affairs (VA) Healthcare sites delivering 6 sessions of group PT over 12 months to patients with symptomatic knee OA
Participants: 19 sites

Comparison: Enhanced implementation support (foundational plus tailored external facilitation) vs foundational support for delivering group PT
Enhanced supportn = 10 sites; 68 patients
Foundational supportn = 9 sites; 76 patientsreference
Primary endpoint: Penetration: mean number of patients enrolled per month (site level)
Follow-up: Months 7 to 12

Methodological detailscluster randomized, implementation trial, Conducted January 31, 2022, to March 18, 2024; 3 cohorts

Cluster randomized
Implementation trial
Conducted January 31, 2022, to March 18, 2024; 3 cohorts

Primary result

Penetration, patients enrolled per month

Mean difference

−0.1 patients enrolled

95% CI −1.1 to 1.0

P = 0.92

By group

Enhanced support1.0mean · 95% CI 0.2–1.7 · patients enrolled per month

Foundational support1.0mean · 95% CI 0.1–1.9 · patients enrolled per month

Enhanced supportvs Foundational support

mean difference −0.1 patients enrolled (95% CI −1.1 to 1.0); P = 0.92

As reported in the abstract

Further findings

Outcome	Enhanced support	Foundational support	← Lower with enhanced support ←→ Higher with enhanced support →	Mean difference (classes per patient) (95% CI)	P value
Fidelity, classes attended per patient (max 6) · months 7 to 12	mean 5.0 (95% CI 4.3–5.7) classes attended per patient	mean 4.1 (95% CI 3.2–4.9) classes attended per patient	−1012	0.9 (0.0–1.9)	P = 0.06
			−1012Difference, classes per patient (linear scale)

Original publication

Implementation of Group Physical Therapy for Knee Osteoarthritis: A Cluster Randomized Clinical Trial. JAMA Netw Open. Published 1 October 2025. doi:10.1001/jamanetworkopen.2025.35038

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