Denise Ayres ¹ Sabrina Saemy Tome Uchiyama ² Andrea Oliveira Prates ¹ Rosana Aparecida de Freitas Lopes ¹ Antenor Bispo dos Santos Silva ¹ Denise Rodrigues Tsukimoto ¹ Rosimeire Alves Amorim ¹ Taynah Souza Ribeiro ¹ Artur César Aquino Santos ¹ Andre Tadeu Sugawara ^1,2 MARCOS MONTAGNINI ³ Linamara Rizzo Battistella ^1,2 Marta Imamura ^1,2*

• ¹ Instituto de Medicina Fisica e Reabilitacao, IMREA, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR, Sao Paulo, Brazil
• ² Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao, Faculdade de Medicina da Universidade de Sao Paulo, FMUSP, Sao Paulo, SP, BR, Sao Paulo, Brazil
• ³ University of Michigan, Ann Arbor, Michigan, United States

Background: Knee osteoarthritis (KOA) is the most common form of arthritis in adults and a leading cause of years lived with disability, representing a significant burden on healthcare worldwide. Objective: Describe the structure and educational elements of the Knee-SCHOOL, a brief patient-centered multidisciplinary educational program for patients with KOA. Design: Observational prospective study. Setting: Academically affiliated rehabilitation outpatient center in Brazil. Methods: The program consisted of three in-person educational sessions (4.5 hours each) for 55 community dwelling adults, aged ≥ 50 years, with primary KOA-related pain. Study measures included demographic data (age, sex, and educational level), pain duration (years), pain intensity (Visual Analogue Scale), affected knee (right, left, or both knees), comorbidities (presence of hypertension, Diabetes, and hypercholesterolemia), Body Mass Index (BMI), Bristol Stool Scale, Adapted Healthy Eating Index (AHEI), bioelectrical impedance, daytime sleepiness, and the impact of the KOA on pain, symptoms, activities of daily living, recreation, and quality of life. Participants attended educational sessions delivered by a multidisciplinary team (two physicians, two nurses, two physical therapists, one occupational therapist, one dietitian, one psychologist, one social worker, and one exercise instructor) addressing several aspects of KOA. They also participated in supervised exercise practice and a home exercise program. Results: Fifty-five subjects completed the study. The mean age was 67.73 (± 7.73) years; most were females (70.9%), 92.7% had bilateral KOA, with mean pain duration of 12.41 (± 10.17) years. The mean BMI was 32.52 (± 5.99), 65.5% were obese, and 96.4% reported an inadequate diet. KOA had a more negative impact on sports, recreation and quality of life. Daytime sleepiness was uncommon. The mean pain intensity, measured with visual analogue scale, score reduced from 5.52 (± 2.11) at baseline to 4.04 (± 2.38) after the program (week 2). The effect size was 0.7 (95% CI 0.32 to 1.07). All participants received the program well, with no drop-out rates or reported adverse events. Conclusion: The Knee-SCHOOL utilized a multidisciplinary educational approach and an exercise practice addressing multiple aspects of KOA pain. While more studies are needed to assess the longitudinal impact of the program, it was promising in managing pain.