EHealth to empower patients with musculoskeletal pain in rural Australia (EMPoweR) a randomised clinical trial: study protocol

Abstract

Background Low back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide. These conditions result in a significant burden at both individual and societal levels. Engagement in regular physical activity and exercise programs are known to improve physical function in both chronic LBP and knee OA populations. For people residing in rural areas, musculoskeletal conditions are often more frequent and disabling compared to urban populations, which could be the result of reduced access to appropriate health services and resources in rural settings. EHealth is an innovative solution to help provide equitable access to treatment for people with musculoskeletal pain living in rural settings. Methods/design We will conduct a randomised clinical trial investigating the effects of an eHealth intervention compared to usual care, for people with chronic non-specific LBP or knee OA in rural Australia. We will recruit 156 participants with non-specific chronic LBP or knee OA. Following the completion of baseline questionnaires, participants will be randomly allocated to either the eHealth intervention group, involving a tailored physical activity and progressive resistance exercise program remotely delivered by a physiotherapist (n = 78), or usual care (n = 78) involving referral to a range of care practices in the community. Outcomes will be measured at baseline, 3 and 6 months post-randomisation. The primary outcome will be physical function assessed by the Patient-Specific Functional Scale (PSFS). Secondary outcomes include pain intensity, physical activity levels, activity limitations, quality of life, pain coping. We will also collect process evaluation data such as recruitment rate, attendance and adherence, follow-up rate, participants’ opinions and any barriers encountered throughout the trial. Discussion The findings from this trial will establish the effectiveness of eHealth-delivered interventions that are known to be beneficial for people with LBP and knee OA when delivered in person. As a result, this trial will help to inform health care policy and clinical practice in Australia and beyond for those living in non-urban areas. Trial registration This study was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12618001494224) registered 09.05.2018.

Effectiveness of an eHealth‐Delivered Program to Empower People With Musculoskeletal Pain in Rural Australia: A Randomized Controlled Trial

“…Planned post hoc analyses 19 investigating the interaction between treatment groups and conditions revealed a statistically significant effect on the outcome of function, and therefore results were reported separately for low back pain (Supplementary Table 1) and knee osteoarthritis (Supplementary Table 2) for this outcome. There was a statistically significant interaction effect favoring the low back pain group at three (4.8; 95% CI 0.1–9.5; P = 0.042) but not at six months (3.6; 95% CI −1.2 to 8.6; P = 0.142) (Figure 2, Supplementary Table 3).…”

Effects of computer-aided rowing exercise systems on improving muscle strength and function in older adults with mild knee osteoarthritis: a randomized controlled clinical trial

“…Knee OA not only results in joint pain and dysfunction of the knee joint but also leads to disabilities in daily life, economic issues, and care burden for older adults in an aging society [6]; therefore, improving the muscle weakness problem is important. Many exercise programs (conventional aerobic exercise, strength training, and cycling exercise programs) may improve muscle weakness, health conditions (pain, stiffness), and lower limb function in patients with mild knee osteoarthritis [15,16].…”

“…Patients with knee OA exhibit weak flexor and extensor muscle strength, which could result in poor knee joint health condition and risk of functional limitation and disabilities in daily living, economic issues, and care burden for older adults in an aging society [6,54,55]. In this study, after 12 weeks of CRE intervention, patients in the CRE group exhibited significant improvements in WOMAC scores, muscle strength (hip adductors, hip abductors, hip extensors, hip flexors, and knee extensors), and functional fitness (functional reach and 10-m walk tests).…”

“…The clinical symptoms for OA in knee joints include joint stiffness, pain, and functional disabilities, which may decrease the quality of life (QOL) for people with OA [4]. Jessica et al revealed that the medical cost of treating patients with OA is $460 billion, and it is increasing annually [2], which may result in a subsequent rise in the care and economic burden of families in an aging society [5,6]. Therefore, the development of appropriate exercise devices and measures to ameliorate muscle weakness and functional disabilities in older adults with knee OA and improve their QOL have become a critical topic of research.…”

Benefits and Mechanisms of Exercise Training for Knee Osteoarthritis

“…Genetic mutations, obesity, trauma, aging local biomechanical factors, and hormones are vital risk factors of KOA ( Martel-Pelletier et al, 2016 ), which can damage in any joint tissue, but mainly cause cartilage destruction, subchondral bone alteration, and synovial inflammation. Moreover, KOA always reduces patients’ ability to perform activities of daily living and work, which causes a severe economic burden on society ( Mesa-Castrillon et al, 2021 ). Therefore, a treatment that can effectively against the degeneration associated with KOA will significantly benefit both patients and society.…”