Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review

Abstract

Background With the increasing adoption of high-speed internet and mobile technologies by older adults, digital health is a promising modality to enhance clinical care for people with knee osteoarthritis (KOA), including those with knee replacement (KR). Objective This study aimed to summarize the current use, cost-effectiveness, and patient and clinician perspectives of digital health for intervention delivery in KOA and KR. Methods In this narrative review, search terms such as mobile health, smartphone, mobile application, mobile technology, ehealth, text message, internet, knee osteoarthritis, total knee arthroplasty, and knee replacement were used in the PubMed and Embase databases between October 2018 and February 2021. The search was limited to original articles published in the English language within the past 10 years. In total, 91 studies were included. Results Digital health technologies such as websites, mobile apps, telephone calls, SMS text messaging, social media, videoconferencing, and custom multi-technology systems have been used to deliver interventions in KOA and KR populations. Overall, there was significant heterogeneity in the types and applications of digital health used in these populations. Digital patient education improved disease-related knowledge, especially when used as an adjunct to traditional methods of patient education for both KOA and KR. Digital health that incorporated person-specific motivational messages, biofeedback, or patient monitoring was more successful at improving physical activity than self-directed digital interventions for both KOA and KR. Many digital exercise interventions were found to be as effective as in-person physical therapy for people with KOA. Many digital exercise interventions for KR incorporated both in-person and web-based treatments (blended format), communication with clinicians, and multi-technology systems and were successful in improving knee range of motion and self-reported symptoms and reducing the length of hospital stays. All digital interventions that incorporated cognitive behavioral therapy or similar psychological interventions showed significant improvements in knee pain, function, and psychological health when compared with no treatment or traditional treatments for both KOA and KR. Although limited in number, studies have indicated that digital health may be cost-effective for these populations, especially when travel costs are considered. Finally, although patients with KOA and KR and clinicians had positive views on digital health, concerns related to privacy and security and concerns related to logistics and training were raised by patients and clinicians, respectively. Conclusions For people with KOA and KR, many studies found digital health to be as effective as traditional treatments for patient education, physical activity, and exercise interventions. All digital interventions that incorporated cognitive behavioral therapy or similar psychological treatments were reported to result in significant improvements in patients with KOA and KR when compared with no treatment or traditional treatments. Overall, technologies that were blended and incorporated communication with clinicians, as well as biofeedback or patient monitoring, showed favorable outcomes.

Assessing the importance of predictors of adherence to a digital self‑management intervention for osteoarthritis

“…Digital therapeutics, including smartphone apps, have emerged as an accessible solution to address these barriers with the potential to facilitate better patient-provider interactions and lead to more personalized care [ 7 , 10 , 11 ]. These interventions have shown efficacy in promoting physical activity and improving patients’ pain, function, and quality of life [ 7 , 12 , 13 ]. A major requisite to a digital intervention’s success is adherence [ 14 , 15 ], defined as the extent to which a person’s behaviour matches agreed recommendations [ 16 ].…”

“…However, implementation of these recommendations in clinical practice is suboptimal, with two recent systematic reviews reporting that only one in three persons with OA receives appropriate non-pharmacological care according to the guidelines [5,6]. Lack of knowledge about treatment approaches and guidelines by healthcare providers and patients, limited provision of these treatments, and constraints related to access, time, and costs have been identified as major barriers to implementing these recommendations in clinical practice [7][8][9].…”

Effect of a mHealth exercise intervention compared with supervised exercise therapy in osteoarthritis management: protocol of the DigiOA trial

“…This trial will contribute with knowledge regarding an innovative approach to OA management, through the integration of a digital intervention strategy. Previous studies have found the use of digital interventions in OA care and musculoskeletal physiotherapy to be potentially as effective as standard treatment 25 40. If deemed to be non-inferior, further integration of digital exercise programmes in the treatment of patients with OA could fulfil the requirement of a personalised treatment approach, creating an option for greater empowerment of the patient 41.…”

“…Increased knowledge and sound trials evaluating the use of digital interventions are sought for in musculoskeletal conditions 40 45. This trial will add to the current knowledge on effectiveness of digital interventions and may provide knowledge that can be used in improving accessibility and quality in OA care.…”

The impact of eHealth on relationships and trust in primary care: A review of reviews

“…104 However, some also valued the "undivided communication" offered via phone-based interventions. 107 One review noted that patients reported more positive experiences with both phone and video consultations being used together. 57 2.…”