Comparing Video-Based Telehealth-Delivered Exercise and Weight Loss Programs With Online Education on Outcomes of Knee Osteoarthritis: A Randomized Trial

Bennell, Kim L; Lawford, Belinda J; Keating, C.; Brown, C.; Kasza, Jess; Mackenzie, Dave; Metcalf, Ben; Kimp, Alexander J.; Egerton, Thorlene; Spiers, Libby; Proietto, J.; Sumithran, Priya; Harris, A.; Quicke, J.G.; Hinman, Rana S

doi:10.1016/j.joca.2022.02.062

Cited by 4 publications

(7 citation statements)

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“…In a recent randomized controlled trial (RCT), we tested the effectiveness of a telehealth program comprising a ketogenic VLCD delivered by dietitians and exercise delivered by physiotherapists for people with knee OA. The trial showed that this combined program led to greater improvements in pain and function, as well as greater weight loss, when compared to an exercise-only program and to online education control [34]. In our qualitative research, participants described positive experiences with the ketogenic VLCD program, valuing its simplicity and effectiveness [35].…”

Section: Introductionmentioning

confidence: 82%

“…Physiotherapists will prescribe a home strengthening exercise program to be performed by the participant at home three times per week. The exercise program was used previously and shown to be effective [34,43,44]. The program will include 5-6 strengthening exercises from a pre-determined list including two quadriceps exercises, one each for the hip abductors, hamstrings and calf muscles, and any other exercise as appropriate from the list (Table 2) [43][44][45][46].…”

Section: A) Exercise Programmentioning

confidence: 99%

“…The exercise components for this group are the same as those described above for the exercise only program. The physiotherapist will support the participant to lose weight (aiming for ≥10% body weight loss) via a ketogenic VLCD, with additional dietary/behavioural educational resources provided in hardcopy [34] (Table 1). Ahead of their initial consultation, participants will be sent approximately 4-5 weeks of meal replacement products from the Optifast product range (Nestlé Health Science, Rhodes, Australia).…”

Section: B) Diet Plus Exercise Programmentioning

confidence: 99%

“…After this time, meal replacements will be self-sourced and self-funded if participants opt to re-engage with the ketogenic VLCD. Participants will be offered strategies and resources during the program, which will assist their long-term weight maintenance after their consultations with the physiotherapist are completed, including regular weight monitoring and dealing with setbacks [34].…”

Section: Hip Abductor Strengthening (1 Exercise) Standing Hip Abductionmentioning

confidence: 99%

“…For a power of 0.8 and a two-tailed significance level of 0.05, we required 37 participants per group. We increased this to 44 participants per group (88 in total) to allow for a 15% loss to follow up [34]. Since physiotherapists treat participants in both arms of the trial, we have not adjusted the sample size calculation for clustering by physiotherapist.…”

Section: Trial Sample Sizementioning

confidence: 99%

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Effectiveness of a telehealth physiotherapist-delivered intensive dietary weight loss program combined with exercise in people with knee osteoarthritis and overweight or obesity: study protocol for the POWER randomized controlled trial

Bennell

Jones

Hinman

et al. 2022

BMC Musculoskelet Disord

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Background Obesity is associated with knee osteoarthritis (OA). Weight loss, alongside exercise, is a recommended treatment for individuals with knee OA and overweight/obesity. However, many patients cannot access weight loss specialists such as dietitians. Innovative care models expanding roles of other clinicians may increase access to weight loss support for people with knee OA. Physiotherapists may be well placed to deliver such support. This two-group parallel, superiority randomized controlled trial aims to compare a physiotherapist-delivered diet and exercise program to an exercise program alone, over 6 months. The primary hypothesis is that the physiotherapist-delivered diet plus exercise program will lead to greater weight loss than the exercise program. Methods 88 participants with painful knee OA and body mass index (BMI) > 27 kg/m2 will be recruited from the community. Following baseline assessment, participants will be randomised to either exercise alone or diet plus exercise groups. Participants in the exercise group will have 6 consultations (20–30 min) via videoconference with a physiotherapist over 6 months for a strengthening exercise program, physical activity plan and educational/exercise resources. Participants in the diet plus exercise group will have 6 consultations (50–75 min) via videoconference with a physiotherapist prescribing a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating, plus the intervention of the exercise only group. Outcomes are measured at baseline and 6 months. The primary outcome is percentage change in body weight measured by a blinded assessor. Secondary outcomes include self-reported knee pain, physical function, global change in knee problems, quality of life, physical activity levels, and internalised weight stigma, as well as BMI, waist circumference, waist-to-hip ratio, physical performance measures and quadriceps strength, measured by a blinded assessor. Additional measures include adherence, adverse events, fidelity and process measures. Discussion This trial will determine whether a physiotherapist-delivered diet plus exercise program is more effective for weight loss than an exercise only program. Findings will inform the development and implementation of innovative health service models addressing weight management and exercise for patients with knee OA and overweight/obesity. Trial registration NIH US National Library of Medicine, Clinicaltrials.gov NCT04733053 (Feb 1 2021).

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Section: Introductionmentioning

confidence: 82%

Section: A) Exercise Programmentioning

confidence: 99%

Section: B) Diet Plus Exercise Programmentioning

confidence: 99%

Section: Hip Abductor Strengthening (1 Exercise) Standing Hip Abductionmentioning

confidence: 99%

Section: Trial Sample Sizementioning

confidence: 99%

See 3 more Smart Citations

Effectiveness of a telehealth physiotherapist-delivered intensive dietary weight loss program combined with exercise in people with knee osteoarthritis and overweight or obesity: study protocol for the POWER randomized controlled trial

Bennell

Jones

Hinman

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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Recommendations for Weight Management in Osteoarthritis: A Systematic Review of Clinical Practice Guidelines

Lim

Wong

Hussain

et al. 2022

Osteoarthritis and Cartilage

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Exercise adherence Mobile app for Knee Osteoarthritis: protocol for the MappKO randomised controlled trial

Hinman

Nelligan

Campbell

et al. 2022

BMC Musculoskelet Disord

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Background In people with knee osteoarthritis (OA), ongoing exercise participation, particularly with strengthening exercises, is central to management. Patient adherence to prescribed exercise typically declines once consultations with a clinician have ceased. Mobile applications (apps) can incorporate behaviour change techniques that may assist adherence, potentially optimising clinical outcomes. Methods This is a two-arm, pragmatic, superiority randomised trial. One hundred and eighty two Australians with chronic knee pain (clinical knee OA) and who have at least a mild level of physical dysfunction are being recruited. Participants are randomly allocated i) exercise (physiotherapist-prescribed exercise) or; ii) exercise plus app (physiotherapist-prescribed exercise plus access to the ‘My Exercise Messages’ mobile app). Exercise care comprises two videoconferencing consultations with a physiotherapist over two weeks (30 min each) for a strengthening exercise program, which is then conducted independently at home for 24 weeks without any further physiotherapist consultations. Participants are also provided with exercise resources to facilitate home-based exercise. Those randomised to exercise plus app will download the app after completing the two weeks of physiotherapy consultations and will be instructed by research staff to use the app for the 24 weeks of unsupervised home-based exercises. The app works by tracking completion of weekly exercise sessions, providing regular messages to facilitate weekly exercise and providing personalised messages to help overcome individual barriers to exercise participation. The two primary outcomes are i) self-reported physical function; and ii) number of days strengthening exercises were performed (previous fortnight), with a primary endpoint of 26 weeks and a secondary endpoint of 14 weeks. Secondary outcomes include knee pain severity; knee-related quality of life; global change; exercise program satisfaction; exercise self-efficacy; physical activity; sport and recreation function; another measure of exercise adherence; and willingness to undergo joint replacement. Process measures are also included. Discussion Findings will determine if a theory-informed mobile app improves exercise adherence and physical function in people with knee OA who have received a home-based strengthening program. Trial Registration Australian New Zealand Clinical Trials Registry, ACTRN12621000724875. Prospectively registered 9/06/2021.

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Comparing Video-Based Telehealth-Delivered Exercise and Weight Loss Programs With Online Education on Outcomes of Knee Osteoarthritis: A Randomized Trial

Cited by 4 publications

References 0 publications

Effectiveness of a telehealth physiotherapist-delivered intensive dietary weight loss program combined with exercise in people with knee osteoarthritis and overweight or obesity: study protocol for the POWER randomized controlled trial

Effectiveness of a telehealth physiotherapist-delivered intensive dietary weight loss program combined with exercise in people with knee osteoarthritis and overweight or obesity: study protocol for the POWER randomized controlled trial

Recommendations for Weight Management in Osteoarthritis: A Systematic Review of Clinical Practice Guidelines

Exercise adherence Mobile app for Knee Osteoarthritis: protocol for the MappKO randomised controlled trial

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