Digital self-management of hip and knee osteoarthritis and trajectories of work and activity impairments

Abstract

Objective To investigate the trajectories of work and activity impairments among people participating in a digital self-management program for osteoarthritis (OA). Methods We conducted an observational longitudinal study using data for baseline, 3, 6, 9 and 12 months follow ups from people participating in a digital OA treatment between June 2018 and September 2021. The Work Productivity and Activity Impairment–Osteoarthritis (WPAI–OA) questionnaire was used to measure work and activity impairments. We applied linear mixed models and group-based trajectory modelling (GBTM) to assess the trajectories of work and activity impairments and their variability. Dominance analysis was performed to explore the relative importance of baseline characteristics in predicting the trajectory subgroup membership. Results A total of 14,676 participants with mean (± standard deviation) age 64.0 (± 9.1) years and 75.5% females were included. The adjusted mean improvements in work impairment from baseline were 5.8% (95% CI 5.3, 6.4) to 6.1% (95% CI 5.5, 6.8). The corresponding figures for activity impairment were 9.4% (95% CI 9.0, 9.7) to 11.3% (95% CI 10.8, 11.8). GBTM identified five (low baseline–declining, moderate baseline–declining, high baseline–declining, very high baseline–substantially declining, and very high baseline–persistent) and three (low baseline–declining, mild baseline–declining, high baseline–declining) subgroups with distinct trajectories of activity and work impairments. Dominance analysis showed that baseline pain was the most important predictor of membership in trajectory subgroups. Conclusion While participation in a digital self-management program for OA was, on average, associated with improvements in work and activity impairments, there were substantial variations among the participants. Baseline pain may provide useful insights to predict trajectories of work and activity impairments.

Sex and age differences in the patient-reported outcome measures and adherence to an osteoarthritis digital self-management intervention

“…Notably, our findings revealed no clinically important outcome disparities among age/sex groups among those who used the digital self-management intervention. Altogether, these findings contribute additional insight into previous studies on this digital intervention, where age and sex exhibited the lowest relative importance as predictors for work and activity impairment improvements, and sex was not a significant predictor of adherence [ 3 , 8 ].…”

“…Nevertheless, age and sex could only explain a small percentage of adherence variance [ 3 ]. Improvements in both activity and work impairments for females and younger adults differed positively from those of males and older adults; however, these differences were not statistically conclusive [ 8 ]. None of these studies explored sex/age differences in Patient-Reported Outcome Measures (PROMs) beyond work/activity impairments (e.g., pain intensity, fear of movement, etc.)…”

“…None of these studies explored sex/age differences in Patient-Reported Outcome Measures (PROMs) beyond work/activity impairments (e.g., pain intensity, fear of movement, etc.) and adherence [ 3 , 8 ]. Hence, the present study aimed to explore sex and age differences in the PROMs and adherence within an OA digital self-management intervention, focussed on exercise and education, to ascertain whether individuals with OA can benefit from such interventions regardless of sex and age once provided with similar opportunities and abilities to utilise these resources.…”