Effectiveness of Human Versus Computer-Based Instructions for Exercise on Physical Activity–Related Health Competence in Patients with Hip Osteoarthritis: Randomized Noninferiority Crossover Trial

Abstract

Background Hip and knee osteoarthritis is ranked as the 11th highest contributor to global disability. Exercise is a core treatment in osteoarthritis. The model for physical activity–related health competence describes possibilities to empower patients to perform physical exercises in the best possible health-promoting manner while taking into account their own physical condition. Face-to-face supervision is the gold standard for exercise guidance. Objective The aim of this study was to evaluate whether instruction and guidance via a digital app is not inferior to supervision by a physiotherapist with regard to movement quality, control competence for physical training, and exercise-specific self-efficacy. Methods Patients with clinically diagnosed hip osteoarthritis were recruited via print advertisements, emails and flyers. The intervention consisted of two identical training sessions with one exercise for mobility, two for strength, and one for balance. One session was guided by a physiotherapist and the other was guided by a fully automated tablet computer-based app. Both interventions took place at a university hospital. Outcomes were assessor-rated movement quality, and self-reported questionnaires on exercise-specific self-efficacy and control competence for physical training. Participants were randomly assigned to one of two treatment sequences. One sequence started with the app in the first session followed by the physiotherapist in the second session after a minimum washout phase of 27 days (AP group) and the other sequence occurred in the reverse order (PA group). Noninferiority was defined as a between-treatment effect (gIG)<0.2 in favor of the physiotherapist-guided training, including the upper confidence interval. Participants, assessors, and the statistician were neither blinded to the treatment nor to the treatment sequence. Results A total of 54 participants started the first training session (32 women, 22 men; mean age 62.4, SD 8.2 years). The treatment sequence groups were similar in size (PA: n=26; AP: n=28). Seven subjects did not attend the second training session (PA: n=3; AP: n=4). The app was found to be inferior to the physiotherapist in all outcomes considered, except for movement quality of the mobility exercise (gIG –0.13, 95% CI –0.41-0.16). In contrast to the two strengthening exercises in different positions (supine gIG 0.76, 95% CI 0.39-1.13; table gIG 1.19, 95% CI 0.84-1.55), movement quality of the balance exercise was close to noninferiority (gIG 0.15, 95% CI –0.17-0.48). Exercise-specific self-efficacy showed a strong effect in favor of the physiotherapist (gIG 0.84, 95% CI 0.46-1.22). In terms of control competence for physical training, the app was only slightly inferior to the physiotherapist (gIG 0.18, 95% CI –0.14-0.50). Conclusions Despite its inferiority in almost all measures of interest, exercise-specific self-efficacy and control competence for physical training did improve in patients who used the digital app. Movement quality was acceptable for exercises that are easy to conduct and instruct. The digital app opens up possibilities as a supplementary tool to support patients in independent home training for less complex exercises; however, it cannot replace a physiotherapist. Trial Registration German Clinical Trial Register: DRKS00015759; http://www.drks.de/DRKS00015759

What About the Environment? How the Physical Activity–Related Health Competence Model Can Benefit From Health Literacy Research

“…The PAHCO model with its multidimensional and integrative view has recently been used in different target groups and settings attributable to both prevention (12,(14)(15)(16)(17)(18)(19) and rehabilitation (12,(20)(21)(22)(23). However, when reviewing the first conceptualtheoretical articles, it becomes obvious that environmental factors hardly play any role within this competence approach (11,24).…”

Intelligent Personalized Exercise Prescription Based on an eHealth Promotion System to Improve Health Outcomes of Middle-Aged and Older Adult Community Dwellers: Pretest–Posttest Study

“…We expected that the structured and combined exercise of aerobic and resistance training would improve cardiovascular function and body composition in participants with exercise habits. However, a possible ceiling effect might have prevented further improvements in functioning, even though these participants had completed more scientific exercise [17]. Theresa et al [30] reported that individuals with more "favorable" values at baseline (eg, lower submaximal heart rate) may potentially show a low subsequent training response if a "ceiling effect" limits further improvement in that parameter.…”

“…The situation for older people may be worse as a result of complex physical conditions [16]. Older individuals may struggle to exercise because of pain or other symptoms [17].…”

Herausforderungen für die Kompetenzorientierung im Gesundheitssport

“…In den vergangenen Jahren hat die Kompetenzorientierung im Gesundheitssport auf der Basis des BGK-Modells zunehmend an Bedeutung gewonnen. So widmen sich aktuelle Vorhaben und Projekte in der Forschung beispielsweise der kompetenzorientierten Bewegungsförderung von Schülerinnen und Schülern [24,25], Auszubildenden [26,27], Menschen mit chronisch obstruktiver Lungenerkrankung [28,29], Kriegsüberlebenden [30], Personen mit Arthrose [31], Akteurinnen und Akteuren im Bereich Pflege [32], Menschen mit sogenannter geistiger Behinderung [33,34] oder Personen mit Multipler Sklerose [35]. Auch einzelne theoretische Annahmen der BGK wurden konzeptionell weiterentwickelt oder empirisch untermauert [22, 36 -38].…”