Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis

Abstract

IMPORTANCE Osteoarthritis is a prevalent, debilitating, and costly chronic disease for which recommended first-line treatment is underused.OBJECTIVE To compare the effect of an internet-based treatment for knee osteoarthritis vs routine self-management (ie, usual care). DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted from October 2018 to March 2020. Participants included individuals aged 45 years or older with a diagnosis of knee osteoarthritis recruited from an existing primary care database or from social media advertisements were invited. Data were analyzed April to July 2020. INTERVENTIONSThe intervention and control group conformed to first-line knee osteoarthritis treatment. For the intervention group, treatment was delivered via a smartphone application. The control group received routine self-management care. MAIN OUTCOMES AND MEASURESThe primary outcome was change from baseline to 6 weeks in self-reported pain during the last 7 days, reported on a numerical rating scale (NRS; range, 0-10, with 0 indicating no pain and 10, worst pain imaginable), compared between groups. Secondary outcomes included 2 physical functioning scores, hamstring and quadriceps muscle strength, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quantitative sensory testing. RESULTS Among a total of 551 participants screened for eligibility, 146 were randomized and 105 were analyzed (mean [SD] age, 66.7 [9.2] years, 71 [67.1%] women), including 48 participants in the intervention group and 57 participants in the control group. There were no significant differences in baseline characteristics between the groups. At the 6-week follow-up, the intervention group showed a greater NRS pain score reduction than the control group (between-group difference, −1.5 [95% CI, −2.2 to −0.8]; P < .001). Similarly, the intervention group had better improvements in the 30-second sit-to-stand test (between-group difference, 3.4 [95% CI, 2.2 to 4.5]; P < .001) and Timed Up-and-Go test (between-group difference, −1.8 [95% CI, −3.0 to −0.5] seconds; P = .007), as well as the WOMAC subscales for pain (between-group difference, −1.1 [95% CI, −2.0 to −0.2]; P = .02), stiffness (between-group difference, −1.0 [95% CI, −1.5 to −0.5]; P < .001), and physical function (between-group difference, −3.4 [95% CI, −6.2 to −0.7]; P = .02). The magnitude of within-group changes in pain (d = 0.83) and function outcomes (30 second sit-to-stand test d = 1.24; Timed Up-and-Go test d = 0.76) in the intervention group corresponded to medium to very strong effects.No adverse events were reported. CONCLUSIONS AND RELEVANCEThese findings suggest that this internet-delivered, evidencebased, first-line osteoarthritis treatment was superior to routine self-managed usual care and could (continued) Key Points Question What is the effectiveness of an internet-based exercise program vs routine self-management on pain outcomes among patients with knee osteoarthritis? Findings This randomized clinical trial including 105 patie...

Digital self-management interventions for osteoarthritis: a systematic scoping review of intervention characteristics, adherence and attrition

“…The sample size of the studies ranged from 40 to 427. Four studies included a follow-up at 12-months [ 15 , 26 , 31 , 34 ], one at 9 months [ 28 ] and the remaining six studies had no follow-up [ 25 , 27 , 29 , 30 , 32 , 33 ]. The control groups varied amongst included studies.…”

“…The control groups varied amongst included studies. Four studies provided education to their control group [ 27 , 28 , 30 , 31 ], one provided a home-based exercise program [ 25 ], one provided usual physical therapy [ 34 ], two included a waitlist control group [ 15 , 26 ] and three studies did not provide anything to their control group [ 29 , 32 , 33 ]. In addition to a control group, two studies also included a physical therapy group, which included individualised home exercise programs.…”

“…In addition to a control group, two studies also included a physical therapy group, which included individualised home exercise programs. Pain was the most commonly reported outcome used by authors to assess the effectiveness of the interventions [ 25 , 28 , 29 , 32 – 34 ].…”

“… Bossen et al 2013 [ 15 ] The Netherlands Age: 62.0 ± 5.7 years BMI: 27.6 ± 4.5 Sex: 129/70 64% knee OA, 21% hip OA and 15% had both Significant improvements in physical function in the intervention group compared to the control group. Gohir et al 2021 [ 29 ] UK Age: 66.7 ± 9.2 years BMI: 31.9 ± 5.9 a Sex: 71/34 100% knee OA Significant improvements in pain and physical function in the intervention group compared to the control group. Kloek et al 2018 [ 34 ] Netherlands Age: 63.8 ± 4.2 a years BMI: 27.8 ± 4.2 a Sex: 141/67 67% knee OA, 18% hip OA and 15% had both Both groups significantly improved pain, quality of life and self-efficacy.…”

“…The length of the interventions ranged from 6 weeks to 9 months. Four interventions were less than 10 weeks [ 15 , 25 , 29 , 33 ], three were between 10 and 20 weeks [ 26 , 28 , 34 ] and four were longer than 20 weeks [ 27 , 30 – 32 ]. Eight studies utilised a website to deliver their intervention [ 15 , 26 – 28 , 30 , 31 , 33 , 34 ] and the remaining three studies used a smartphone application [ 25 , 29 , 32 ].…”