App-based exercise program decreases knee osteoarthritis pain

Reuters Health - 26/02/2021 - An app-based exercise program may be more effective for easing pain from knee osteoarthritis than usual care alone, a small study suggests.

Researchers randomized 105 patients with knee osteoarthritis 1:1 to receive either routine self-management care alone or in combination with a six-week digitally-delivered exercise program focused on balance, core stability, and neuromuscular leg strengthening.

At six weeks, patients in the intervention group had significantly larger reductions in pain (-1.5 points more than the control group on 0-10 pain scale). Patients in the digital exercise group also had significantly greater improvements in outcomes for the 30-second sit to stand test and the timed up and go test.

"One of the challenges of getting people with knee osteoarthritis to exercise regularly is to keep them motivated to do exercises daily or to see a physical therapist regularly," said lead study author Ana Maria Valdes of the University of Nottingham and Nottingham NIHR Biomedical Research Centre in the UK.

"These data show that it is possible in a very inexpensive way to get people with painful knee osteoarthritis to see substantial improvements in just a few weeks," Valdes said by email.

With usual care, patients with knee osteoarthritis might see a general practitioner or family doctor who may suggest reading a leaflet about exercises to reduce pain, or recommend over-the-counter pain relievers, but not necessarily refer them to physiotherapy, Valdes said.

"The smartphone app delivers a package of physiotherapy exercises every day, encourages daily activities and provides information on what osteoarthritis is every day for 6 weeks," Valdes added. "The exercises are tailored to the perceived level of difficulty by the person using the app and they can chat to a physiotherapist to resolve any queries."

One limitation of the study is that 27 participants didn't attend follow-up assessments due to the COVID-19 lockdown, researchers note in JAMA Network Open. An additional five people discontinued treatment, leaving a very small proportion of participants with complete data.

There also was no significant difference in muscle strength at six weeks between the two groups.

Even so, the results suggest that using apps and other digital tools that don't require office visits may be one effective way to encourage patients to start and stick with any exercise program prescribed for knee osteoarthritis, said Hakan Nero, a researcher at Lund University, in Sweden, who wasn't involved in the study.

"The comparison is of importance since regular care, at least the care delivered in this specific study, is what people are normally offered and contains no supervision, no nudging, no easy access to exercise instructions or a personal physical therapist," Nero said by email.

Monitoring patient progress in exercise regimens should be a key component of clinical care for knee osteoarthritis, said Martin van der Esch of the Reade Centre for Rehabilitation and Rheumatology at the Amsterdam Rehabilitation Research Centre in The Netherlands.

"This can be done using a digitally delivered program, but it can also be done in other ways," van der Esch, who wasn't involved in the study, said by email

SOURCE: https://bit.ly/3aZntNw JAMA Network Open, online February 23, 2021.

By Lisa Rapaport



Posted on 26 February 20212 March 2021