Researchers examined data on 206 patients with knee osteoarthritis who were provided with online resources about the importance of exercise and physical activity for symptom management. Half the participants were randomized to also receive access to a self-directed knee strengthening exercise regimen, guidance to increase physical activity, and automated text message reminders.
The primary endpoints were changes in overall knee pain (on a 0-10 scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0-68 points) by 24 weeks.
Compared with participants in the control group that didn't get access to the self-directed exercise program and text messages, those in the intervention group experienced significantly larger improvement in knee pain (mean difference 1.6 points) and physical function (mean difference 5.2 points) at 24 weeks, according to the report in JAMA Internal Medicine.
"The reason we believe people in the intervention group experienced more improvements in pain and function compared to the control group was they received detailed exercise instructions plus regular exercise adherence support which helped them start and stick to self-directed exercise," said lead study author Rachel Nelligan of the Centre for Health Exercise and Sports Medicine at the University of Melbourne in Australia.
"Our study demonstrates this web and mobile phone intervention is an effective means of improving outcomes for people with knee osteoarthritis," Nelligan said by email.
Often, patients with knee osteoarthritis are fearful of exercise or unsure how to begin, particularly when they don't have access to health professionals who can provide guidance, Nelligan said. Even when people with knee osteoarthritis are given clear exercise guidance to get started, they often find it hard to do the exercises regularly or lose momentum over time, Nelligan added.
To address some of these challenges, researchers developed and tested the My Knee Exercise website and text messaging app. The control group received access only to educational information on the site, without access to the self-directed exercise program or the text messaging app.
One limitation of the study is the potential for inclusion bias, with participants who enrolled in the trial more apt to have a favorable view of technology than those who didn't join the study, researchers note. All the participants also had at least a high school education, making it possible that results would not be generalizable to all individuals with knee osteoarthritis.
However, the results do underscore how additional support may help encourage more patients with knee osteoarthritis to get moving, said Martin van der Esch of the Reade Centre for Rehabilitation and Rheumatology and the Amsterdam Rehabilitation Research Centre in The Netherlands.
"One of the main characteristics why people with osteoarthritis and also other chronic diseases do not exercise in the long term is because they receive little feedback and feel that they are not being supported and therefore, do not make behavioral changes," van der Esch, who wasn't involved in the study, said by email.
"Positive feedback is the key to behavioral change," van der Esch said.
SOURCE: https://bit.ly/3dbZls7 JAMA Internal Medicine, online April 12, 2021.
By Lisa Rapaport
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