Web-based program plus text messaging may help improve knee OA pain
medwireNews: A web-based exercise intervention combined with text messaging support for people with knee osteoarthritis (OA) leads to greater improvements in pain and function at 6 months than web-based information alone, Australian research shows.
Rachel Nelligan (University of Melbourne, Victoria) and co-authors say that the “freely available digital intervention is a useful and effective option for improving access to recommended OA exercise and/or supporting clinicians in providing exercise management to people with knee OA at scale across the population.”
They explain in JAMA Internal Medicine that the custom-built “My Knee Exercise” website contains educational information on OA and exercise, guidance to increase physical activity, and a prescription for a structured 24-week self-directed strengthening regimen.
Its use was accompanied by automated behavior-change text messages encouraging exercise adherence and was compared with that of a control “My Knee Education” website that had the same educational information but without references to the specific strengthening exercise regimen and physical activity guidance.
The researchers report that each of the 103 participants (mean age 60 years, 58% women) in the intervention arm logged into the website a mean 6.0 times during the 24-week period. By comparison, the 103 participants (mean age 59 years, 64% women) in the control arm each recorded a mean 3.2 website logins during the study.
At the end of the study period, the team found that individuals in the intervention group had a significant 1.6-point greater improvement in pain, on average, than those in the control group, when measured on a scale of 0 to 10.
Intervention group members also had a significantly greater mean improvement in WOMAC physical function of 5.2 points relative to control group members.
Furthermore, significantly more individuals who used the intervention versus control websites had clinically meaningful improvements in pain (≥1.8 points; 72.1 vs 42.0%) and function (≥6.0 points; 68.0 vs 40.8%).
In spite of this, Nelligan et al note that around 30% of participants did not derive clinical benefit “from the unsupervised approach, suggesting that more intensive, personalized management may be required.”
They suggest: “Our free-to-access, unsupervised program could serve as an entry-level intervention, with participants who do not experience clinical benefits progressing to subsequent steps for more intensive, personalized management.
“Such an approach has the potential to better distribute limited health care resources and reduce demand for contact with health professionals, thus improving access for those requiring it.”
The primary findings were also supported by significantly greater improvements in a number of secondary measures including three KOOS subscales (pain, sports/recreation, and quality of life), health-related quality of life, Arthritis Self-Efficacy Scale pain, and overall treatment satisfaction.
The investigators conclude: “Taken together, the findings of the present study demonstrate that this easily scalable, unsupervised, free-to-access intervention is effective and may be clinically relevant on a population level.”
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