Implementation of Tele-Exercise for Management of Knee Osteoarthritis in Older Rural Primary Care Patients

Implementation of Tele-Exercise for Management of Knee Osteoarthritis in Older Rural Primary Care Patients


Lead Sponsor: University of Washington

Source University of Washington
Brief Summary

Knee osteoarthritis (OA) is highly prevalent and a leading cause of pain that limits physical functioning in older adults. Clinical practice guidelines recommend physical exercise for managing symptoms of knee OA. As a result, several evidence-based exercise programs have been implemented in community centers. However, access to these programs is severely limited in rural settings. Considering that rural communities have a higher disease burden and higher proportion of older adults than non-rural areas, there is a critical need to (1) adapt evidence-based exercise programs for remote delivery to increase access for rural older adults and (2) develop pathways to implement exercise programs in rural health care systems that consistently reach and engage patients with knee OA. Accordingly, we aim to engage rural primary care practices (including medical directors, clinicians, and staff) to develop a clinical pathway that refers patients to an evidence-based exercise program, called Enhance Fitness® (EF), which we have adapted for remote delivery (tele-EF). Enhance Fitness is a group exercise program that is recommended by the CDC for OA management. It is available in over 800 sites nationally and is covered by Medicare Advantage plans, but it is generally not available in rural communities. In addition, we will assess the feasibility and acceptability of implementing the clinical pathway that identifies physically inactive older patients with knee OA, facilitates exercise prescription, and streamlines referral to tele-EF in a rural primary care clinic over a 5-month period.

Overall Status Not yet recruiting
Start Date March 1, 2021
Completion Date February 28, 2022
Primary Completion Date February 18, 2022
Phase N/A
Study Type Interventional
Primary Outcome
Measure Time Frame
Active minutes per day Change from Baseline Active Minutes at 12 weeks
Secondary Outcome
Measure Time Frame
Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function 8-item Short Form Change from Baseline PROMIS Physical Function score at 12 weeks
Knee injury and Osteoarthritis Outcome Score (KOOS) Physical Function Subscale Change from Baseline KOOS Physical Function Subscale score at 12 weeks
Enrollment 15

Intervention Type: Behavioral

Intervention Name: Tele-EnhanceFitness

Description: Livestream, instructor-led tele-exercise classes, involving balance, endurance, and strength training

Arm Group Label: Tele-EF



Inclusion Criteria: - Age ≥65 years - Community-dwelling - English-speaking - Physician diagnosed knee osteoarthritis - Physically inactive as determined by the 2-item Physical Activity Vital Sign questionnaire Exclusion Criteria: - Cognitive impairment determined by a Mini Montreal Cognitive Assessment score of <11 - Significant, non-corrected visual or hearing impairment - Plans to move out of the area in the next 6 months - Cancer requiring treatment (except for non-melanoma skin cancer) in the past 6 months - Heart attack in the past 6 months - Stroke in the past 6 months - Hip fracture in the past 6 months - Hip/knee replacement in the past 6 months - Spinal surgery in the past 6 months - Heart surgery in the past 6 months - Deep vein thrombosis in the past 6 months - Pulmonary embolus in the past 6 months - Hospitalization within the last month - ≥3 falls within the past month

Gender: All

Minimum Age: 65 Years

Maximum Age: N/A

Healthy Volunteers: No

Overall Official
Last Name Role Affiliation
Kushang V Patel, PhD Principal Investigator University of Washington
Overall Contact

Last Name: Kushang V Patel, PhD

Phone: 2066168052

Email: [email protected]

Facility: University of Washington
Location Countries

United States

Verification Date

January 2021

Responsible Party

Type: Principal Investigator

Investigator Affiliation: University of Washington

Investigator Full Name: Kushang Patel

Investigator Title: Research Associate Professor

Has Expanded Access No
Condition Browse
Number Of Arms 1
Arm Group

Label: Tele-EF

Type: Experimental

Description: Tele-EnhanceFitness

Patient Data Yes
Study Design Info

Allocation: N/A

Intervention Model: Single Group Assignment

Primary Purpose: Treatment

Masking: None (Open Label)