Efficacy of a Community-Based Technology-Enabled Physical Activity Counseling Program for People With Knee Osteoarthritis: Proof-of-Concept Study

Linda C Li, Eric C Sayre, Hui Xie, Ryan S Falck, John R Best, Teresa Liu-Ambrose, Navi Grewal, Alison M Hoens, Greg Noonan, Lynne M Feehan, Linda C Li, Eric C Sayre, Hui Xie, Ryan S Falck, John R Best, Teresa Liu-Ambrose, Navi Grewal, Alison M Hoens, Greg Noonan, Lynne M Feehan

Abstract

Background: Current practice guidelines emphasize the use of physical activity as the first-line treatment of knee osteoarthritis; however, up to 90% of people with osteoarthritis are inactive.

Objective: We aimed to assess the efficacy of a technology-enabled counseling intervention for improving physical activity in people with either a physician-confirmed diagnosis of knee osteoarthritis or having passed two validated criteria for early osteoarthritis.

Methods: We conducted a proof-of-concept randomized controlled trial. The immediate group received a brief education session by a physical therapist, a Fitbit Flex, and four biweekly phone calls for activity counseling. The delayed group received the same intervention 2 months later. Participants were assessed at baseline (T0) and at the end of 2 months (T1), 4 months (T2), and 6 months (T3). Outcomes included (1) mean time on moderate-to-vigorous physical activity (MVPA ≥3 metabolic equivalents [METs], primary outcome), (2) mean time on MVPA ≥4 METs, (3) mean daily steps, (4) mean time on sedentary activities, (5) Knee Injury and Osteoarthritis Outcome Score (KOOS), and (6) Partners in Health scale. Mixed-effects repeated measures analysis of variance was used to assess five planned contrasts of changes in outcome measures over measurement periods. The five contrasts were (1) immediate T1-T0 vs delayed T1-T0, (2) delayed T2-T1 vs delayed T1-T0, (3) mean of contrast 1 and contrast 2, (4) immediate T1-T0 vs delayed T2-T1, and (5) mean of immediate T2-T1 and delayed T3-T2. The first three contrasts estimate the between-group effects. The latter two contrasts estimate the effect of the 2-month intervention delay on outcomes.

Results: We recruited 61 participants (immediate: n=30; delayed: n=31). Both groups were similar in age (immediate: mean 61.3, SD 9.4 years; delayed: mean 62.1, SD 8.5 years) and body mass index (immediate: mean 29.2, SD 5.5 kg/m2; delayed: mean 29.2, SD 4.8 kg/m2). Contrast analyses revealed significant between-group effects in MVPA ≥3 METs (contrast 1 coefficient: 26.6, 95% CI 4.0-49.1, P=.02; contrast 3 coefficient: 26.0, 95% CI 3.1-49.0, P=.03), daily steps (contrast 1 coefficient: 1699.2, 95% CI 349.0-3049.4, P=.02; contrast 2 coefficient: 1601.8, 95% CI 38.7-3164.9, P=.045; contrast 3 coefficient: 1650.5, 95% CI 332.3-2968.7; P=.02), KOOS activity of daily living subscale (contrast 1 coefficient: 6.9, 95% CI 0.1-13.7, P=.047; contrast 3 coefficient: 7.2, 95% CI 0.8-13.6, P=.03), and KOOS quality of life subscale (contrast 1 coefficient: 7.4, 95% CI 0.0-14.7, P=.049; contrast 3 coefficient: 7.3, 95% CI 0.1-14.6, P=.048). We found no significant effect in any outcome measures due to the 2-month delay of the intervention.

Conclusions: Our counseling program improved MVPA ≥3 METs, daily steps, activity of daily living, and quality of life in people with knee osteoarthritis. These findings are important because an active lifestyle is an important component of successful self-management.

Trial registration: ClinicalTrials.gov NCT02315664; https://ichgcp.net/clinical-trials-registry/NCT02315664 (Archived by WebCite at http://www.webcitation.org/6ynSgUyUC).

Keywords: eHealth; goal setting; osteoarthritis; physical activity; physiotherapy; wearables.

Conflict of interest statement

Conflicts of Interest: None declared.

©Linda C Li, Eric C Sayre, Hui Xie, Ryan S Falck, John R Best, Teresa Liu-Ambrose, Navi Grewal, Alison M Hoens, Greg Noonan, Lynne M Feehan. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.04.2018.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) flowchart.
Figure 2
Figure 2
Bouted moderate to vigorous physical activity (≥3 metabolic equivalent tasks [METs]).
Figure 3
Figure 3
Bouted moderate to vigorous physical activity (≥4 METs).
Figure 4
Figure 4
Bouted sedentary time.
Figure 5
Figure 5
Mean daily step count.
Figure 6
Figure 6
Knee Injury and Osteoarthritis Outcome Score (KOOS) symptoms subscale.
Figure 7
Figure 7
KOOS pain subscale.
Figure 8
Figure 8
KOOS sports and recreation subscale.
Figure 9
Figure 9
Partners in Health scale.
Figure 10
Figure 10
KOOS activities of daily living subscale.
Figure 11
Figure 11
KOOS quality of life subscale.

References

    1. Bombardier C, Hawker G, Mosher D. The Impact of Arthritis in Canada: Today and Over the Next 30 Years. Toronto, ON: Arthritis Alliance of Canada; 2011.
    1. Brosseau L, MacLeay L, Robinson V, Wells G, Tugwell P. Intensity of exercise for the treatment of osteoarthritis. Cochrane Database Syst Rev. 2003;(2):CD004259. doi: 10.1002/14651858.CD004259.
    1. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage. 2007 Sep;15(9):981–1000. doi: 10.1016/j.joca.2007.06.014.
    1. Roos E, Dahlberg L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis Rheum. 2005 Nov;52(11):3507–3514. doi: 10.1002/art.21415. doi: 10.1002/art.21415.
    1. Munukka M, Waller B, Häkkinen Arja, Nieminen M, Lammentausta E, Kujala U, Paloneva J, Kautiainen H, Kiviranta I, Heinonen A. Physical activity Is related with cartilage quality in women with knee osteoarthritis. Med Sci Sports Exerc. 2017 Jul;49(7):1323–1330. doi: 10.1249/MSS.0000000000001238.
    1. Skou S. Roos EM: Good Life with osteoArthritis in Denmark (GLA:D)vidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide. BMC Musculoskelet Disord. 2017;18(1):72. doi: 10.1186/s12891-017-1439-y.
    1. Davis AM, Kennedy D, Wong R, Robarts S, Skou SrT, McGlasson R, Li LC, Roos E. Cross-cultural adaptation and implementation of Good Life with osteoarthritis in Denmark (GLA:D™): group education and exercise for hip and knee osteoarthritis is feasible in Canada. Osteoarthritis Cartilage. 2018 Feb;26(2):211–219. doi: 10.1016/j.joca.2017.11.005.
    1. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008 Feb;16(2):137–162. doi: 10.1016/j.joca.2007.12.013.
    1. Haskell W, Lee I, Pate R, Powell K, Blair S, Franklin B, Macera C, Heath G, Thompson P, Bauman Adrian. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007 Aug;39(8):1423–1434. doi: 10.1249/mss.0b013e3180616b27.
    1. Wallis JA, Webster KE, Levinger P, Taylor NF. What proportion of people with hip and knee osteoarthritis meet physical activity guidelines? A systematic review and meta-analysis. Osteoarthritis Cartilage. 2013 Nov;21(11):1648–1659. doi: 10.1016/j.joca.2013.08.003.
    1. Dunlop DD, Song J, Semanik PA, Chang RW, Sharma L, Bathon JM, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Mysiw WJ, Nevitt MC, Hootman JM. Objective physical activity measurement in the osteoarthritis initiative: are guidelines being met? Arthritis Rheum. 2011 Nov;63(11):3372–3382. doi: 10.1002/art.30562. doi: 10.1002/art.30562.
    1. Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM. A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Semin Arthritis Rheum. 2014 Jun;43(6):701–712. doi: 10.1016/j.semarthrit.2013.11.012.
    1. Gyurcsik N, Brawley L, Spink K, Brittain D, Fuller D, Chad K. Physical activity in women with arthritis: examining perceived barriers and self-regulatory efficacy to cope. Arthritis Rheum. 2009 Aug 15;61(8):1087–1094. doi: 10.1002/art.24697. doi: 10.1002/art.24697.
    1. Der Ananian C, Wilcox S, Saunders R, Watkins K, Evans A. Factors that influence exercise among adults with arthritis in three activity levels. Prev Chronic Dis. 2006 Jul;3(3):A81.
    1. Henchoz Y, Zufferey P, So A. Stages of change, barriers, benefits, and preferences for exercise in RA patients: a cross-sectional study. Scand J Rheumatol. 2013;42(2):136–145. doi: 10.3109/03009742.2012.724707.
    1. Jordan J, Holden M, Mason EJ, Foster NE. Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD005956. doi: 10.1002/14651858.CD005956.pub2.
    1. Li L, Sayre E, Xie H, Clayton C, Feehan LM. A community-based physical activity counselling program for people with knee osteoarthritis: feasibility and preliminary efficacy of the track-OA study. JMIR Mhealth Uhealth. 2017 Jun 26;5(6):e86. doi: 10.2196/mhealth.7863.
    1. Marra C, Cibere J, Tsuyuki R, Soon J, Esdaile J, Gastonguay L, Oteng B, Embley P, Colley L, Enenajor G, Kok R. Improving osteoarthritis detection in the community: pharmacist identification of new, diagnostically confirmed osteoarthritis. Arthritis Rheum. 2007 Oct 15;57(7):1238–1244. doi: 10.1002/art.23019. doi: 10.1002/art.23019.
    1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke T, Greenwald R, Hochberg M. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986 Aug;29(8):1039–1049.
    1. Thomas S, Reading J, Shephard R J. Revision of the Physical Activity Readiness Questionnaire (PAR-Q) Can J Sport Sci. 1992 Dec;17(4):338–345.
    1. Rollnick S, Miller W, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press; 2009. Jul 02,
    1. Miller W, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York: Guilford Press; 2012.
    1. Richards J, Hillsdon M, Thorogood M, Foster C. Face-to-face interventions for promoting physical activity. Cochrane Database Syst Rev. 2013 Sep 30;(9):CD010392. doi: 10.1002/14651858.CD010392.pub2.
    1. Gutnick D, Reims K, Davis C, Gainforth H, Jay M, Cole S. Brief action planning to facilitate behavior change and support patient self-management. J Clin Outcomes Manag. 2014;21:17–29.
    1. Tierney M, Fraser A, Purtill H, Kennedy Norelee. Study to determine the criterion validity of the SenseWear Armband as a measure of physical activity in people with rheumatoid arthritis. Arthritis Care Res (Hoboken) 2013 Jun;65(6):888–895. doi: 10.1002/acr.21914. doi: 10.1002/acr.21914.
    1. Holsgaard-Larsen A, Roos EM. Objectively measured physical activity in patients with end stage knee or hip osteoarthritis. Eur J Phys Rehabil Med. 2012 Dec;48(4):577–585.
    1. Semanik P, Lee J, Manheim L, Dipietro L, Dunlop D, Chang RW. Relationship between accelerometer-based measures of physical activity and the Yale Physical Activity Survey in adults with arthritis. Arthritis Care Res (Hoboken) 2011 Dec;63(12):1766–1772. doi: 10.1002/acr.20644. doi: 10.1002/acr.20644.
    1. Almeida G, Wasko M, Jeong K, Moore C, Piva Sara R. Physical activity measured by the SenseWear Armband in women with rheumatoid arthritis. Phys Ther. 2011 Sep;91(9):1367–1376. doi: 10.2522/ptj.20100291.
    1. Ainsworth B, Haskell EW. Compendium of Physical Activities Tracking Guide. [2018-04-06].
    1. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, Chastin SF, Altenburg TM, Chinapaw MJ, SBRN Terminology Consensus Project Participants Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act. 2017 Dec 10;14(1):75. doi: 10.1186/s12966-017-0525-8.
    1. Roos E, Roos P, Lohmander L, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998 Aug;28(2):88–96. doi: 10.2519/jospt.1998.28.2.88.
    1. Roos E, Roos P, Ekdahl C, Lohmander LS. Knee injury and Osteoarthritis Outcome Score (KOOS)--validation of a Swedish version. Scand J Med Sci Sports. 1998 Dec;8(6):439–448.
    1. Petkov J, Harvey P, Battersby M. The internal consistency and construct validity of the partners in health scale: validation of a patient rated chronic condition self-management measure. Qual Life Res. 2010 Sep;19(7):1079–1085. doi: 10.1007/s11136-010-9661-1.
    1. Feehan L, Goldsmith CH, Leung AF, Li LC. SenseWearMini and Actigraph GT3X accelerometer classification of observed sedentary and light-intensity physical activities in a laboratory setting. Physiother Can. 2016 May;68(2):116–123. doi: 10.3138/PTC.2015-12.
    1. Owen N. Sedentary behavior: understanding and influencing adults' prolonged sitting time. Prev Med. 2012 Dec;55(6):535–539. doi: 10.1016/j.ypmed.2012.08.024.
    1. Dunstan D, Kingwell B, Larsen R, Healy G, Cerin E, Hamilton M, Shaw J, Bertovic D, Zimmet P, Salmon J, Owen N. Breaking up prolonged sitting reduces postprandial glucose and insulin responses. Diabetes Care. 2012 May;35(5):976–983. doi: 10.2337/dc11-1931.
    1. Latouche C, Jowett J, Carey A, Bertovic D, Owen N, Dunstan D, Kingwell BA. Effects of breaking up prolonged sitting on skeletal muscle gene expression. J Appl Physiol (1985) 2013 Feb 15;114(4):453–460. doi: 10.1152/japplphysiol.00978.2012.
    1. Howard B, Fraser S, Sethi P, Cerin E, Hamilton M, Owen N, Dunstan D, Kingwell BA. Impact on hemostatic parameters of interrupting sitting with intermittent activity. Med Sci Sports Exerc. 2013 Jul;45(7):1285–1291. doi: 10.1249/MSS.0b013e318285f57e.
    1. Ory M, Resnick B, Jordan P, Coday M, Riebe D, Ewing GC, Pruitt L, Bazzarre T. Screening, safety, and adverse events in physical activity interventions: collaborative experiences from the behavior change consortium. Ann Behav Med. 2005 Apr;29 Suppl:20–28. doi: 10.1207/s15324796abm2902s_5.
    1. Schoenfeld D. Statistical considerations for pilot studies. Int J Radiat Oncol Biol Phys. 1980 Mar;6(3):371–374.
    1. Carter R, Woolson RF. Statistical design considerations for pilot studies transitioning therapies from the bench to the bedside. J Transl Med. 2004 Oct 28;2(1):37. doi: 10.1186/1479-5876-2-37.
    1. Lyons J, Lewis H, Mayrsohn G, Rowland JL. Behavior change techniques implemented in electronic lifestyle activity monitors: a systematic content analysis. J Med Internet Res. 2014 Aug 15;16(8):e192. doi: 10.2196/jmir.3469.
    1. Task Force on Community Preventive Services Recommendations to increase physical activity in communities. Am J Prev Med. 2002 May;22(4 Suppl):67–72.
    1. Lewis Z, Lyons E, Jarvis J, Baillargeon J. Using an electronic activity monitor system as an intervention modality: A systematic review. BMC Public Health. 2015 Jun 24;15:585. doi: 10.1186/s12889-015-1947-3.
    1. Broekhuizen K, de Gelder J, Wijsman C, Wijsman L, Westendorp R, Verhagen E, Slagboom P, de Craen A, van Mechelen W, van Heemst D, van der Ouderaa F, Mooijaart SP. An Internet-based physical activity intervention to improve quality of life of inactive older adults: a randomized controlled trial. J Med Internet Res. 2016 Apr 27;18(4):e74. doi: 10.2196/jmir.4335.
    1. Tulloch H, Fortier M, Hogg W. Physical activity counseling in primary care: who has and who should be counseling? Patient Educ Couns. 2006 Dec;64(1-3):6–20. doi: 10.1016/j.pec.2005.10.010.
    1. Hutchison A, Breckon J, Johnston LH. Physical activity behavior change interventions based on the transtheoretical model: a systematic review. Health Educ Behav. 2009 Oct;36(5):829–845. doi: 10.1177/1090198108318491.
    1. O'Donoghue G, Perchoux C, Mensah K, Lakerveld J, van der Ploeg H, Bernaards C, Chastin S, Simon C, O'Gorman D, Nazare J, DEDIPAC Consortium A systematic review of correlates of sedentary behaviour in adults aged 18-65 years: a socio-ecological approach. BMC Public Health. 2016 Feb 17;16:163. doi: 10.1186/s12889-016-2841-3.
    1. Rutten G, Savelberg H, Biddle S, Kremers SP. Interrupting long periods of sitting: good STUFF. Int J Behav Nutr Phys Act. 2013 Jan 02;10:1. doi: 10.1186/1479-5868-10-1.
    1. Gardner B, Smith L, Lorencatto F, Hamer M, Biddle SJ. How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults. Health Psychol Rev. 2016;10(1):89–112. doi: 10.1080/17437199.2015.1082146.
    1. Gardner B, Lally P, Wardle J. Making health habitual: the psychology of 'habit-formation' and general practice. Br J Gen Pract. 2012 Dec;62(605):664–666. doi: 10.3399/bjgp12X659466.
    1. Gupta A, Tong X, Shaw C, Li L, Feehan L. In: HCI International 19th International Conference, Proceedings, Part II. Stephanidis C, editor. Cham, Switzerland: Springer; 2017. pp. 232–240.
    1. Li LC, Feehan LM, Shaw C, Xie H, Sayre EC, Aviña-Zubeita A, Grewal N, Townsend AF, Gromala D, Noonan G, Backman Cl. A technology-enabled counselling program versus a delayed treatment control to support physical activity participation in people with inflammatory arthritis: study protocol for the OPAM-IA randomized controlled trial. BMC Rheumatol. 2017 Nov 28;1(1):1. doi: 10.1186/s41927-017-0005-4.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe