Capitalizing on the teachable moment: osteoarthritis physical activity and exercise net for improving physical activity in early knee osteoarthritis

Linda C Li, Sydney Lineker, Jolanda Cibere, Valorie A Crooks, Catherine A Jones, Jacek A Kopec, Scott A Lear, James Pencharz, Ryan E Rhodes, John M Esdaile, Linda C Li, Sydney Lineker, Jolanda Cibere, Valorie A Crooks, Catherine A Jones, Jacek A Kopec, Scott A Lear, James Pencharz, Ryan E Rhodes, John M Esdaile

Abstract

Background: Practice guidelines emphasize the use of exercise and weight reduction as the first line of management for knee osteoarthritis (OA). However, less than half of the people with mild OA participate in moderate intensity physical activity. Given that physical activities have been shown to reduce pain, improve quality of life, and have the potential to reduce the progression of joint damage, many people with OA are missing the benefits of this inexpensive intervention.

Objective: The objectives of this study are (1) to develop a behavioral theory-informed Internet intervention called Osteoarthritis Physical Activity & Exercise Net (OPEN) for people with previously undiagnosed knee OA, and (2) to assess the efficacy of the OPEN website for improving physical activity participation through a proof-of-concept study.

Methods: OPEN was developed based on the theory of planned behavior. Efficacy of this online intervention is being assessed by an ongoing proof-of-concept, single-blind randomized controlled trial in British Columbia, Canada. We are currently recruiting participants and plan to recruit a total of 252 sedentary people with previously undiagnosed knee OA using a set of validated criteria. Half of the participants will be randomized to use OPEN and receive an OA education pamphlet. The other half only will receive the pamphlet. Participants will complete an online questionnaire at baseline, 3 months, and 6 months about their participation in physical activities, health-related quality of life, and motivational outcomes. In addition, we will perform an aerobic fitness test in a sub-sample of participants (n=20 per study arm). In the primary analysis, we will use logistic regression to compare the proportion of participants reporting being physically active at or above the recommended level in the 2 groups, adjusting for baseline measurement, age, and sex.

Results: This study evaluates a theory-informed behavioral intervention at a time when people affected with OA tend to be more motivated to adopt an active lifestyle (ie, at the early stage of OA). Our approach, which consisted of the identification of early knee OA followed immediately by an online intervention that directly targets physical inactivity, can be easily implemented across communities.

Conclusions: Our online intervention directly targets physical inactivity at a time when the joint damage tends to be mild. If OPEN is found to be effective in changing long-term physical activity behaviors, it opens further opportunities to promote early diagnosis and to implement lifestyle interventions.

Trial registration: Clinicaltrial.gov: NCT01608282; https://ichgcp.net/clinical-trials-registry/NCT01608282 (Archived by WebCite at http://www.webcitation.org/6G7sBBayI).

Keywords: Internet; lifestyle intervention; osteoarthritis physical activity; theory of planned behavior.

Conflict of interest statement

Conflicts of Interest: None declared.

References

    1. Woolf AD, Akesson K. Understanding the burden of musculoskeletal conditions. The burden is huge and not reflected in national health priorities. BMJ. 2001 May 5;322(7294):1079–80.
    1. Public Health Agency of Canada. Ottawa, Canada: Centre for Chronic Disease Prevention and Control, Chronic Disease Surveillance Division Resource Team; 2010. [2013-04-30]. Life with Arthritis in Canada: A Personal and Public Health Challenge .
    1. Badley EM, Wang PP. Arthritis and the aging population: projections of arthritis prevalence in Canada 1991 to 2031. J Rheumatol. 1998 Jan;25(1):138–44.
    1. Brosseau L, MacLeay L, Robinson VA, Tugwell P. Wells G: Intensity of exercise for the treatment of osteoarthritis. Cochrane Database Syst Rev 2006. 2006:4.
    1. Ottawa Panel Ottawa panel evidence-based clinical practice guidelines for therapeutic exercises and manual therapy in the management of osteoarthritis. Physical Therapy. 2005;85:907–971.
    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. Marra C, Colley L, Oteng B, Cibere J, Esdaile JM, Gastonguay L, Kopec J, Tsuyuki RT, Soon JA: When patients are diagnosed with knee OA. What do they do and how does it impact on quality of life? Arthritis Rheum. 2008;56(supplement):S511.
    1. Bliddal H, Christensen R. The management of osteoarthritis in the obese patient: practical considerations and guidelines for therapy. Obes Rev. 2006 Nov;7(4):323–31. doi: 10.1111/j.1467-789X.2006.00252.x.
    1. Christensen R, Bartels EM, Astrup A, Bliddal H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2007 Apr;66(4):433–9. doi: 10.1136/ard.2006.065904.
    1. Wendelboe AM, Hegmann KT, Biggs JJ, Cox CM, Portmann AJ, Gildea JH, Gren LH, Lyon JL. Relationships between body mass indices and surgical replacements of knee and hip joints. Am J Prev Med. 2003 Nov;25(4):290–5.
    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):137–62. doi: 10.1016/j.joca.2007.12.013.
    1. Pencharz JN, MacLean CH. Measuring quality in arthritis care: the Arthritis Foundation's Quality Indicator set for osteoarthritis. Arthritis Rheum. 2004 Aug 15;51(4):538–48. doi: 10.1002/art.20521.
    1. Shekelle PG, MacLean CH, Morton SC, Wenger NS. Assessing care of vulnerable elders: methods for developing quality indicators. Ann Intern Med. 2001;135(8 Pt 2):647–652.
    1. MacLean CH. Quality indicators for the management of osteoarthritis in vulnerable elders. Ann Intern Med. 2001 Oct 16;135(8 Pt 2):711–21.
    1. Pencharz JN, MacLean CH. Measuring quality in arthritis care: the Arthritis Foundation's Quality Indicator set for osteoarthritis. Arthritis Rheum. 2004 Aug 15;51(4):538–48. doi: 10.1002/art.20521.
    1. Li LC . British Columbia Osteoarthritis Survey. Vancouver, Canada: Arthritis Research Centre of Canada; 2008. [2013-04-26]. .
    1. Gyurcsik NC, Brawley LR, Spink KS, Brittain DR, Fuller DL, Chad K. Physical activity in women with arthritis: examining perceived barriers and self-regulatory efficacy to cope. Arthritis Rheum. 2009 Aug 15;61(8):1087–94. doi: 10.1002/art.24697.
    1. Kang HS, Ferrans CE, Kim MJ, Kim JI, Lee EO. Aquatic exercise in older Korean women with arthritis: identifying barriers to and facilitators of long-term adherence. J Gerontol Nurs. 2007 Jul;33(7):48–56.
    1. Reed RK, Townsley MI, Pitts VH, Laurent TC, Taylor AE. Increased lymphatic flux of hyaluronan from cat intestine during fat absorption. Am J Physiol. 1992 Jul;263(1 Pt 1):G6–11.
    1. Li LC, Sayre EC, Kopec JA, Esdaile JM, Bar S, Cibere J. Quality of nonpharmacological care in the community for people with knee and hip osteoarthritis. J Rheumatol. 2011 Oct;38(10):2230–7. doi: 10.3899/jrheum.110264.
    1. Li LC, Maetzel A, Pencharz JN, Maguire L, Bombardier C, Community Hypertension and Arthritis Project (CHAP) Team Use of mainstream nonpharmacologic treatment by patients with arthritis. Arthritis Rheum. 2004 Apr 15;51(2):203–9. doi: 10.1002/art.20244.
    1. Marra CA, Cibere J, Tsuyuki RT, Soon JA, Esdaile JM, 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):1238–44. doi: 10.1002/art.23019.
    1. Godin G, Kok G. The theory of planned behavior: a review of its applications to health-related behaviors. Am J Health Promot. 1996;11(2):87–98.
    1. Heilbroner RL, Ajzen I, Thurow LC, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs, N.J: Prentice-Hall; 1980.
    1. Ajzen I The theory of planned behaviour. Organizational Behaviour and Human Decision Processes. 1991;50:179–211.
    1. Hagger MS, Chatzisarantis NL. Integrating the theory of planned behaviour and self-determination theory in health behaviour: a meta-analysis. Br J Health Psychol. 2009 May;14(Pt 2):275–302. doi: 10.1348/135910708X373959.
    1. Rhodes RE, Fiala B, Conner M. A review and meta-analysis of affective judgments and physical activity in adult populations. Ann Behav Med. 2009 Dec;38(3):180–204. doi: 10.1007/s12160-009-9147-y.
    1. Courneya KS. Understanding readiness for regular physical activity in older individuals: an application of the theory of planned behavior. Health Psychol. 1995 Jan;14(1):80–7.
    1. Galea MN, Bray SR. Predicting walking intentions and exercise in individuals With intermittent claudication: an application of the theory of planned behavior. Rehabilitation Psychology. 2006;51:299–305.
    1. Godin G, Amireault S, Bélanger-Gravel A, Vohl MC, Pérusse L. Prediction of leisure-time physical activity among obese individuals. Obesity (Silver Spring) 2009 Apr;17(4):706–12. doi: 10.1038/oby.2008.599.
    1. Fiala B . Social cognitive correlates of physical activity among total joint replacement patients (unpublished Master's thesis) Victoria, BC, Canada: School of Exercise Science, Physical Health Education, University of Victoria; 2010.
    1. Hochbaum GM . Public Health Service publication, no. 572. Washington, DC: US Government Printing Office; 1958. Public participation in medical screening programs: a sociopsychological study.
    1. Blanchard CM, Denniston MM, Baker F, Ainsworth SR, Courneya KS, Hann DM, Gesme DH, Reding D, Flynn T, Kennedy JS. Do adults change their lifestyle behaviors after a cancer diagnosis? Am J Health Behav. 2003;27(3):246–56.
    1. McBride CM, Emmons KM, Lipkus IM. Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res. 2003 Apr;18(2):156–70.
    1. Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer. 2000 Feb 1;88(3):674–84.
    1. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol. 2005 Aug 20;23(24):5814–30. doi: 10.1200/JCO.2005.01.230.
    1. Grindrod KA, Marra CA, Colley L, Cibere J, Tsuyuki RT, Esdaile JM, Gastonguay L, Kopec J. After patients are diagnosed with knee osteoarthritis, what do they do? Arthritis Care Res (Hoboken) 2010 Apr;62(4):510–5. doi: 10.1002/acr.20170.
    1. Krishna S, Balas EA, Spencer DC, Griffin JZ, Boren SA. Clinical trials of interactive computerized patient education: implications for family practice. J Fam Pract. 1997 Jul;45(1):25–33.
    1. Lewis D. Computers in patient education. Comput Inform Nurs. 2003;21(2):88–96.
    1. Williams DM, Matthews CE, Rutt C, Napolitano MA, Marcus BH. Interventions to increase walking behavior. Med Sci Sports Exerc. 2008 Jul;40(7 Suppl):S567–73. doi: 10.1249/MSS.0b013e31817c7006.
    1. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13–24. doi: 10.1002/chp.47.
    1. Arthritis isn't a big deal until you get it. Ask 4 million Canadians. Ottawa, Ontario, Canada: Alliance for the Canadian Arthritis Program; 2006. [2013-04-26]. .
    1. Thomas S, Reading J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q) Can J Sport Sci. 1992 Dec;17(4):338–45.
    1. Richardson MT, Leon AS, Jacobs DR, Ainsworth BE, Serfass R. Comprehensive evaluation of the Minnesota Leisure Time Physical Activity Questionnaire. J Clin Epidemiol. 1994 Mar;47(3):271–81.
    1. Folsom AR, Jacobs DR, Caspersen CJ, Gomez-Marin O, Knudsen J. Test-retest reliability of the Minnesota Leisure Time Physical Activity Questionnaire. J Chronic Dis. 1986;39(7):505–11.
    1. Taylor HL, Jacobs DR, Schucker B, Knudsen J, Leon AS, Debacker G. A questionnaire for the assessment of leisure time physical activities. J Chronic Dis. 1978;31(12):741–55.
    1. De Backer G, Kornitzer M, Sobolski J, Dramaix M, Degré S, de Marneffe M, Denolin H. Physical activity and physical fitness levels of Belgian males aged 40-55 years. Cardiology. 1981;67(2):110–28.
    1. Leon AS, Jacobs DR, DeBacker G, Taylor HL. Relationship of physical characteristics and life habits to treadmill exercise capacity. Am J Epidemiol. 1981 Jun;113(6):653–60.
    1. Roos EM, Roos HP, Lohmander LS, 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.
    1. Roos EM, Roos HP, 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):439–48.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 Dec;15(12):1833–40.
    1. Rhodes RE, Courneya KS, Blanchard CM, Plotnikoff RC. Prediction of leisure-time walking: an integration of social cognitive, perceived environmental, and personality factors. Int J Behav Nutr Phys Act. 2007;4:51. doi: 10.1186/1479-5868-4-51.
    1. Rhodes RE, Fiala B. Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: the evidence. Physiother Theory Pract. 2009 Jul;25(5-6):424–41.
    1. Rhodes RE, Blanchard CM, Courneya KS, Plotnikoff RC. Identifying belief-based targets for the promotion of leisure-time walking. Health Educ Behav. 2009 Apr;36(2):381–93. doi: 10.1177/1090198107308376.
    1. Ory M, Resnick B, Jordan PJ, Coday M, Riebe D, Ewing Garber C, 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:20–8. doi: 10.1207/s15324796abm2902s_5.
    1. Schoenfeld D. Statistical considerations for pilot studies. Int J Radiat Oncol Biol Phys. 1980 Mar;6(3):371–4.
    1. Carter RE, Woolson RF. Statistical design considerations for pilot studies transitioning therapies from the bench to the bedside. J Transl Med. 2004 Dec 28;2(1):37. doi: 10.1186/1479-5876-2-37.
    1. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput. 2004 Nov;36(4):717–31.
    1. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008 Aug;40(3):879–91.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren