Effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis: randomized controlled trial

Daniël Bossen, Cindy Veenhof, Karin Ec Van Beek, Peter Mm Spreeuwenberg, Joost Dekker, Dinny H De Bakker, Daniël Bossen, Cindy Veenhof, Karin Ec Van Beek, Peter Mm Spreeuwenberg, Joost Dekker, Dinny H De Bakker

Abstract

Background: Patients with knee and/or hip osteoarthritis (OA) are less physically active than the general population, while the benefits of physical activity (PA) have been well documented. Based on the behavioral graded activity treatment, we developed a Web-based intervention to improve PA levels in patients with knee and/or hip OA, entitled "Join2move". The Join2move intervention is a self-paced 9-week PA program in which the patient's favorite recreational activity is gradually increased in a time-contingent way.

Objective: The aim of the study was to investigate whether a fully automated Web-based PA intervention in patients with knee and/or hip OA would result in improved levels of PA, physical function, and self-perceived effect compared with a waiting list control group.

Methods: The study design was a two-armed randomized controlled trial which was not blinded. Volunteers were recruited via articles in newspapers and health-related websites. Eligibility criteria for participants were: (1) aged 50-75 years, (2) self-reported knee and/or hip OA, (3) self-reported inactivity (30 minutes of moderate PA, 5 times or less per week), (4) no face-to-face consultation with a health care provider other than general practitioners, for OA in the last 6 months, (5) ability to access the Internet weekly, and (6) no contra-indications to exercise without supervision. Baseline, 3-month, and 12-month follow-up data were collected through online questionnaires. Primary outcomes were PA, physical function, and self-perceived effect. In a subgroup of participants, PA was measured objectively using accelerometers. Secondary outcomes were pain, fatigue, anxiety, depression, symptoms, quality of life, self-efficacy, pain coping, and locus of control.

Results: Of the 581 interested respondents, 199 eligible participants were randomly assigned to the intervention (n=100) or waiting list control group (n=99). Response rates of questionnaires were 84.4% (168/199) after 3 months and 75.4% (150/199) after 12 months. In this study, 94.0% (94/100) of participants actually started the program, and 46.0% (46/100) reached the adherence threshold of 6 out of 9 modules completed. At 3 months, participants in the intervention group reported a significantly improved physical function status (difference=6.5 points, 95% CI 1.8-11.2) and a positive self-perceived effect (OR 10.7, 95% CI 4.3-26.4) compared with the control group. No effect was found for self-reported PA. After 12 months, the intervention group showed higher levels of subjective (difference=21.2 points, 95% CI 3.6-38.9) and objective PA (difference=24 minutes, 95% CI 0.5-46.8) compared with the control group. After 12 months, no effect was found for physical function (difference=5 points, 95% CI -1.0 to 11.0) and self-perceived effect (OR 1.2, 95% CI 0.6-2.4). For several secondary endpoints, the intervention group demonstrated improvements in favor of the intervention group.

Conclusions: Join2move resulted in changes in the desired direction for several primary and secondary outcomes. Given the benefits and its self-help format, Join2move could be a component in the effort to enhance PA in sedentary patients with knee and/or hip OA.

Keywords: Web-based intervention; osteoarthritis; physical activity; randomized controlled trial.

Conflict of interest statement

Conflicts of Interest: The authors Daniel Bossen and Cindy Veenhof are the creators of the Join2move intervention.

Figures

Figure 1
Figure 1
Join2move homepage.
Figure 2
Figure 2
Flow of participants throughout the trial.
Figure 3
Figure 3
Module completion rate.

References

    1. Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006 Mar 14;174(6):801–9. doi: 10.1503/cmaj.051351.
    1. Conn VS, Hafdahl AR, Brown SA, Brown LM. Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. Patient Educ Couns. 2008 Feb;70(2):157–72. doi: 10.1016/j.pec.2007.10.004.
    1. Dunlop DD, Song J, Semanik PA, Sharma L, Chang RW. Physical activity levels and functional performance in the osteoarthritis initiative: a graded relationship. Arthritis Rheum. 2011 Jan;63(1):127–36. doi: 10.1002/art.27760.
    1. Esser S, Bailey A. Effects of exercise and physical activity on knee osteoarthritis. Curr Pain Headache Rep. 2011 Dec;15(6):423–30. doi: 10.1007/s11916-011-0225-z.
    1. van Dijk GM, Dekker J, Veenhof C, van den Ende CH, Carpa Study Group Course of functional status and pain in osteoarthritis of the hip or knee: a systematic review of the literature. Arthritis Rheum. 2006 Oct 15;55(5):779–85. doi: 10.1002/art.22244.
    1. Creamer P, Lethbridge-Cejku M, Hochberg MC. Determinants of pain severity in knee osteoarthritis: effect of demographic and psychosocial variables using 3 pain measures. J Rheumatol. 1999 Aug;26(8):1785–92.
    1. Hootman JM, Macera CA, Ham SA, Helmick CG, Sniezek JE. Physical activity levels among the general US adult population and in adults with and without arthritis. Arthritis Rheum. 2003 Feb 15;49(1):129–35. doi: 10.1002/art.10911.
    1. Shih M, Hootman JM, Kruger J, Helmick CG. Physical activity in men and women with arthritis National Health Interview Survey, 2002. Am J Prev Med. 2006 May;30(5):385–93. doi: 10.1016/j.amepre.2005.12.005.
    1. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Leeb B, Lequesne M, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Serni U, Swoboda B, Verbruggen G, Zimmerman-Gorska I, Dougados M, Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) Ann Rheum Dis. 2003 Dec;62(12):1145–55.
    1. Cottrell E, Roddy E, Foster NE. The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain: a systematic review. BMC Fam Pract. 2010;11:4. doi: 10.1186/1471-2296-11-4.
    1. Denoeud L, Mazières B, Payen-Champenois C, Ravaud P. First line treatment of knee osteoarthritis in outpatients in France: adherence to the EULAR 2000 recommendations and factors influencing adherence. Ann Rheum Dis. 2005 Jan;64(1):70–4. doi: 10.1136/ard.2003.015263.
    1. Porcheret M, Jordan K, Jinks C, Croft P, Primary Care Rheumatology Society Primary care treatment of knee pain--a survey in older adults. Rheumatology (Oxford) 2007 Nov;46(11):1694–700. doi: 10.1093/rheumatology/kem232.
    1. Mamlin LA, Melfi CA, Parchman ML, Gutierrez B, Allen DI, Katz BP, Dittus RS, Heck DA, Freund DA. Management of osteoarthritis of the knee by primary care physicians. Arch Fam Med. 1998 Nov;7(6):563–7.
    1. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001 Feb;60(2):91–7.
    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. Petursdottir U, Arnadottir SA, Halldorsdottir S. Facilitators and barriers to exercising among people with osteoarthritis: a phenomenological study. Phys Ther. 2010 Jul;90(7):1014–25. doi: 10.2522/ptj.20090217.
    1. Internet World Stats. [2012-06-07]. World Internet Users and Population Stats .
    1. CBS-Statline: CBS Statistics Netherlands, The Hague (2011) [2013-10-08]. .
    1. Barak A, Klein B, Proudfoot JG. Defining internet-supported therapeutic interventions. Ann Behav Med. 2009 Aug;38(1):4–17. doi: 10.1007/s12160-009-9130-7.
    1. Bossen D, Veenhof C, Dekker J, de Bakker D. The Effectiveness of Self-Guided Web-Based Physical Activity Interventions Among Patients with a Chronic Disease: A Systematic Review. J Phys Act Health. 2013 Mar 14;:1.
    1. Vandelanotte C, Spathonis KM, Eakin EG, Owen N. Website-delivered physical activity interventions a review of the literature. Am J Prev Med. 2007 Jul;33(1):54–64. doi: 10.1016/j.amepre.2007.02.041.
    1. Davies CA, Spence JC, Vandelanotte C, Caperchione CM, Mummery WK. Meta-analysis of internet-delivered interventions to increase physical activity levels. Int J Behav Nutr Phys Act. 2012;9:52. doi: 10.1186/1479-5868-9-52.
    1. Veenhof C, Köke AJ, Dekker J, Oostendorp RA, Bijlsma JW, van Tulder MW, van den Ende CH. Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and/or knee: A randomized clinical trial. Arthritis Rheum. 2006 Dec 15;55(6):925–34. doi: 10.1002/art.22341.
    1. Eysenbach G, CONSORT-EHEALTH Group CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011;13(4):e126. doi: 10.2196/jmir.1923.
    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. Nielsen J. Iterative user-interface design. Computer. 1993 Nov;26(11):32–41. doi: 10.1109/2.241424.
    1. Bossen D, Veenhof C, Dekker J, de Bakker D. The usability and preliminary effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis. BMC Med Inform Decis Mak. 2013;13:61. doi: 10.1186/1472-6947-13-61.
    1. Fordyce WE, Fowler RS, Lehmann JF, Delateur BJ, Sand PL, Trieschmann RB. Operant conditioning in the treatment of chronic pain. Arch Phys Med Rehabil. 1973 Sep;54(9):399–408.
    1. Washburn RA, Smith KW, Jette AM, Janney CA. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol. 1993 Feb;46(2):153–62.
    1. Actigraph. [2013-02-21].
    1. Hart TL, Swartz AM, Cashin SE, Strath SJ. How many days of monitoring predict physical activity and sedentary behaviour in older adults? Int J Behav Nutr Phys Act. 2011;8:62. doi: 10.1186/1479-5868-8-62.
    1. Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998 May;30(5):777–81.
    1. ActiGraph . MeterPlus User's Manual, Version 4.3.0. San Diego State: MeterPlus; 2011.
    1. Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes. 2003;1:64. doi: 10.1186/1477-7525-1-64.
    1. de Groot IB, Favejee MM, Reijman M, Verhaar JA, Terwee CB. The Dutch version of the Knee Injury and Osteoarthritis Outcome Score: a validation study. Health Qual Life Outcomes. 2008;6:16. doi: 10.1186/1477-7525-6-16.
    1. Klässbo M, Larsson E, Mannevik E. Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol. 2003;32(1):46–51.
    1. de Groot IB, Reijman M, Terwee CB, Bierma-Zeinstra S, Favejee MM, Roos E, Verhaar JA. Validation of the Dutch version of the Hip disability and Osteoarthritis Outcome Score. Osteoarthritis Cartilage. 2009 Jan;17(1):132. doi: 10.1016/j.joca.2008.05.014.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–70.
    1. Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989 Jan;32(1):37–44.
    1. Taal E, Rasker JJ, Wiegman O. Group education for rheumatoid arthritis patients. Semin Arthritis Rheum. 1997 Jun;26(6):805–16.
    1. Kraaimaat FW, Evers AW. Pain-coping strategies in chronic pain patients: psychometric characteristics of the pain-coping inventory (PCI) Int J Behav Med. 2003;10(4):343–63.
    1. Wallston KA, Wallston BS, DeVellis R. Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Educ Monogr. 1978;6(2):160–70.
    1. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, N.J: L. Erlbaum Associates; 1988.
    1. Twisk J, de Vente W. Attrition in longitudinal studies. How to deal with missing data. J Clin Epidemiol. 2002 Apr;55(4):329–37.
    1. Dunlop DD, Song J, Semanik PA, Sharma L, Chang RW. Physical activity levels and functional performance in the osteoarthritis initiative: a graded relationship. Arthritis Rheum. 2011 Jan;63(1):127–36. doi: 10.1002/art.27760.
    1. Neville LM, O'Hara B, Milat A. Computer-tailored physical activity behavior change interventions targeting adults: a systematic review. Int J Behav Nutr Phys Act. 2009;6:30. doi: 10.1186/1479-5868-6-30.
    1. Norman GJ, Zabinski MF, Adams MA, Rosenberg DE, Yaroch AL, Atienza AA. A review of eHealth interventions for physical activity and dietary behavior change. Am J Prev Med. 2007 Oct;33(4):336–345. doi: 10.1016/j.amepre.2007.05.007.
    1. Hagströmer M, Oja P, Sjöström M. Physical activity and inactivity in an adult population assessed by accelerometry. Med Sci Sports Exerc. 2007 Sep;39(9):1502–8. doi: 10.1249/mss.0b013e3180a76de5.
    1. Sallis JF, Saelens BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exerc Sport. 2000 Jun;71(2 Suppl):S1–14.
    1. Pisters MF, Veenhof C, van Meeteren NL, Ostelo RW, de Bakker DH, Schellevis FG, Dekker J. Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review. Arthritis Rheum. 2007 Oct 15;57(7):1245–53. doi: 10.1002/art.23009.
    1. Eysenbach G. The law of attrition. J Med Internet Res. 2005;7(1):e11. doi: 10.2196/jmir.7.1.e11.
    1. Wanner M, Martin-Diener E, Braun-Fahrländer C, Bauer G, Martin BW. Effectiveness of active-online, an individually tailored physical activity intervention, in a real-life setting: randomized controlled trial. J Med Internet Res. 2009;11(3):e23. doi: 10.2196/jmir.1179.
    1. McConnon A, Kirk SF, Cockroft JE, Harvey EL, Greenwood DC, Thomas JD, Ransley JK, Bojke L. The Internet for weight control in an obese sample: results of a randomised controlled trial. BMC Health Serv Res. 2007;7:206. doi: 10.1186/1472-6963-7-206.
    1. Hansen AW, Grønbæk M, Helge JW, Severin M, Curtis T, Tolstrup JS. Effect of a Web-based intervention to promote physical activity and improve health among physically inactive adults: a population-based randomized controlled trial. J Med Internet Res. 2012;14(5):e145. doi: 10.2196/jmir.2109.
    1. Wanner M, Martin-Diener E, Bauer G, Braun-Fahrländer C, Martin BW. Comparison of trial participants and open access users of a web-based physical activity intervention regarding adherence, attrition, and repeated participation. J Med Internet Res. 2010;12(1):e3. doi: 10.2196/jmir.1361.
    1. Schneider F, van Osch L, Schulz DN, Kremers SP, de Vries H. The influence of user characteristics and a periodic email prompt on exposure to an internet-delivered computer-tailored lifestyle program. J Med Internet Res. 2012;14(2):e40. doi: 10.2196/jmir.1939.
    1. Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. 2010;12(1):e4. doi: 10.2196/jmir.1376.
    1. Kelders SM, Kok RN, Ossebaard HC, Van Gemert-Pijnen JE. Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res. 2012;14(6):e152. doi: 10.2196/jmir.2104.
    1. Bossen D, Buskermolen M, Veenhof C, de Bakker D, Dekker J. Adherence to a Web-Based Physical Activity Intervention for Patients With Knee and/or Hip Osteoarthritis: A Mixed Method Study. J Med Internet Res. 2013;15(10):e223. doi: 10.2196/jmir.2742.
    1. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P, American College of Rheumatology American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012 Apr;64(4):465–74.
    1. Bennell KL, Hunter DJ, Hinman RS. Management of osteoarthritis of the knee. BMJ. 2012;345:e4934.
    1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, 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):1039–49.
    1. Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Feldman D. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991 May;34(5):505–14.
    1. March LM, Schwarz JM, Carfrae BH, Bagge E. Clinical validation of self-reported osteoarthritis. Osteoarthritis Cartilage. 1998 Mar;6(2):87–93. doi: 10.1053/joca.1997.0098.
    1. Eysenbach G. Poverty, human development, and the role of eHealth. J Med Internet Res. 2007;9(4):e34. doi: 10.2196/jmir.9.4.e34.
    1. Verheijden MW, Jans MP, Hildebrandt VH, Hopman-Rock M. Rates and determinants of repeated participation in a web-based behavior change program for healthy body weight and healthy lifestyle. J Med Internet Res. 2007;9(1):e1. doi: 10.2196/jmir.9.1.e1.
    1. Kelders SM, Van Gemert-Pijnen JE, Werkman A, Nijland N, Seydel ER. Effectiveness of a Web-based intervention aimed at healthy dietary and physical activity behavior: a randomized controlled trial about users and usage. J Med Internet Res. 2011;13(2):e32. doi: 10.2196/jmir.1624.
    1. De Cocker K, Spittaels H, Cardon G, De Bourdeaudhuij I, Vandelanotte C. Web-based, computer-tailored, pedometer-based physical activity advice: development, dissemination through general practice, acceptability, and preliminary efficacy in a randomized controlled trial. J Med Internet Res. 2012;14(2):e53. doi: 10.2196/jmir.1959.
    1. Solomon M, Wagner SL, Goes J. Effects of a Web-based intervention for adults with chronic conditions on patient activation: online randomized controlled trial. J Med Internet Res. 2012;14(1):e32. doi: 10.2196/jmir.1924.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir