IntroductionSoaring prevalence of hip and knee osteoarthritis (OA) inflicts high costs on the healthcare system. A further rise in the OA incidence is expected, generating increased demand of care potentially challenging accessibility and threatening to overwhelm the healthcare system. Innovative solutions that may improve accessibility to recommended OA care for patients in primary care and maintain healthcare sustainability are warranted. Digitalising home exercise therapy may be one such solution. The primary aim of this study is to evaluate the effectiveness of a mobile health app providing digitalised home exercises, compared with supervised exercise therapy in patients with OA. Second, we will evaluate the cost-efficiency of the intervention and explore potential differences in outcome and adherence to exercises in the experimental treatment group.Methods and analysisA two-armed non-inferiority randomised controlled trial will be conducted. In total, 156 patients with hip and/or knee OA will be recruited from physiotherapy clinics in primary care in Norway. Following patient education, patients will be randomised to either 6 weeks of standard treatment (2 weekly sessions of supervised exercise therapy) or experimental treatment (home exercises via the Virtual Training (VT) app). Primary outcome is the proportion of Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responders at 6 weeks. Secondary outcomes include physical performance, patient-reported outcomes related to pain, fatigue, disease activity, physical function, mental health, health related quality of life, self-efficacy, utilisation of healthcare services and medication, digital competence and use of apps.Ethics and disseminationPatients will sign an informed consent form before participating in the trial. Approval has been granted by the Regional Ethics Committee (201105) and Data Protection Officer at Diakonhjemmet Hospital (00221). Patient research partners will contribute in all parts of the study.Trial registration numberNCT04767854.

BackgroundAs the prevalence and costs related to osteoarthritis (OA) are expected to rise in the coming years, actions have to be taken to ensure access to effective and economical sustainable recommended treatment for this patient population. Digital tools, such as the use of mobile health applications (mHealth), could serve as a solution. Though, little is known about characteristics of patients participating in a mHealth osteoarthritis management program (OAMP) in physiotherapy practice.ObjectivesTo describe demographic and disease-related characteristics of patients with hip and/or knee OA recruited to a mHealth OAMP and compare these characteristics to those of other OAMPs.MethodsThe Digital Osteoarthritis Care-study (DigiOA) is a two-armed non-inferiority RCT currently running in primary health care in Norway. In total 156 participants with hip and/or knee OA seeking physiotherapy in primary care will be asked to participate. Consenting patients will receive 1-2 hours of education before randomization to 6 weeks of either exercise therapy via the Virtual Training mobile health application or supervised exercise therapy. Inclusion rate is reported as frequency and percentage. To describe patient characteristics, we have included baseline data on patients currently included in the study. These characteristics are compared to baseline data from a web-based OAMP (1) and a standard OAMP in physiotherapy care (2).ResultsOf 39 eligible patients, 25 (64%) have to date consented to participate in the study. An overweight of the included patients are presented with knee OA, have had symptoms for five years or less, and have higher education (Table 1).Table 1.Demographic and disease-related characteristics of patients with hip and/or knee OA recruited to a mHealth OA management program (n=25)Age years, n=24, mean (SD)63.2 (10.4)Female, n (%)17 (70.8)BMI, mean (SD)27.3 (5.4)Education, n (%)10 (40)-Upper secondary15 (60)-College/universityNon-Smoking, n (%)23 (92)Work status, n (%)12 (48)-Employed4 (16)-Sick leave/receiving disability benefits11 (44)-RetiredPrimary joint affected, n (%)17 (68)-Knee8 (32)-HipOther joints affected, n (%)21 (84)Other chronic conditions, n (%)15 (60)Symptom duration years, n (%)5 (20)-Less than a year15 (60)-1-5 years5 (20)-More than 10 yearsOA medication use last 3 months, n (%)19 (76)Pain last weeka, mean (SD)4.7 (2.3)HOOS/KOOSb, mean (SD)59.4 (18.5)-Pain48.4 (10.2)-Symptoms67.2 (19.1)-ADL39.7 (19.7)-Sport/Rec46.5 (14.2)-QOLASESc, mean (SD)2.2 (0.8)-Pain2.5 (0.7)-Other symptomsExercise self-efficacy scaled, mean (SD)40.2 (3.4)a= NRS 0-10 (10=most pain) b= (HOOS: Hip disability and Osteoarthritis Outcome Score/KOOS: Knee injury and Osteoarthritis Outcome Score (0-100, 100=no problems) c= Arthritis Self-Efficacy scale (0-4, 4=most certain) d= (20-100, 100=most certain)The study sample report high impact of symptoms, and decreased function. Self-efficacy related to pain and symptoms are relatively high, but the patients report lower exercise self-efficacy.The study sample is comparable to patients included in both standard and web-based OAMPs, except from lower impact of pain and higher usage of pain medication in DigiOA.ConclusionPreliminary results show that baseline characteristics are comparable to patients included in other OAMPs, but with only two third of eligible patients consenting to participate in a mHealth OAMP there is a need for more in-depth knowledge on patients’ attitude towards mHealth OAMPs.References[1]Nero H, Dahlberg J, Dahlberg LE. A 6-Week Web-Based osteoarthritis treatment program: Observational quasi-experimental study. Journal Of Medical Internet Research. 2017;19(12).[2]Moseng T, Dagfinrud H, Bodegom-Vos Lv, Dziedzic K, Hagen KB, Natvig B, et al. Low adherence to exercise may have influenced the proportion of OMERACT-OARSI responders in an integrated osteoarthritis care model: secondary analyses from a cluster-randomised stepped-wedge trial. BMC Musculoskeletal Disorders. 2020;21(1):1-11.Disclosure of InterestsNone declared