Addition of telephone coaching to a physiotherapist-delivered physical activity program in people with knee osteoarthritis: A randomised controlled trial protocol

Abstract

BackgroundKnee osteoarthritis (OA) is one of the most common and costly chronic musculoskeletal conditions world-wide and is associated with substantial pain and disability. Many people with knee OA also experience co-morbidities that further add to the OA burden. Uptake of and adherence to physical activity recommendations is suboptimal in this patient population, leading to poorer OA outcomes and greater impact of associated co-morbidities. This pragmatic randomised controlled trial will investigate the clinical- and cost-effectiveness of adding telephone coaching to a physiotherapist-delivered physical activity intervention for people with knee OA.Methods/Design168 people with clinically diagnosed knee OA will be recruited from the community in metropolitan and regional areas and randomly allocated to physiotherapy only, or physiotherapy plus nurse-delivered telephone coaching. Physiotherapy involves five treatment sessions over 6 months, incorporating a home exercise program of 4–6 exercises (targeting knee extensor and hip abductor strength) and advice to increase daily physical activity. Telephone coaching comprises 6–12 telephone calls over 6 months by health practitioners trained in applying the Health Change Australia (HCA) Model of Health Change to provide behaviour change support. The telephone coaching intervention aims to maximise adherence to the physiotherapy program, as well as facilitate increased levels of participation in general physical activity. The primary outcomes are pain measured by an 11-point numeric rating scale and self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale after 6 months. Secondary outcomes include physical activity levels, quality-of-life, and potential moderators and mediators of outcomes including self-efficacy, pain coping and depression. Relative cost-effectiveness will be determined from health service usage and outcome data. Follow-up assessments will also occur at 12 and 18 months.DiscussionThe findings will help determine whether the addition of telephone coaching sessions can improve sustainability of outcomes from a physiotherapist-delivered physical activity intervention in people with knee OA.Trial RegistrationAustralian New Zealand Clinical Trials Registry reference: ACTRN12612000308897

Consensus on Exercise Reporting Template (CERT): Explanation and Elaboration Statement

“…Physiotherapists were chosen to deliver the physical activity intervention as they have expertise in exercise prescription and are key providers of structured physical activity in the community for people with knee osteoarthritis. Three registered nurses who complete training and mentoring from Health Change Australia to develop skills in providing behaviour change support will provide the telephone coaching for the study”28…”

“…Calls will occur in weeks 2, 4, 8, 13, 21 and 25. Up to six additional calls can be made at any time during the 6 months”28…”

Telephone Coaching to Enhance a Home‐Based Physical Activity Program for Knee Osteoarthritis: A Randomized Clinical Trial

“…We conducted a 2‐arm parallel‐design pragmatic randomized controlled trial. The protocol is reported elsewhere . The institutional Human Ethics Committee approved the study (no.…”

“…Details of the interventions can be found elsewhere . Participants in both groups visited a project physiotherapist for 5 individual 30‐minute sessions over 6 months (at weeks 1, 3, 7, 12, and 20).…”

“…Participants were encouraged to monitor their progress and assisted with identifying individual barriers as well as strategies to overcome barriers. Following each consultation, physiotherapists and coaches completed an online communication form outlining topics discussed and any problems, as well as other relevant information, such as goals and adherence, to facilitate 2‐way interaction .…”