Effect of the dr. Bart application on healthcare use and clinical outcomes in people with osteoarthritis of the knee and/or hip in the Netherlands; a randomized controlled trial

Abstract

Objective: To evaluate the short-term effects of use of the dr. Bart app, compared to usual care, on the number of secondary health care consultations and clinical outcomes in people with knee/hip OA in the Netherlands. Method: A randomized controlled design involving participants !50 years with self-reported knee and/ or hip OA recruited from the community. The number of secondary health care consultations (primary outcome) and secondary outcomes were assessed at baseline, 3 and 6 months via online questionnaires. Data were analyzed using longitudinal mixed models, corrected for baseline values. Due to the design of this study, blinding of participants and researchers was not possible. Results: In total, 427 eligible participants were allocated to either the dr. Bart group (n ¼ 214) or usual care (n ¼ 213). We found no difference between groups in the number of secondary (i.e., orthopaedic surgeon, rheumatologist, or physician assistant) health care consultations (incidence rate ratio (IRR) 1.20 (95% CI: 0.67; 2.19)). We found positive treatment effects of the dr. Bart app on symptoms (2.6 (95% CI: 0.4; 4.9)), pain (3.5 (95% CI: 0.9; 6.0)), and activities of daily living (2.9 (95% CI: 0.2; 5.6)) on a 0e100 scale, higher score indicating less complaints, but not in any other secondary outcome. Conclusion: The dr. Bart app did not change the number of secondary health care consultations compared to usual care. However, we found small positive effects (not clinically relevant) on pain, symptoms, and activities of daily living in people with knee/hip OA. Trial registration: Dutch Trial Register (Trial Number NTR6693/NL6505) (https://www.trialregister.nl/ trial/6505).

Digital self-management interventions for osteoarthritis: a systematic scoping review of intervention characteristics, adherence and attrition

“…A summary of the study information, participant characteristics and main findings of the 11 included studies is reported in Table 1 and briefly described. Six studies included individuals with knee OA [ 25 – 30 ], one included individuals with hip OA [ 31 ] and four included individuals with either hip or knee OA [ 15 , 32 – 34 ]. Ten studies reported a higher numbers of female participants (range, 56–100%).…”

“…The sample size of the studies ranged from 40 to 427. Four studies included a follow-up at 12-months [ 15 , 26 , 31 , 34 ], one at 9 months [ 28 ] and the remaining six studies had no follow-up [ 25 , 27 , 29 , 30 , 32 , 33 ]. The control groups varied amongst included studies.…”

Use and usability of the dr. Bart app and its relation with health care utilisation and clinical outcomes in people with knee and/or hip osteoarthritis

“…The original randomised controlled trial included 427 participants with knee/hip OA [ 14 ]. Of those, 214 participants were randomised into the intervention group and subsequently included in the current explorative study.…”

“…The content of the dr. Bart app is based on the Fogg model for behavioural change, augmented with reminders, rewards and self-monitoring to reinforce app engagement [ 13 , 23 ]. In a randomized evaluation, we found that the dr. Bart app did not impact health care utilisation (HCU), but resulted in small positive effects on pain, symptoms and activities of daily living [ 14 ]. However, a fundamental issue in eHealth research is non-usage attrition; a proportion of participants do not use the intervention at all, or use it sparsely [ 15 ].…”

Reply to letter to the editor: ‘effect of the dr. Bart application on healthcare use and clinical outcomes in people with osteoarthritis of the knee and/or hip in the Netherlands — a randomized controlled trial’

“…This letter is in response to the letter by Chudy et al 13 regarding our article: 'Effect of the dr. Bart application on health care use and clinical outcomes in people with osteoarthritis of the knee and/or hip in the Netherlands; a randomized controlled trial' 1 .…”