Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial

Abstract

BackgroundIntegrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions.ObjectiveThe objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA.DesignThe design was a prospective, single-blind, multicenter, superiority, cluster- randomized controlled trial.SettingThe setting included 143 primary care physical therapist practices.ParticipantsThe participants were 208 people who had hip/knee OA and were 40 to 80 years of age.Interventione-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA.MeasurementsPrimary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions.ResultsThe e-Exercise group (n = 109) received, on average, 5 face-to-face sessions; the usual physical therapy group (n = 99) received 12. No significant differences in primary outcomes between the e-Exercise group and the usual physical therapy group were found. Within-group analyses for both groups showed a significant improvement in physical functioning. After 3 months, participants in the e-Exercise group reported an increase in physical activity; however, no objectively measured differences in physical activity were found. With respect to secondary outcomes, after 12 months, sedentary behavior significantly increased in the e-Exercise group compared with the usual physical therapy group. In both groups, there were significant improvements for pain, tiredness, quality of life, and self-efficacy.LimitationsThe response rate at 12 months was 65%.ConclusionsThe blended intervention, e-Exercise, was not more effective than usual physical therapy in people with hip/knee OA.

Development and proof of concept of a blended physiotherapeutic intervention for patients with non-specific low back pain

“…First, national and international clinical LBP guidelines were studied. Second, the results and experiences from the previous study on e-Exercise Osteoarthritis were used [21][22][23].…”

“…If patients were insufficiently physically active, the physiotherapist could activate the graded activity functionality and set a goal to reach within 12 weeks. This graded activity functionality with tailored feedback has been studied previously in two osteoarthritis studies [23,35]. Patients received weekly reminders to visit the web application.…”

“…Recently, the authors' research group developed and evaluated a blended physiotherapeutic intervention for patients with osteoarthritis of the hip and/or knee (e-Exercise Osteoarthritis) [21,22]. Patients treated with e-Exercise Osteoarthritis experienced improvements in physical functioning, pain, tiredness, quality of life and selfefficacy [23]. Moreover, patients were highly positive and satisfied with the availability of information and assignments regardless of time or place [24].…”

Effectiveness and cost-effectiveness of stratified blended physiotherapy in patients with non-specific low back pain: study protocol of a cluster randomized controlled trial

“…At the long-term, e-Exercise LBP could result in an improved handling of recurrent LBP and direct and indirect costs. This blended care intervention is an adapted version of previously developed and evaluated blended physiotherapy programs [34,35]. A pilot study using a prototype of the e-Exercise LBP intervention in 41 patients with LBP demonstrated feasibility and proofof-concept on functional disability and pain [33].…”

“…Primary care physiotherapy practices will be invited by letter to participate in the study. Contact details of potential participating practices will be obtained from the professional network of the authors and a previous e-Exercise study [35]. Additionally, a recruitment advertisement will be placed in the online newsletter of The Royal Dutch Association for Physiotherapy (KNGF).…”