Effectiveness of internet-delivered education and home exercise supported by behaviour change SMS on pain and function for people with knee osteoarthritis: a randomised controlled trial protocol

Abstract

Background Knee osteoarthritis (OA) is a prevalent and chronic condition with no known cure. Exercise is advocated in all clinical guidelines due to its positive effects on symptoms. Despite this, exercise participation is often poor in people with knee OA with access to exercise treatments a known barrier. Internet-delivered exercise interventions have the potential to improve access to evidence-based exercise treatments and can benefit OA outcomes, although non-usage and low adherence potentially limit their effectiveness. Short message services (SMS) show promise in facilitating exercise adherence and may be one solution to improve adherence to internet-delivered exercise interventions. The combination of internet-delivered exercise and SMS adherence support has not been specifically evaluated in people with knee OA. Methods This protocol reports a two-arm parallel-design, assessor- and participant-blinded randomised controlled trial. This trial is recruiting 206 people aged 45 years and older, with a clinical diagnosis of knee OA from the Australian-wide community. Eligible and consenting participants are enrolled and randomised to receive access to either i) ‘My Knee Education’, an education control website containing OA and exercise information only or ii) a combined intervention that includes a website, ‘My Knee Exercise’, containing the same educational information as the control, guidance to increase general physical activity, and the prescription of a 24-week self-directed home-based lower-limb strengthening program in addition to a 24-week behaviour change SMS exercise adherence program. Outcome measures are being collected at baseline and 24-weeks. Primary outcomes are self-reported knee pain and physical function. Secondary outcomes include another self-reported measure of knee pain, function in sport and recreation, quality-of-life, physical activity, self-efficacy, participant satisfaction and perceived global change. Discussion This randomised controlled trial will provide evidence about the effectiveness of a combined intervention of internet-delivered OA and exercise education, physical activity guidance and prescription of a 24-week lower-limb strengthening exercise program supported by a behaviour change SMS program compared to internet delivered OA and exercise education alone. Trial registration ACTRN12618001167257 /13th July 2018. Electronic supplementary material The online version of this article (10.1186/s12891-019-2714-x) contains supplementary material, which is available to authorized users.

Exploring Attitudes and Experiences of People With Knee Osteoarthritis Toward a Self-Directed eHealth Intervention to Support Exercise: Qualitative Study

“…A qualitative study based on an interpretivist paradigm [ 30 ] was nested within an RCT [ 28 ] evaluating the effectiveness of an eHealth intervention of web-based information and exercise prescription supported by behavior change mobile phone SMS (data collection completed and manuscript in preparation; Australian New Zealand Clinical Trials Registry ACTRN12618001167257). Reporting complies with The Consolidated Criteria for Reporting Qualitative Research checklist [ 31 ].…”

“…Full details of the digital intervention are described elsewhere [ 28 ]. In summary, the intervention included a website, “My Knee Exercise,” and a 24-week mobile phone SMS behavior change program.…”

“…Eligibility criteria for the RCT included age ≥45 years and a clinical diagnosis of knee OA [5]. Full RCT eligibility criteria are reported elsewhere [28]. Table 1 describes the characteristics of the 16 participants interviewed.…”

“…To explore this, we developed a “light-touch,” self-directed, eHealth intervention that combines a website, “My Knee Exercise,” and a 24-week behavior change SMS program. The effect of this intervention on knee pain and function is currently being evaluated in a randomized controlled trial (RCT) of 206 people with a clinical diagnosis of knee OA [ 28 ]. In addition, as patient acceptability is a key component to successful intervention implementation [ 29 ], qualitative enquiry is also needed to understand if the eHealth intervention is accepted by people with knee OA to facilitate self-directed exercise.…”

Optimizing telehealth pain care after COVID-19

“…Numerous pilot trials or in-progress clinical trials on this topic indicate more evidence is imminent. 35 , 39 , 56 , 58 , 69 …”