Exercise-Based Interventions for the Presurgical Management of Knee Osteoarthritis: A Rapid Qualitative Review

Abstract


 One reviewer conducted a thematic synthesis of 16 studies focused on the perspectives, expectations, and experiences of people living with knee osteoarthritis (OA) regarding accessing and engaging with presurgical interventions for managing knee OA incorporating individual and/or group-based exercise.
 People with knee OA held various beliefs regarding the safety and usefulness of presurgical exercise-based interventions for the condition, often informed by interactions with health care providers early in their knee OA journey. Negative beliefs about exercise could make people apprehensive about engaging in it, while positive beliefs motivated initial access and engagement.
 Intrinsic, personal, and extrinsic contexts could influence people’s beliefs about presurgical exercise-based interventions and their ability and motivation to access, use, and ultimately benefit from them. People experiencing intrinsic motivation, self-efficacy, and a natural tendency toward physical activity, and those who did not experience symptoms or comorbidities interfering with exercise, described accessing and engaging in these interventions as easier. Initial access also depended largely on the nature of interactions with health care providers early in their knee OA journey. Some people reported difficulty accessing or engaging in these interventions when they had competing commitments or lacked sufficient funds, insurance coverage, equipment, and appropriate physical environments.
 People with knee OA generally reported feeling motivated by and benefiting from interventions that were structured, had an educational component, contained appropriately challenging but easily mastered exercises tailored to their contexts and needs, and included either in-person or virtual guidance from an exercise expert. They tended to find encouragement and motivation through group-based exercises. Some also reported feeling externally motivated by technologies sending automated reminders, motivations, and feedback regarding their physical activity. Many experienced positive outcomes after engaging in these interventions, which improved their quality of life, encouraged positive beliefs about exercise, and promoted continued use.
 Decision-makers interested in promoting equity in access, use, and benefit may consider publicly funding exercise-based interventions that can be tailored to individuals’ needs; may be delivered either in-person or virtually; can be offered outside of working hours; include exercises that are easy to execute while tending to other commitments; and use affordable equipment suitable for a range of body types.