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

Abstract

Background Knee osteoarthritis (OA) is a highly prevalent and debilitating condition. Exercise is a recommended treatment because of its effectiveness at improving pain and function. However, exercise is underutilized in OA management. Difficulty accessing health care has been identified as a key barrier to exercise uptake. Innovative and scalable methods of delivering exercise treatments to people with knee OA are needed. We developed a self-directed eHealth intervention to enable and encourage exercise participation. The effectiveness of this intervention on pain and function in people with knee OA is being evaluated in a randomized clinical trial. Objective This study aimed to explore the attitudes and experiences of people with knee OA who accessed the self-directed eHealth intervention and the features perceived as useful to facilitate self-directed exercise. Methods This was a qualitative study embedded within a randomized controlled trial. Individual, semistructured phone interviews were conducted with 16 people with knee OA who had accessed a 24-week eHealth intervention (website and behavior change SMS program) designed to support exercise participation. Interviews were audiorecorded, transcribed verbatim, and thematically analyzed using an inductive approach. Results Five themes arose: (1) technology easy to use and follow (website ease of use, SMS ease of use), (2) facilitators to exercise participation (credible OA and exercise information, website features, prescribed exercises simple to do unsupervised, freedom to adapt the exercise to suit needs, influence of other health care experiences), (3) sense of support and accountability (SMS good reminder and prompt, accountable, SMS tone and automation could trigger negative emotions [eg, guilt or shame], inability to contact someone when needed), (4) positive outcomes (knee symptom improvements, confidence to self-manage, encouraged active living), (5) suggestions for real-world application (provided by a health professional preferred, should be provided at subsidized or low out-of-pocket cost). Conclusions People with knee OA had mostly positive experiences with and attitudes towards the use of an eHealth intervention that supported exercise participation independent of a health professional. A human connection associated with the eHealth intervention appeared important.

Applications of Wearable Technology in a Real-Life Setting in People with Knee Osteoarthritis: A Systematic Scoping Review

“…Of these, 2219 records did not meet the inclusion criteria. Subsequently, 266 full-text articles were assessed for eligibility, and 68 studies [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ...…”

Barriers and Facilitators of a New Model of Stratified Exercise Therapy in Knee Osteoarthritis: A Qualitative Study

“…As this alliance has been proposed as a crucial condition for an effective treatment 15 , this might be an actual downside of our HMS treatment. On the other hand, previous studies showed that minimally supervised exercise therapy interventions (e.g., webbased 27,28 , Skype-based 29 , telephone-based 30 or a combination of web-based and face-to-face interventions 31,32 ) may not be inferior to fully supervised interventions or even superior for the longer term due to their focus on self-management. This qualitative study was embedded within a large cluster RCT (OCTOPuS-trial) evaluating the (cost-)effectiveness of our model in primary care.…”

Patients’ and clinicians’ experiences with stratified exercise therapy in knee osteoarthritis: a qualitative study

“…Recent work showed that a so-called ‘therapeutic alliance’ could be a crucial condition for an effective treatment [ 20 ], which underlines the reported concerns. On the other hand, a number of studies has shown that minimally supervised exercise therapy interventions (e.g., web-based [ 34 , 35 ], Skype-based [ 36 ], telephone-based [ 37 ] or a combination of web-based and face-to-face interventions [ 38 , 39 ]) are not necessarily inferior to fully supervised interventions and may even be superior in the longer term, due to their focus on self-management. Our OCTOPuS-trial confirms this conclusion, as stratified exercise therapy resulted in similar effects as usual exercise therapy in the ‘high muscle strength subgroup’, while saving a number of physiotherapy sessions in the meantime [ 9 ].…”