“It's the single best thing I've done in the last 10 years”: a qualitative study exploring patient and dietitian experiences with, and perceptions of, a multi-component dietary weight loss program for knee osteoarthritis

Lawford, Belinda J; Bennell, Kim L; Jones, Sarah E.; Keating, Catherine; Brown, Courtney; Hinman, Rana S

doi:10.1016/j.joca.2021.01.001

Cited by 18 publications

(16 citation statements)

References 33 publications

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“…After removal of duplicates and exclusion of articles based on title or abstract, 93 potentially relevant articles remained for full-text screening. Ultimately, 36 articles were included in the qualitative synthesis 27–62…”

Section: Resultsmentioning

confidence: 99%

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Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review

et al. 2022

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ObjectiveTo provide an overview of barriers and facilitators that healthcare professionals (HCPs) perceive regarding the implementation of lifestyle interventions (LIs) in patients with hip and/or knee osteoarthritis (OA).DesignScoping review.Data sourcesThe databases PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception up to January 2021.Eligibility criteriaPrimary research articles with a quantitative, qualitative or mixed-methods design were eligible for inclusion if they reported: (1) perceptions of primary and/or secondary HCPs (population); (2) on implementing LIs with physical activity and/or weight management as key components (concept) and (3) on conservative management of hip and/or knee OA (context). Articles not published in English, German or Dutch were excluded.Data extraction and synthesisBarriers and facilitators were extracted by two researchers independently. Subsequently, the extracted factors were linked to a framework based on the Tailored Implementation for Chronic Diseases checklist.ResultsThirty-six articles were included. In total, 809 factors were extracted and subdivided into nine domains. The extracted barriers were mostly related to non-optimal interdisciplinary collaboration, patients’ negative attitude towards LIs, patients’ low health literacy and HCPs’ lack of knowledge and skills around LIs or promoting behavioural change. The extracted facilitators were mostly related to good interdisciplinary collaboration, a positive perception of HCPs’ own role in implementing LIs, the content or structure of LIs and HCPs’ positive attitude towards LIs.ConclusionsMultiple individual and environmental factors influence the implementation of LIs by HCPs in patients with hip and/or knee OA. The resulting overview of barriers and facilitators can guide future research on the implementation of LIs within OA care. To investigate whether factor frequency is related to the relevance of each domain, further research should assess the relative importance of the identified factors involving all relevant disciplines of primary and secondary HCPs.PROSPERO registration numberCRD42019129348.

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Section: Resultsmentioning

confidence: 99%

“…Positive experiences with or suggestions to improve the content or structure of LIs 28 30 34 37 40 45 52 60 62…”

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review

et al. 2022

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“…Importantly, in combination with exercise, using nutritionally complete meal replacement products is considered safe in adults aged up to 80 years or older [ 20 ]. A VLCD is perceived as acceptable to people with knee OA [ 21 ], and our pilot study in hip OA ( n = 18) demonstrated feasibility of a ketogenic VLCD and exercise intervention delivered remotely [ 22 ]. We observed an average of 10% [95% CI 8 to 12%] reduction in body weight at 3 months and no adverse events related to the diet program were reported [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of adding a diet intervention to exercise on hip osteoarthritis pain: protocol for the ECHO randomized controlled trial

Hall

Hinman

Knox

et al. 2022

BMC Musculoskelet Disord

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Background Hip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Despite some clinical guidelines also recommending weight loss for hip OA, there is no evidence from randomised controlled trials (RCT) to substantiate these recommendations. This superiority, 2-group, parallel RCT will compare a combined diet and exercise program to an exercise only program, over 6 months. Methods One hundred people with symptomatic and radiographic hip OA will be recruited from the community. Following baseline assessment, participants will be randomly allocated to either, i) diet and exercise or; ii) exercise only. Participants in the diet and exercise group will have six consultations with a dietitian and five consultations with a physiotherapist via videoconferencing over 6 months. The exercise only group will have five consultations with a physiotherapist via videoconferencing over 6 months. The exercise program for both groups will include prescription of strengthening exercise and a physical activity plan, advice about OA management and additional educational resources. The diet intervention includes prescription of a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating. Primary outcome is self-reported hip pain via an 11-point numeric rating scale (0 = ‘no pain’ and 10 = ‘worst pain possible’) at 6 months. Secondary outcomes include self-reported body weight (at 0, 6 and 12 months) and body mass index (at 0, 6 and 12 months), visceral fat (measured using dual energy x-ray absorptiometry at 0 and 6 months), pain, physical function, quality of life (all measured using subscales of the Hip Osteoarthritis Outcome Scale at 0, 6 and 12 months), and change in pain and physical activity (measured using 7-point global rating of change Likert scale at 6 and 12 months). Additional measures include adherence, adverse events and cost-effectiveness. Discussion This study will determine whether a diet intervention in addition to exercise provides greater hip pain-relief, compared to exercise alone. Findings will assist clinicians in providing evidence-based advice regarding the effect of a dietary intervention on hip OA pain. Trial registration ClinicalTrials.gov . Identifier: NCT04825483. Registered 31st March 2021.

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“…The trial showed that this combined program led to greater improvements in pain and function, as well as greater weight loss, when compared to an exercise-only program and to online education control [ 34 ]. In our qualitative research, participants described positive experiences with the ketogenic VLCD program, valuing its simplicity and effectiveness [ 35 ]. Support from dietitians and a comprehensive suite of educational and behaviour change resources, incorporated with an exercise program, were considered crucial for weight loss success.…”

Section: Introductionmentioning

confidence: 99%

“…Support from dietitians and a comprehensive suite of educational and behaviour change resources, incorporated with an exercise program, were considered crucial for weight loss success. The telehealth delivery mode was valued for its convenience [ 35 , 36 ], particularly time efficiency and access. The protocolized and nutritionally complete manner of the ketogenic VLCD using meal replacements means that healthcare practitioners without formal nutrition qualifications, such as physiotherapists, may be capable of effectively and safely supporting such a VLCD for some people with knee OA.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a telehealth physiotherapist-delivered intensive dietary weight loss program combined with exercise in people with knee osteoarthritis and overweight or obesity: study protocol for the POWER randomized controlled trial

Bennell

Jones

Hinman

et al. 2022

BMC Musculoskelet Disord

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Background Obesity is associated with knee osteoarthritis (OA). Weight loss, alongside exercise, is a recommended treatment for individuals with knee OA and overweight/obesity. However, many patients cannot access weight loss specialists such as dietitians. Innovative care models expanding roles of other clinicians may increase access to weight loss support for people with knee OA. Physiotherapists may be well placed to deliver such support. This two-group parallel, superiority randomized controlled trial aims to compare a physiotherapist-delivered diet and exercise program to an exercise program alone, over 6 months. The primary hypothesis is that the physiotherapist-delivered diet plus exercise program will lead to greater weight loss than the exercise program. Methods 88 participants with painful knee OA and body mass index (BMI) > 27 kg/m2 will be recruited from the community. Following baseline assessment, participants will be randomised to either exercise alone or diet plus exercise groups. Participants in the exercise group will have 6 consultations (20–30 min) via videoconference with a physiotherapist over 6 months for a strengthening exercise program, physical activity plan and educational/exercise resources. Participants in the diet plus exercise group will have 6 consultations (50–75 min) via videoconference with a physiotherapist prescribing a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating, plus the intervention of the exercise only group. Outcomes are measured at baseline and 6 months. The primary outcome is percentage change in body weight measured by a blinded assessor. Secondary outcomes include self-reported knee pain, physical function, global change in knee problems, quality of life, physical activity levels, and internalised weight stigma, as well as BMI, waist circumference, waist-to-hip ratio, physical performance measures and quadriceps strength, measured by a blinded assessor. Additional measures include adherence, adverse events, fidelity and process measures. Discussion This trial will determine whether a physiotherapist-delivered diet plus exercise program is more effective for weight loss than an exercise only program. Findings will inform the development and implementation of innovative health service models addressing weight management and exercise for patients with knee OA and overweight/obesity. Trial registration NIH US National Library of Medicine, Clinicaltrials.gov NCT04733053 (Feb 1 2021).

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“It's the single best thing I've done in the last 10 years”: a qualitative study exploring patient and dietitian experiences with, and perceptions of, a multi-component dietary weight loss program for knee osteoarthritis

Cited by 18 publications

References 33 publications

Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review

Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review

Effects of adding a diet intervention to exercise on hip osteoarthritis pain: protocol for the ECHO randomized controlled trial

Effectiveness of a telehealth physiotherapist-delivered intensive dietary weight loss program combined with exercise in people with knee osteoarthritis and overweight or obesity: study protocol for the POWER randomized controlled trial

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