Osteoarthritis physical activity care pathway (OA-PCP): results of a feasibility trial

Abstract

Background: To obtain information on feasibility and acceptability, as well as preliminary data on efficacy, of an Osteoarthritis Physical activity Care Pathway (OA-PCP). Methods: This was a single group pilot study involving 60 participants with symptomatic, physician diagnosed knee or hip OA, recruited from primary care clinics. Participants self-reported completing less than 150 min per week of moderate-to-vigorous physical activity (MVPA) at baseline. The 3-month OA-PCP intervention involved 3 physical activity (PA) coaching calls (focused on goal setting), three check-in emails and linkage with communitybased or online resources to support PA. Efficacy outcomes were collected at baseline and 4-month follow-up. The primary efficacy outcome was minutes of MVPA, assessed via accelerometer. Secondary outcomes included minutes of light intensity activity, sedentary minutes, step counts, and Western Ontario and McMaster Universities (WOMAC) pain and function subscales. Participants were also asked to rate the helpfulness of the OA-PCP intervention on a scale of 0-10. Differences in efficacy outcomes between baseline and 4-month follow-up were assessed using paired t-tests. Results: Among participants beginning the study, 88% completed follow-up assessments and ≥ 90% completed each of the intervention calls. Average daily minutes of MVPA was 8.0 at baseline (standard deviation (SD) = 9.9) and 8.9 at follow-up (SD = 12.1, p = 0.515). There were no statistically significant changes in light intensity activity, sedentary time or step counts. The mean WOMAC pain score improved from 8.1 (SD = 3.6) at baseline to 6.2 (SD = 3.8) at follow-up (p < 0.001); the mean WOMAC function score improved from 26.2 (SD = 13.2) to 20.2 (SD = 12.5; p < 0.001). The mean rating of helpfulness was 7.6 (SD = 2.5). Conclusions: Results supported the feasibility and acceptability of the study, and participants reported clinically relevant improvements in pain and function. PA metrics did not improve substantially. Based on these results and participant feedback, modifications including enhanced self-monitoring are being made to increase the impact of the OA-PCP intervention on PA behavior.

Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review

“…Digital physical activity interventions for people with KOA were delivered via website programs (1/91, 1%), telephone calls or SMS text messaging (1/91, 1%), mobile apps with or without activity monitors (1/91, 1%), or a combination of these technologies (3/91, 3%). Although 4% (4/91) of these interventions were self-directed or self-paced [ 36 - 39 ], 2% (2/91) of physical activity interventions included calls with a personal coach [ 40 ] and physical therapist [ 41 ] for individualized goal setting.…”

“…The use of a self-directed intervention ( Join2Move ) with minimum personal contact resulted in a high attrition rate, with only 55% of participants completing at least 75% of the program, potentially resulting in nonsignificant improvements in physical activity [ 38 ]. In contrast, the osteoarthritis physical care pathway intervention used the website and telephone calls for 4 phases (ie, physical activity screening, brief coaching calls for goal setting based on motivational interviewing principles, access to community and local resources to support physical activity, and follow-up coaching calls) [ 40 ]. Although this intervention included person-specific information using motivational interviewing, it did not include visible biofeedback or physical activity self-monitoring, which might have resulted in nonsignificant results.…”

“…Although this intervention included person-specific information using motivational interviewing, it did not include visible biofeedback or physical activity self-monitoring, which might have resulted in nonsignificant results. Interestingly, although 5% (5/91) of studies in this section found no significant changes in physical activity [ 36 - 40 ], 2% (2/91) of studies observed statistically significant but clinically nonsignificant improvements in secondary outcome measures of sleep [ 39 ] and pain and function subscales on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [ 40 ].…”

“…Moreover, the within-group improvements in pain on the Numeric Pain Rating Scale and function on the WOMAC in the My Knee Exercise group had large effect sizes and exceeded the minimal clinically important difference (MCID) in the study [ 54 , 42 ]. In another RCT, Allen et al [ 40 , 52 ] (Physical Therapy versus Internet-Based Exercise Training [PATH-IN] trial) compared an unsupervised website exercise program called Internet-Based Exercise Therapy (IBET) with in-person PT and waitlist controls. Interestingly, the study found that IBET was noninferior to in-person PT in improvements on the WOMAC and that both IBET and in-person PT were not superior to the waitlist at the 4 or 12 months follow-up [ 52 ].…”

Accelerometer-Based Physical Activity Patterns and Associations With Outcomes Among Individuals With Osteoarthritis

“…results have been published previously. 16 Briefly, the study intervention involved 3 PA coaching calls (focused on goal setting), 3 check-in emails, and linkage with community-based or online resources to support PA. The study was approved by the institutional review board of the University of North Carolina at Chapel Hill.…”