Physical therapy vs. internet-based exercise training (PATH-IN) for patients with knee osteoarthritis: study protocol of a randomized controlled trial

Abstract

BackgroundPhysical activity improves pain and function among individuals with knee osteoarthritis (OA), but most people with this condition are inactive. Physical therapists play a key role in helping people with knee OA to increase appropriate physical activity. However, health care access issues, financial constraints, and other factors impede some patients from receiving physical therapy (PT) for knee OA. A need exists to develop and evaluate other methods to provide physical activity instruction and support to people with knee OA. This study is examining the effectiveness of an internet-based exercise training (IBET) program designed for knee OA, designed by physical therapists and other clinicians.Methods/DesignThis is a randomized controlled trial of 350 participants with symptomatic knee OA, allocated to three groups: IBET, standard PT, and a wait list (WL) control group (in a 2:2:1 ratio, respectively). The study was funded by the Patient Centered Outcomes Research Institute, which conducted a peer review of the proposal. The IBET program provides patients with a tailored exercise program (based on functional level, symptoms, and current activity), video demonstrations of exercises, and guidance for appropriate exercise progression. The PT group receives up to 8 individual visits with a physical therapist, mirroring standard practice for knee OA and with an emphasis on a home exercise program. Outcomes are assessed at baseline, 4 months (primary time point) and 12 months (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include objective physical function, satisfaction with physical function, physical activity, depressive symptoms and global assessment of change. Linear mixed models will be used to compare both the IBET and standard PT groups to the WL control group, examine whether IBET is non-inferior to PT (a treatment that has an established evidence base for knee OA), and explore whether participant characteristics are associated with differential effects of IBET and/or standard PT. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Board of the University of North Carolina at Chapel Hill.DiscussionThe IBET program could be disseminated widely at relatively low cost and could be an important resource for helping patients with knee OA to adopt and maintain appropriate physical activity. This trial will provide an important evaluation of the effectiveness of this IBET program for knee OA.Trial registrationNCT02312713

Demographic and Clinical Factors Associated With Nonsurgical Osteoarthritis Treatment Among Patients in Outpatient Clinics

“…The third study examined PhysicAl THerapy vs INternet Based Exercise Training for Patients with Knee OA (PATH-IN); this study primarily involved patients receiving care within the University of North Carolina (UNC) healthcare system, with 2% enrolled from the surrounding community with various sources of healthcare. Details of the study protocols have been described previously (16, 17). Briefly, in the PRIMO-Duke cluster randomized trial, the clinics were randomized to Provider Intervention or Control, and then study participants within those clinics were assigned to Patient Intervention or Control.…”

“…Individuals were included in the studies if they had: a diagnosis of hip OA (PRIMO-Duke and PRIMO-VA) or knee OA (PRIMO-Duke, PRIMO-VA, and PATH-IN), based on either radiographic evidence in the electronic medical record or American College of Rheumatology clinical criteria (18), along with current symptoms in the joint(s) with OA(16, 17). Participants in all studies were not meeting US Department of Health and Human Services physical activity recommendations(19), and participants in the PRIMO-Duke and PRIMO-VA studies also had a body mass index (BMI) ≥ 25.…”

“…Study design and setting. This is a secondary data analysis of baseline data from 3 (16,17). Briefly, in the PRIMO-Duke cluster randomized trial, the clinics were randomized to provider intervention or control, and then study participants within those clinics were assigned to patient intervention or control.…”

Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis

“…Knee osteoarthritis (KOA) is a common knee degenerative disease characterized by cartilage degeneration, cartilage exfoliation, and subchondral bone hyperplasia, leading to knee pain, joint instability and functional limitations [1]. KOA severely affects patients' quality of life and is a major public health issue [2]. An epidemiological survey published in Proceedings of the National Academy of Sciences (PNAS) showed that the incidence of KOA in the U.S. population has doubled since the mid-twentieth century [3].…”

Evaluación de la eficacia de un programa de ejercicios para osteoartritis de rodilla

“…La OA está incluida entre las principales causas de discapacidad 3,4 . Según la OMS 4 , cerca de Dada la alta prevalencia de estas afecciones, el grado de discapacidad que pueden generar y los gastos sanitarios relacionados, la presente investigación tiene como objetivo realizar una intervención en los pacientes afectados con OA para valorar la efectividad del programa de tratamiento kinesiológico, destacando así las ventajas que ofrece con respecto a otras técnicas [14][15][16] .…”