Translating Comprehensive Conservative Care for Chronic Knee Pain Into a Digital Care Pathway: 12-Week and 6-Month Outcomes for the Hinge Health Program

Abstract

BackgroundChronic knee pain (CKP) affects a large number of adults, many of whom do not receive best-practice care and are at high risk for unnecessary surgery.ObjectiveThe aim of this study was to investigate the effect of the Hinge Health 12-week digital care program (DCP) for CKP on knee pain and function, with secondary outcomes of surgery interest and satisfaction, at 12 weeks and 6 months after starting the program.MethodsIndividuals with CKP were recruited onto the 12-week program, comprising sensor-guided physical exercises, weekly education, activity tracking, and psychosocial support such as personal coaching and cognitive behavioral therapy (CBT). We used a single-arm design with assessment of outcomes at baseline, 12 weeks, and 6 months after starting the program. We used a linear mixed effects model with Tukey contrasts to compare timepoints and report intention-to-treat statistics with last observation carried forward.ResultsThe cohort consisted of 41 individuals (32 female, mean age 52 years, SD 9 years). Between baseline and week 12, participants reported clinically significant improvements in the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) function scales of 16 points (95% CI 12-21, P<.001) and 10 points (95% CI 6-14, P<.001), respectively. Significant reductions of 57% (mean difference 30, 95% CI 21-38, P<.001) and 51% (mean difference 25, 95% CI 16-33, P<.001) in visual analog scale (VAS) knee pain and stiffness, respectively, were observed at 12 weeks, as well as a 67% reduction in surgery interest (mean reduction 2.3 out of 10, 95% CI 1.5-3.1, P<.001). Average satisfaction at week 12 was 9.2 out of 10. Critically, all improvements were maintained at 6 months at similar or greater magnitude.ConclusionsParticipants on the Hinge Health DCP for CKP showed substantial clinical improvements that were maintained 6 months after enrolling in the program. This shows that DCPs carry strong potential to deliver evidence-based, cost-effective care to those suffering from CKP.

Feedback Design in Targeted Exercise Digital Biofeedback Systems for Home Rehabilitation: A Scoping Review

“…Nineteen articles remained after the screening process, describing 13 separate biofeedback home rehabilitation systems. Eight systems were described by one paper only [34][35][36][37][38][39][40][41], four systems were described by two separate papers [42][43][44][45][46][47][48][49] and one system was described by three papers [50][51][52]. All included papers fulfilled the inclusion criteria for this scoping review.…”

“…Five systems were developed for use in knee rehabilitation (chronic knee pain or post-operative care) [34,35,43,44,49], three for rehabilitation after a cerebrovascular accident (CVA/stroke) [38,46,51], two for elderly at risk of falls [37,43], and one each for rehabilitation related to carpal tunnel release surgery [36], total hip replacement [40], cerebral palsy [39] and chronic obstructive pulmonary disease (COPD) [41].…”

“…The terminal feedback was given after the completion of an exercise repetition, set or full session, and provided technique information or progress reports. Seven systems used descriptive feedback [34,36,37,39,40,43,46], three used both prescriptive and descriptive [35,38,51], one used prescriptive alone [41], and it was unclear what quality of feedback was used in two systems [44,49]. As each system provided feedback on more than one feature of the targeted exercise, KR and KP were noted to be applied in a variety of ways and eight systems applied both KP and KR [35,38,39,41,43,44,46,51].…”

“…As each system provided feedback on more than one feature of the targeted exercise, KR and KP were noted to be applied in a variety of ways and eight systems applied both KP and KR [35,38,39,41,43,44,46,51]. Five systems used KR only [34,36,37,40,49] and no system used KP only. Constant feedback was given by all systems, but Durfee et al [50] also employed a fading frequency protocol for some feedback features.…”

“…Six main components of exercise were represented in the feedback; these are: ROM, movement (a 'mirroring' of user's movements), repetitions, technique, time spent exercising and reports of progress with, or adherence to, an exercise programme. Exercise components were at times represented in a concrete design style, for example realistic human avatars [35,[37][38][39]41], repetition counters [35,37,41,43,46] and technique feedback via text [35,38,41,49,50]. These designs can be contrasted with abstract avatars [39,43], scores to indicate repetitions [39,40] and colours [43], faces [46] or game features [39] to comment on technique.…”