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Allison K, Jones S, Hinman RS, Pardo J, Li P, DeSilva A, Quicke JG, Sumithran P, Prendergast J, George E, Holden MA, Foster NE, Bennell KL. Alternative models to support weight loss in chronic musculoskeletal conditions: effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, the POWER randomised controlled trial. Br J Sports Med 2024; 58:538-547. [PMID: 38637135 DOI: 10.1136/bjsports-2023-107793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To determine if physiotherapists can deliver a clinically effective very low energy diet (VLED) supplementary to exercise in people with knee osteoarthritis (OA) and overweight or obesity. METHODS 88 participants with knee OA and body mass index (BMI) >27 kg/m2 were randomised to either intervention (n=42: VLED including two daily meal replacement products supplementary to control) or control (n=46: exercise). Both interventions were delivered by unblinded physiotherapists via six videoconference sessions over 6 months. The primary outcome was the percentage change in body weight at 6 months, measured by a blinded assessor. Secondary outcomes included BMI, waist circumference, waist-to-hip ratio, self-reported measures of pain, function, satisfaction and perceived global change, and physical performance tests. RESULTS The intervention group lost a mean (SD) of 8.1% (5.2) body weight compared with 1.0% (3.2) in the control group (mean (95% CI) between-group difference 7.2% (95% CI 5.1 to 9.3), p<0.001), with significantly lower BMI and waist circumference compared with control group at follow-up. 76% of participants in the intervention group achieved ≥5% body weight loss and 37% acheived ≥10%, compared with 12% and 0%, respectively, in the control group. More participants in the intervention group (27/38 (71.1%)) reported global knee improvement than in the control group (20/42 (47.6%)) (p=0.02). There were no between-group differences in any other secondary outcomes. No serious adverse events were reported. CONCLUSION A VLED delivered by physiotherapists achieved clinically relevant weight loss and was safe for people with knee OA who were overweight or obese. The results have potential implications for future service models of care for OA and obesity. TRIAL REGISTRATION NUMBER NIH, US National Library of Medicine, Clinicaltrials.gov NCT04733053 (1 February 2021).
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Affiliation(s)
- Kim Allison
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Jones
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse Pardo
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peixuan Li
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
- Methods and Implementation Support for Clinical and Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anurika DeSilva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
- Methods and Implementation Support for Clinical and Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan George Quicke
- Primary Care and Health Sciences, School of Medicine, Keele University, Keele, UK
- Chartered Society of Physiotherapy, Chancery Exchange, London, UK
| | - Priya Sumithran
- Department of Surgery, Division of Clinical Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
| | | | - Elena George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Melanie A Holden
- Primary Care and Health Sciences, School of Medicine, Keele University, Keele, UK
| | - Nadine E Foster
- Primary Care and Health Sciences, School of Medicine, Keele University, Keele, UK
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, St Lucia, Queensland, Australia
| | - Kim L Bennell
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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Bennell KL, Keating C, Lawford B, Graham B, Hall M, Simpson JA, McManus F, Hosking B, Sumithran P, Harris A, Woode ME, Francis JJ, Marlow J, Poh S, Hinman RS. Effectiveness of a telehealth-delivered clinician-supported exercise and weight loss program for hip osteoarthritis - protocol for the Better Hip randomised controlled trial. BMC Musculoskelet Disord 2024; 25:138. [PMID: 38350917 PMCID: PMC10863299 DOI: 10.1186/s12891-023-07131-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/18/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Hip osteoarthritis (OA) is a leading cause of chronic pain and disability worldwide. Self-management is vital with education, exercise and weight loss core recommended treatments. However, evidence-practice gaps exist, and service models that increase patient accessibility to clinicians who can support lifestyle management are needed. The primary aim of this study is to determine the effectiveness of a telehealth-delivered clinician-supported exercise and weight loss program (Better Hip) on the primary outcomes of hip pain on walking and physical function at 6 months, compared with an information-only control for people with hip OA. METHODS A two-arm, parallel-design, superiority pragmatic randomised controlled trial. 212 members from a health insurance fund aged 45 years and over, with painful hip OA will be recruited. Participants will be randomly allocated to receive: i) Better Hip; or ii) web-based information only (control). Participants randomised to the Better Hip program will have six videoconferencing physiotherapist consultations for education about OA, prescription of individualised home-based strengthening and physical activity programs, behaviour change support, and facilitation of other self-management strategies. Those with a body mass index > 27 kg/m2, aged < 80 years and no specific health conditions, will also be offered six videoconferencing dietitian consultations to undertake a weight loss program. Participants in the control group will be provided with similar educational information about managing hip OA via a custom website. All participants will be reassessed at 6 and 12 months. Primary outcomes are hip pain on walking and physical function. Secondary outcomes include measures of pain; hip function; weight; health-related quality of life; physical activity levels; global change in hip problem; willingness to undergo hip replacement surgery; rates of hip replacement; and use of oral pain medications. A health economic evaluation at 12 months will be conducted and reported separately. DISCUSSION Findings will determine whether a telehealth-delivered clinician-supported lifestyle management program including education, exercise/physical activity and, for those with overweight or obesity, weight loss, is more effective than information only in people with hip OA. Results will inform the implementation of such programs to increase access to core recommended treatments. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry (ACTRN12622000461796).
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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia.
| | | | - Belinda Lawford
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
| | - Bridget Graham
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic, Melbourne, Australia
| | - Fiona McManus
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic, Melbourne, Australia
| | | | - Priya Sumithran
- Department of Medicine, The University of Melbourne, Vic, Melbourne, Australia
- Department of Endocrinology, Austin Health, Vic, Melbourne, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Vic, Melbourne, Australia
| | - Maame Esi Woode
- Centre for Health Economics, Monash University, Vic, Melbourne, Australia
| | - Jill J Francis
- School of Health Sciences, The University of Melbourne, Vic, Melbourne, Australia
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jennifer Marlow
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
| | - Sharon Poh
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
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Bowden JL, Hunter DJ, Mills K, Allen K, Bennell K, Briggs AM, Dziedzic K, Hinman RS, Kim JS, Martinez N, Quicke JG, Tan Yijia B, van der Esch M, Verges J, Eyles J. The OARSI Joint Effort Initiative: Priorities for osteoarthritis management program implementation and research 2024-2028. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100408. [PMID: 37771392 PMCID: PMC10522998 DOI: 10.1016/j.ocarto.2023.100408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
Objective The Joint Effort Initiative (JEI) is an international collaboration of clinicians, researchers, and consumer organisations with a shared vision of improving the implementation of osteoarthritis management programs (OAMPs). This study aimed to identify JEI's future priorities and guide direction. Design A two-part international survey to prioritise topics of importance to our membership and research stakeholders. Survey one presented a list of 40 topics under 5 themes. Consenting participants were asked to choose their top three topics in each theme. A short list of 25 topics was presented in survey two. Participants were asked to rank the importance (100-point NRS scale, 100 = highest priority). Response frequency (median, IQR) was used to rank the top priorities by theme. Results Ninety-five participants completed survey one (61% female, 48% clinicians) and 57 completed survey two. The top ranked topic/s were:i. Promotion and advocacy: support training for health professionals (median 85, IQR 24).ii. Education and training: incorporating behaviour change into OAMPs (80, 16), advanced OA skills (80, 30), and integration of OA education into clinical training (80, 36).iii. Improving OAMPs delivery: regular updates on changes to best-evidence OA care (84, 24).iv. Future research: improve uptake of exercise, physical activity, and weight-loss (89, 16).v. Enhancing relationships, alliances, and shared knowledge: promote research collaborations (81, 30), share challenges and opportunities for OAMP implementation (80, 23). Conclusions These topics will set the JEI's research and collaboration agenda for the next 5 years and stimulate ideas for others working in the field.
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Affiliation(s)
- Jocelyn L. Bowden
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Kathryn Mills
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Kelli Allen
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA
- Durham Department of Veterans Affairs Health Care System, USA
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M. Briggs
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - K. Dziedzic
- Impact Accelerator Unit, School of Medicine and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nina Martinez
- Department of Research and Development, Osteoarthritis Foundation International, Barcelona, Spain
| | - Jonathan G. Quicke
- Chartered Society of Physiotherapy, Chancery Exchange, London, UK
- School of Medicine, Keele University, Keele, UK
| | - Bryan Tan Yijia
- Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, Singapore
| | - Martin van der Esch
- Faculty of Health, Amsterdam University of Applied Sciences, Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands
| | - Josep Verges
- President of the Osteoarthritis Foundation International, Barcelona, Spain
| | - Jillian Eyles
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
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Gorniak M, Pardillo M, Keating C, Brown C, Schilling C. Net cost savings arising from patient completion of an active self-management program. PLoS One 2023; 18:e0293352. [PMID: 37967085 PMCID: PMC10650977 DOI: 10.1371/journal.pone.0293352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 10/10/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE The objective of this study is to investigate changes in willingness for total knee replacement (TKR) surgery following a randomised control trial (RCT) of an osteoarthritis management program, and to extrapolate orthopaedic cost consequences for private health insurers (PHI). METHODS Willingness for surgery data from the RCT is analysed using a multinomial logistic regression model. A decision analytic model is used to conduct a break-even cost benefit analysis of the intervention from a PHI payer perspective. The analysis estimates the minimum probability of progression to surgery required for the intervention to be cost-neutral when considering savings limited to reduced orthopaedic costs. Cost data and orthopaedic pathway probabilities are sourced from payer data. RESULTS At baseline, 39% of participants in the treatment and control group were willing for surgery. At 12 months, 16% of participants in the treatment group remained willing for surgery, versus 36% in the control group. Participants in the treatment group are 2.96 (95% CI: 1.01-8.66) times more likely than those in the control group to move from initially willing for surgery, to unsure or unwilling at 12 months. The analysis indicates that the intervention is likely to be cost saving when at least 60% of initially willing participants progress to surgery over a 5-year time horizon. CONCLUSION Our study estimates that an education, exercise and weight loss intervention can deliver both improved participant outcomes and a return on investment to Australian PHIs through a reduction in TKR surgery incidence.
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Affiliation(s)
- Maja Gorniak
- KPMG, Economic Modelling, Melbourne, VIC, Australia
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Lawford BJ, Hinman RS, McManus F, Lamb KE, Egerton T, Keating C, Brown C, Oliver K, Bennell KL. How Does Exercise, With and Without Diet, Improve Pain and Function in Knee Osteoarthritis? A Secondary Analysis of a Randomized Controlled Trial Exploring Potential Mediators of Effects. Arthritis Care Res (Hoboken) 2023; 75:2316-2327. [PMID: 37128836 PMCID: PMC10952828 DOI: 10.1002/acr.25140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/29/2023] [Accepted: 04/25/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To explore the mediators of effects of two 6-month telehealth-delivered exercise programs, including exercise with and without weight-loss diet, on pain and function improvements in knee osteoarthritis (OA). METHODS Secondary analysis of 345 participants from a 3-arm randomized controlled trial of exercise (Exercise program) and exercise plus diet (Diet + Exercise program) versus information (Control program) was conducted. Outcomes were changes in pain (11-point numeric rating scale) and function (Western Ontario and McMaster Universities Osteoarthritis Index [score range 0-68]) at 12 months. Potential mediators were change at 6 months in attitudes toward self-management, fear of movement, arthritis self-efficacy, weight, physical activity, and willingness for knee surgery. For the Diet + Exercise program versus the Exercise program, only change in weight was evaluated. RESULTS Possible mediators of the Exercise program versus the Control program included reduced fear of movement (accounting for -1.11 units [95% confidence interval (95% CI) -2.15, -0.07] improvement in function) and increased arthritis self-efficacy (-0.40 units [95% CI -0.75, -0.06] reduction in pain, -1.66 units [95% CI -3.04, -0.28] improvement in function). The Diet + Exercise program versus the Control program mediators included reduced fear of movement (-1.13 units [95% CI -2.17, -0.08] improvement in function), increased arthritis self-efficacy (-0.77 units [95% CI -1.26, -0.28] reduction in pain, -5.15 units [95% CI -7.34, -2.96] improvement in function), and weight loss (-1.20 units [95% CI -1.73, -0.68] reduction in pain, -5.79 units [95% CI -7.96, -3.63] improvement in function). Weight loss mediated the Diet + Exercise program versus the Exercise program (-0.89 units [95% CI -1.31, -0.47] reduction in pain, -4.02 units [95% CI -5.77, -2.26] improvement in function). CONCLUSION Increased arthritis self-efficacy, reduced fear of movement, and weight loss may partially mediate telehealth-delivered exercise program effects, with and without diet, on pain and/or function in knee OA. Weight loss may partially mediate the effect of diet and exercise compared to exercise alone.
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Affiliation(s)
| | | | - Fiona McManus
- The University of MelbourneMelbourneVictoriaAustralia
| | - Karen E. Lamb
- The University of MelbourneMelbourneVictoriaAustralia
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Newton FJ, Haregu TN, Newton JD, Donovan R, Mahal A, Mackenzie-Stewart R, Ewing MT, Bauman A, Manera KE, Smith BJ. Effects of customer relationship management (CRM) strategies and socio-cognitive constructs on the physical activity of individuals with arthritis over time. PLoS One 2023; 18:e0292692. [PMID: 37816022 PMCID: PMC10564229 DOI: 10.1371/journal.pone.0292692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/26/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Regular physical activity is important for arthritis self-management and could be promoted through tailoring community leisure and fitness centers' customer-relationship management (CRM) strategies. OBJECTIVES This study investigates the influence of two CRM strategies on individuals with arthritis reaching or maintaining two moderate-to-vigorous physical activity (MVPA) thresholds (≥150 and ≥45 minutes/week) from baseline-to-12 months and 12-to-24 months as well as mean changes in total minutes/week of MVPA. It also explores time-dependent variations in the influence of socio-cognitive variables on MVPA outcomes. METHODS Survey data from 374 participants with arthritis in a two-year randomized controlled trial (control versus two CRM strategies: IncentiveOnly and Incentive+Support) were used. Participants reported measures of physical activity participation, socio-cognitive decision-making, mental and physical wellbeing, friendship, community connectedness, sense of trust in others, and demographics. FINDINGS/DISCUSSION Receiving the Incentive+Support CRM strategy (versus control) increased participants' likelihood of reaching/maintaining both physical activity thresholds from 12-to-24 months (≥150 MVPA minutes/week, p < .001; ≥45 MVPA minutes/week, p < .032) but not from baseline-to-12 months. However, receiving the IncentiveOnly CRM strategy (versus control) did not predict reaching/maintaining these thresholds. Importantly, socio-cognitive decision-making variables' influence on reaching/maintaining these MVPA thresholds varied over time, suggesting CRM strategies may require further tailoring based on time-specific profiles. Perhaps because of new facility induced excitement, the mean change in total MVPA minutes/week for the control group significantly increased (26.8 minute/week, p = .014, 95% CI [5.5, 48.0]) from baseline-to-12 months, but subsequently declined by 11.4 minute/week from 12-to-24 months (p = .296, 95% CI [-32.7, 9.9]). Mean changes in total MVPA minutes/week were non-significant for those receiving IncentiveOnly content but significant for those receiving Incentive+Support content: baseline-to-12 months (38.2 minute/week increase, p = .023, 95% CI [4.9, 71.4]) and baseline-to-24-months (45.9 minute/week increase, p = .007, 95% CI [12.7, 79.1]).
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Affiliation(s)
- Fiona J. Newton
- Department of Marketing, Monash Business School, Monash University, Frankston, Victoria, Australia
| | - Tilahun N. Haregu
- Nossal Institute for Global Health, Melbourne School of Population and Global Health University of Melbourne, Melbourne, Victoria, Australia
| | - Joshua D. Newton
- Department of Marketing, Deakin Business School, Deakin University, Geelong, Victoria, Australia
| | - Robert Donovan
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health University of Melbourne, Melbourne, Victoria, Australia
| | - Ruth Mackenzie-Stewart
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Michael T. Ewing
- Department of Marketing, Deakin Business School, Deakin University, Geelong, Victoria, Australia
- Faculty of Business, Law & Arts, Southern Cross University, Gold Coast Campus, Bilinga, Queensland, Australia
- Distinguished visiting professor, Department of Marketing, University of Johannesburg, Johannesburg, South Africa
| | - Adrian Bauman
- School of Public Health, Level 6, The Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Karine E. Manera
- School of Public Health, Level 6, The Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ben J. Smith
- School of Public Health, Level 6, The Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Harris A, Hinman RS, Lawford BJ, Egerton T, Keating C, Brown C, Metcalf B, Spiers L, Sumithran P, Quicke JG, Bennell KL. Cost-Effectiveness of Telehealth-Delivered Exercise and Dietary Weight Loss Programs for Knee Osteoarthritis Within a Twelve-Month Randomized Trial. Arthritis Care Res (Hoboken) 2023; 75:1311-1319. [PMID: 36106928 PMCID: PMC10953202 DOI: 10.1002/acr.25022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of telehealth-delivered exercise and diet-plus-exercise programs within 12 months. METHODS An economic evaluation within a 12-month, 3-arm, parallel randomized trial of two 6-month telehealth-delivered exercise programs, with and without a dietary component. A total of 415 people with knee osteoarthritis ages 45-80 years and body mass index of 28-40 kg/m2 were assigned to 1 of 2 telehealth-delivered exercise programs, 1 without (n = 172) and 1 with (n = 175) a dietary component (ketogenic very low calorie diet), or to an education control (n = 67), for 6 months, with 6 months follow-up. The primary economic outcomes were quality-adjusted life years (QALYs) and health system costs. Measured costs were the direct intervention (consultations, equipment/resources, and meal replacements) and health care use in 2020 Australian dollars ($AU1.5 = $US1). Secondary analysis included weight loss and work productivity gains. RESULTS The clinical trial demonstrated greater improvements in pain and function compared to information only for individuals with knee osteoarthritis and overweight/obesity. We can be 88% confident that diet plus exercise is cost effective ($45,500 per QALY), 53% confident that exercise is cost-effective ($67,600 per QALY) compared to the control, and 86% confident that augmenting exercise with the diet program is cost effective ($21,100 per QALY). CONCLUSION Telehealth-delivered programs targeting exercise with dietary intervention for people with knee osteoarthritis who have overweight/obesity are likely to be cost-effective, particularly if potential long-term gains from weight loss and work productivity are realized.
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Affiliation(s)
| | | | | | | | | | | | - Ben Metcalf
- University of MelbourneMelbourneVictoriaAustralia
| | - Libby Spiers
- University of MelbourneMelbourneVictoriaAustralia
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Lawford B, Hinman RS, Jones S, Keating C, Brown C, Bennell KL. 'The fact that I know I can do it is quite a motivator now': a qualitative study exploring experiences maintaining weight loss 6 months after completing a weight loss programme for knee osteoarthritis. BMJ Open 2023; 13:e068157. [PMID: 37142310 PMCID: PMC10163509 DOI: 10.1136/bmjopen-2022-068157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE To explore experiences maintaining weight loss 6 months after completing a multicomponent weight loss programme for knee osteoarthritis. DESIGN Qualitative study based on an interpretivist paradigm and a phenomenological approach that was embedded within a randomised controlled trial. SETTING Semistructured interviews were conducted with participants 6 months after completing a 6-month weight loss programme (ACTRN12618000930280) involving a ketogenic very low calorie diet (VLCD), exercise and physical activity programme, videoconferencing consultations with a dietitian and physiotherapist, and provision of educational and behaviour change resources and meal replacement products. Interviews were audio recorded, transcribed verbatim and data were analysed based on the principles of reflexive thematic analysis. PARTICIPANTS 20 people with knee osteoarthritis. RESULTS Three themes were developed: (1) successfully maintained weight loss; (2) empowering self-management of weight (understand importance of exercise; increased knowledge about food and nutrition; resources from programme still useful; knee pain as a motivator; confidence in ability to self-regulate weight) and (3) challenges keeping on track (loss of accountability to dietitian and study; old habits and social situations; stressful life events or changes in health). CONCLUSION Participants had overall positive experiences maintaining their weight loss since completing the weight loss programme and were confident in their ability to self-regulate their weight in the future. Findings suggest a programme incorporating dietitian and physiotherapist consultations, a VLCD, and educational and behaviour change resources supports confidence maintaining weight loss in the medium term. Further research is required to explore strategies to overcome barriers like loss of accountability and returning to old eating habits.
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Affiliation(s)
- Belinda Lawford
- CHESM, University of Melbourne, Parkville, Victoria, Australia
| | - Rana S Hinman
- CHESM, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Jones
- CHESM, University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Kim L Bennell
- CHESM, University of Melbourne, Parkville, Victoria, Australia
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Báez-Suárez A, Padrón-Rodriguez I, Santana-Cardeñosa D, Santana-Perez L, Lopez-Herrera VM, Pestana-Miranda R. Implementation of a telerehabilitation program for children with neurodevelopmental disorders during the lockdown caused by COVID-19. Br J Occup Ther 2023; 86:284-292. [PMID: 38603341 PMCID: PMC9791071 DOI: 10.1177/03080226221141322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 10/31/2022] [Indexed: 04/13/2024]
Abstract
Introduction Telerehabilitation is a tool for patients who, for different reasons, cannot participate in person with their physical presence. We aimed to identify the factors associated with satisfaction with telerehabilitation in families with children with neurodevelopmental disorders through a program that included physiotherapy, occupational therapy, and speech therapy. Methods The program was developed during the COVID-19 lockdown period. Outcome measures: Child's age, the school stage to which they belonged, the person of reference in their daily care at home. The resources provided to the families, as well as the frequency of activities and difficulties detected, were evaluated through a survey. Findings One hundred thirteen families responded to the survey. The general assessment resources were classified as very good. The average frequency of carrying out the activities was two times a week, with an average of 30 minutes per session. The ability to understand the information in the manual was not affected by the academic status of the caregivers (p = 0.286). Conclusions This is the first study to quantify the multidisciplinary approach to children with neurodevelopmental disorders using telerehabilitation. The results show high levels of participation and satisfaction. The resources could be shared for their applicability in other countries whose families have similar needs conditioned by COVID-19.
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Affiliation(s)
- Aníbal Báez-Suárez
- Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain
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Godziuk K, Prado CM, Quintanilha M, Forhan M. Acceptability and preliminary effectiveness of a single-arm 12-week digital behavioral health intervention in patients with knee osteoarthritis. BMC Musculoskelet Disord 2023; 24:129. [PMID: 36797720 PMCID: PMC9936108 DOI: 10.1186/s12891-023-06238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Digital health interventions may improve osteoarthritis (OA) management. This study evaluated the acceptability and preliminary effectiveness of a multimodal digital nutrition, exercise, and mindfulness intervention in adults with knee OA. METHODS Adults with advanced knee OA and an orthopaedic referral were invited to self-enroll in a pragmatic 12-week single-arm intervention. OA-focused nutrition and exercise resources were delivered weekly by email, and secondary components accessed on-demand (web-platform, webinars, and nutrition consultation). Acceptability was assessed by qualitative interview data and completion rates. Preliminary effectiveness on clinical outcomes was assessed by change in health-related quality of life, well-being, mindfulness, self-efficacy, and interest in total knee arthroplasty (TKA) between baseline and 12-weeks. RESULTS N = 102 patients self-enrolled (73.5% female, age 64 ± 7 years, body mass index 32.9 ± 7.3 kg/m2); n = 53 completed the 12-week intervention (71.7% female, age 65 ± 7 years, body mass index 33.4 ± 6.3 kg/m2). Acceptability was demonstrated by positive perceptions of tailored intervention resources. In study completers, health-related quality of life components of pain and physical functioning domains improved at 12-weeks [change in SF36 4.4 (95%CI 0.2-8.6), p = 0.016, and 6.7 (95%CI 2.7-10.7), p < 0.001, respectively]. Self-efficacy for managing daily activities improved [change in PROMIS T-score 4.4 (95%CI 2.8-6.0), p < 0.001]. CONCLUSION A 12-week digital multimodal intervention for knee OA was acceptable to patients and shows preliminary effectiveness in improving self-efficacy, aspects of quality of life, and decreasing interest in TKA. Digital behavioral interventions for knee OA may be an acceptable approach to improve patient outcomes and OA self-management while potentially reducing utilization of costly health system resources.
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Affiliation(s)
- Kristine Godziuk
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB, T6G 2P5, Canada.
| | - Carla M. Prado
- grid.17089.370000 0001 2190 316XDepartment of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5 Canada
| | - Maira Quintanilha
- grid.17089.370000 0001 2190 316XDepartment of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5 Canada
| | - Mary Forhan
- grid.17063.330000 0001 2157 2938Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON Canada
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Kooranian F, ParsaYekta Z, Rassouli M. Explaining the Concept of Self-Care Competence and Its Dimensions in Elderly Women with Knee Osteoarthritis in Iran: A Qualitative Study. Ethiop J Health Sci 2023; 33:151-162. [PMID: 36890926 PMCID: PMC9987279 DOI: 10.4314/ejhs.v33i1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/08/2022] [Indexed: 03/10/2023] Open
Abstract
Background Chronic diseases, especially knee osteoarthritis, are more likely to occur among women with the increase in age. Self-care is an effective strategy for the management of disease in patients with knee osteoarthritis. Therefore, recognizing the dimensions of self-care competence in elderly women with knee osteoarthritis is particularly important for long-term management of the disease. The current study aimed to explain the concept and dimensions of self-care competence in elderly women with knee osteoarthritis. Methods This qualitative study was conducted using a conventional content analysis method proposed by Graneheim and Landman, from March to November 2020 in Mashhad (one of the largest cities in Iran). A total of 19 participants including 11 elderly women with knee osteoarthritis, 4 first-degree relatives and 4 medical staff were selected by the purposive sampling. Data were collected through in-depth and semi-structured interviews which continued until data saturation was reached. The MAXQDA (Version 10) was used to organize, code, and manage the data. Findings Three main themes including "symptom management", "personal growth" and "social cohesion" were emerged as the dimensions of self-care competence in elderly women with knee osteoarthritis. Conclusions Understanding the dimensions of self-care competence as one of the basic needs of the elderly women with knee osteoarthritis who live alone, is very important. Symptoms management, personal growth, and social cohesion as dimensions of self-care competence among this group of the elderly help to develop self-care competence interventions based on their needs.
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Affiliation(s)
- Faranak Kooranian
- Department of Nursing, PhD Candidate of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Zohreh ParsaYekta
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Lawford BJ, Bennell KL, Hall M, Egerton T, McManus F, Lamb KE, Hinman RS. Effect of Information Content and General Practitioner Recommendation to Exercise on Treatment Beliefs and Intentions for Knee Osteoarthritis: An Online Multi-Arm Randomized Controlled Trial. ACR Open Rheumatol 2022; 5:17-27. [PMID: 36444919 PMCID: PMC9837392 DOI: 10.1002/acr2.11513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/27/2022] [Accepted: 10/12/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To evaluate effects of general osteoarthritis (OA) information in addition to a treatment option grid and general practitioner (GP) recommendation to exercise on treatment beliefs and intentions. METHODS An online randomized trial of 735 people 45 years old or older without OA who were recruited from a consumer survey network. Participants read a hypothetical scenario about visiting their GP for knee problems and were randomized to the following: i) 'general information', ii) 'option grid' (general information plus option grid), or iii) 'option grid plus recommendation' (general information plus option grid plus GP exercise recommendation). The primary outcome was an agreement that exercise is the best management option (0-10 numeric rating scale; higher scores indicating higher agreement that exercise is best). The secondary outcomes were beliefs about other management options and management intentions. Linear regression models estimated the mean (95% confidence interval [CI]) between-group difference in postintervention scores, adjusted for baseline. RESULTS Option grid plus recommendation led to higher agreement that exercise is the best management by a mean of 0.4 units (95% CI: 0.1-0.6) compared with general information. There were no other between-group differences for the primary outcome. Option grid led to higher agreement that surgery was best, and x-rays were necessary, compared with general information (mean between-group differences: 0.7 [CI: 0.2-1.1] and 0.5 [CI: 0.1-1.0], respectively) and option grid plus recommendation (0.5 [CI: 0.1-0.9] and 0.9 [CI: 0.4-1.3]). CONCLUSION Addition of an option grid and GP exercise recommendation to general OA information led to more favorable views that exercise was best for the hypothetical knee problem. However, differences were small and of unclear clinical importance.
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13
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French HP, Abbott JH, Galvin R. Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee. Cochrane Database Syst Rev 2022; 10:CD011915. [PMID: 36250418 PMCID: PMC9574868 DOI: 10.1002/14651858.cd011915.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Land-based exercise therapy is recommended in clinical guidelines for hip or knee osteoarthritis. Adjunctive non-pharmacological therapies are commonly used alongside exercise in hip or knee osteoarthritis management, but cumulative evidence for adjuncts to land-based exercise therapy is lacking. OBJECTIVES To evaluate the benefits and harms of adjunctive therapies used in addition to land-based exercise therapy compared with placebo adjunctive therapy added to land-based exercise therapy, or land-based exercise therapy only for people with hip or knee osteoarthritis. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and clinical trials registries up to 10 June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs of people with hip or knee osteoarthritis comparing adjunctive therapies alongside land-based exercise therapy (experimental group) versus placebo adjunctive therapies alongside land-based exercise therapy, or land-based exercise therapy (control groups). Exercise had to be identical in both groups. Major outcomes were pain, physical function, participant-reported global assessment, quality of life (QOL), radiographic joint structural changes, adverse events and withdrawals due to adverse events. We evaluated short-term (6 months), medium-term (6 to 12 months) and long-term (12 months onwards) effects. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of evidence for major outcomes using GRADE. MAIN RESULTS We included 62 trials (60 RCTs and 2 quasi-RCTs) totalling 6508 participants. One trial included people with hip osteoarthritis, one hip or knee osteoarthritis and 59 included people with knee osteoarthritis only. Thirty-six trials evaluated electrophysical agents, seven manual therapies, four acupuncture or dry needling, or taping, three psychological therapies, dietary interventions or whole body vibration, two spa or peloid therapy and one foot insoles. Twenty-one trials included a placebo adjunctive therapy. We presented the effects stratified by different adjunctive therapies along with the overall results. We judged most trials to be at risk of bias, including 55% at risk of selection bias, 74% at risk of performance bias and 79% at risk of detection bias. Adverse events were reported in eight (13%) trials. Comparing adjunctive therapies plus land-based exercise therapy against placebo therapies plus exercise up to six months (short-term), we found low-certainty evidence for reduced pain and function, which did not meet our prespecified threshold for a clinically important difference. Mean pain intensity was 5.4 in the placebo group on a 0 to 10 numerical pain rating scale (NPRS) (lower scores represent less pain), and 0.77 points lower (0.48 points better to 1.16 points better) in the adjunctive therapy and exercise therapy group; relative improvement 10% (6% to 15% better) (22 studies; 1428 participants). Mean physical function on the Western Ontario and McMaster (WOMAC) 0 to 68 physical function (lower scores represent better function) subscale was 32.5 points in the placebo group and reduced by 5.03 points (2.57 points better to 7.61 points better) in the adjunctive therapy and exercise therapy group; relative improvement 12% (6% better to 18% better) (20 studies; 1361 participants). Moderate-certainty evidence indicates that adjunctive therapies did not improve QOL (SF-36 0 to 100 scale, higher scores represent better QOL). Placebo group mean QOL was 81.8 points, and 0.75 points worse (4.80 points worse to 3.39 points better) in the placebo adjunctive therapy group; relative improvement 1% (7% worse to 5% better) (two trials; 82 participants). Low-certainty evidence (two trials; 340 participants) indicates adjunctive therapies plus exercise may not increase adverse events compared to placebo therapies plus exercise (31% versus 13%; risk ratio (RR) 2.41, 95% confidence interval (CI) 0.27 to 21.90). Participant-reported global assessment was not measured in any studies. Compared with land-based exercise therapy, low-certainty evidence indicates that adjunctive electrophysical agents alongside exercise produced short-term (0 to 6 months) pain reduction of 0.41 points (0.17 points better to 0.63 points better); mean pain in the exercise-only group was 3.8 points and 0.41 points better in the adjunctive therapy plus exercise group (0 to 10 NPRS); relative improvement 7% (3% better to 11% better) (45 studies; 3322 participants). Mean physical function (0 to 68 WOMAC subscale) was 18.2 points in the exercise group and 2.83 points better (1.62 points better to 4.04 points better) in the adjunctive therapy plus exercise group; relative improvement 9% (5% better to 13% better) (45 studies; 3323 participants). These results are not clinically important. Mean QOL in the exercise group was 56.1 points and 1.04 points worse in the adjunctive therapies plus exercise therapy group (1.04 points worse to 3.12 points better); relative improvement 2% (2% worse to 5% better) (11 studies; 1483 participants), indicating no benefit (low-certainty evidence). Moderate-certainty evidence indicates that adjunctive therapies plus exercise probably result in a slight increase in participant-reported global assessment (short-term), with success reported by 45% in the exercise therapy group and 17% more individuals receiving adjunctive therapies and exercise (RR 1.37, 95% CI 1.15 to 1.62) (5 studies; 840 participants). One study (156 participants) showed little difference in radiographic joint structural changes (0.25 mm less, 95% CI -0.32 to -0.18 mm); 12% relative improvement (6% better to 18% better). Low-certainty evidence (8 trials; 1542 participants) indicates that adjunctive therapies plus exercise may not increase adverse events compared with exercise only (8.6% versus 6.5%; RR 1.33, 95% CI 0.78 to 2.27). AUTHORS' CONCLUSIONS Moderate- to low-certainty evidence showed no difference in pain, physical function or QOL between adjunctive therapies and placebo adjunctive therapies, or in pain, physical function, QOL or joint structural changes, compared to exercise only. Participant-reported global assessment was not reported for placebo comparisons, but there is probably a slight clinical benefit for adjunctive therapies plus exercise compared with exercise, based on a small number of studies. This may be explained by additional constructs captured in global measures compared with specific measures. Although results indicate no increased adverse events for adjunctive therapies used with exercise, these were poorly reported. Most studies evaluated short-term effects, with limited medium- or long-term evaluation. Due to a preponderance of knee osteoarthritis trials, we urge caution in extrapolating the findings to populations with hip osteoarthritis.
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Affiliation(s)
- Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - J Haxby Abbott
- Orthopaedics: Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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STARKEY SCOTTC, DIAMOND LAURAE, HINMAN RANAS, SAXBY DAVIDJ, KNOX GABRIELLE, HALL MICHELLE. Muscle Forces during Weight-Bearing Exercises in Medial Knee Osteoarthritis and Varus Malalignment: A Cross-Sectional Study. Med Sci Sports Exerc 2022; 54:1448-1458. [DOI: 10.1249/mss.0000000000002943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Kooranian F, ParsaYekta Z, Rassouli M. Barriers and Challenges to Self-Care among Older Adults with Knee Osteoarthritis: A Qualitative Study. Ethiop J Health Sci 2022; 32:963-974. [PMID: 36262711 PMCID: PMC9554779 DOI: 10.4314/ejhs.v32i5.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Knee osteoarthritis (KOA) is a chronic disease causing disability in older adults. Self-care is an effective strategy for KOA management in older adults and clinicians have shown increased interest regarding the challenges of self-care activities in these patients. The present study aimed to explore the perception of older adults' patients with KOA regarding barriers and challenges faced in their self-care management. Methods In this qualitative study, data were collected using purposeful sampling and in-depth semi-structured interviews with 22 older adults with KOA, their first-degree caregivers, and medical team members in Mashhad, northeast Iran, from April to December 2020. All the interviews were transcribed verbatim. Interviews continued until reaching data saturation. All interviews were recorded. Data analysis was done using conventional content analysis according to the technique described by Graneheim and Lundman. The MAXQDA (Version 10) was used to organize, code, and manage the data. Findings Three main themes (confusion, confrontation with increasing stresses, and social rupture) were emerged as the barriers and challenges to self-care among older adults with KOA. Conclusions The results of this study provide a broad range of context-specific of barriers and challenges to self-care among older adults with KOA, which can be used for designing and implementing appropriate interventions to improve self-care in these patients.
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Affiliation(s)
- Faranak Kooranian
- Department of Nursing, PhD Candidate of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Zohreh ParsaYekta
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Bennell KL, Jones SE, Hinman RS, McManus F, Lamb KE, Quicke JG, Sumithran P, Prendergast J, George ES, Holden MA, Foster NE, Allison K. 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. BMC Musculoskelet Disord 2022; 23:733. [PMID: 35907828 PMCID: PMC9338658 DOI: 10.1186/s12891-022-05685-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Sarah E Jones
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Fiona McManus
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Karen E Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Methods and Implementation Support for Clinical Health research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jonathan G Quicke
- School of Medicine, Keele University, Keele, UK.,Chartered Society of Physiotherapy, Chancery Exchange, London, UK
| | - Priya Sumithran
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | | | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | | | - Nadine E Foster
- School of Medicine, Keele University, Keele, UK.,STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Australia
| | - Kim Allison
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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17
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Hall M, Hinman RS, Knox G, Spiers L, Sumithran P, Murphy NJ, McManus F, Lamb KE, Cicuittini F, Hunter DJ, Messier SP, Bennell KL. Effects of adding a diet intervention to exercise on hip osteoarthritis pain: protocol for the ECHO randomized controlled trial. BMC Musculoskelet Disord 2022; 23:215. [PMID: 35248012 PMCID: PMC8898434 DOI: 10.1186/s12891-022-05128-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05128-9.
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18
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Bennell KL, Lawford BJ, Keating C, Brown C, Kasza J, Mackenzie D, Metcalf B, Kimp AJ, Egerton T, Spiers L, Proietto J, Sumithran P, Harris A, Quicke JG, Hinman RS. Comparing Video-Based, Telehealth-Delivered Exercise and Weight Loss Programs With Online Education on Outcomes of Knee Osteoarthritis : A Randomized Trial. Ann Intern Med 2022; 175:198-209. [PMID: 34843383 DOI: 10.7326/m21-2388] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Scalable knee osteoarthritis programs are needed to deliver recommended education, exercise, and weight loss interventions. OBJECTIVE To evaluate two 6-month, telehealth-delivered exercise programs, 1 with and 1 without dietary intervention. DESIGN 3-group, parallel randomized (5:5:2) trial. (Australian New Zealand Clinical Trials Registry: ACTRN12618000930280). SETTING Australian private health insurance members. PARTICIPANTS 415 persons with symptomatic knee osteoarthritis and a body mass index between 28 and 40 kg/m2 who were aged 45 to 80 years. INTERVENTION All groups received access to electronic osteoarthritis information (control). The exercise program comprised 6 physiotherapist consultations via videoconference for exercise, self-management advice, and behavioral counseling, plus exercise equipment and resources. The diet and exercise program included an additional 6 dietitian consultations for a ketogenic very-low-calorie diet (2 formulated meal replacements and a low-carbohydrate meal daily) followed by a transition to healthy eating, as well as nutrition and behavioral resources. MEASUREMENTS Primary outcomes were changes in knee pain (numerical rating scale [NRS] of 0 to 10, higher indicating worse) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]; scale, 0 to 68, higher indicating worse) at 6 months (primary time point) and 12 months. Secondary outcomes were weight, physical activity, quality of life, mental health, global change, satisfaction, willingness to have surgery, orthopedic appointments, and knee surgery. RESULTS A total of 379 participants (91%) provided 6-month primary outcomes, and 372 (90%) provided 12-month primary outcomes. At 6 months, both programs were superior to control for pain (between-group mean difference in change on NRS: diet and exercise, -1.5 [95% CI, -2.1 to -0.8]; exercise, -0.8 [CI, -1.5 to -0.2]) and function (between-group mean difference in change on WOMAC: diet and exercise, -9.8 [CI, -12.5 to -7.0]; exercise, -7.0 [CI, -9.7 to -4.2]). The diet and exercise program was superior to exercise (pain, -0.6 [CI, -1.1 to -0.2]; function, -2.8 [CI, -4.7 to -0.8]). Findings were similar at 12 months. LIMITATION Participants and clinicians were unblinded. CONCLUSION Telehealth-delivered exercise and diet programs improved pain and function in people with knee osteoarthritis and overweight or obesity. A dietary intervention conferred modest additional pain and function benefits over exercise. PRIMARY FUNDING SOURCE Medibank, the Medibank Better Health Foundation Research Fund, and a National Health and Medical Research Council Centre of Research Excellence.
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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Belinda J Lawford
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | | | | | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.K.)
| | - Dave Mackenzie
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Ben Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Alexander J Kimp
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Thorlene Egerton
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Joseph Proietto
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia (J.P., P.S.)
| | - Priya Sumithran
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia (J.P., P.S.)
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia (A.H.)
| | - Jonathan G Quicke
- School of Medicine, Keele University, Keele, United Kingdom (J.G.Q.)
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
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Abstract
Advancements in medical science and technology, along with global increases in life expectancy, are changing the way health care services are delivered to the aging society. Telerehabilitation refers to rehabilitation services involving evaluation and treatment. It is an attractive option for older adults who may have multiple comorbidities. Limited access to in-person services and the concern about potential exposure to severe acute respiratory syndrome coronavirus-2 during this pandemic accelerated the implementation of telerehabilitation. This article review the scope, need, and implementation of telehealth and telerehabilitation in the aging population from the perspective of clinicians, patients, and caregivers.
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Affiliation(s)
- Mooyeon Oh-Park
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Montefiore Health System, Burke Rehabilitation Hospital, 785 Mamaroneck Avenue, White Plains, NY 10605, USA.
| | - Henry L Lew
- Department of Communication Sciences and Disorders, University of Hawai'i at Mānoa, John A. Burns School of Medicine, 677 Ala Moana Boulevard, Suite 625, Honolulu, HI 96813, USA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Söderlund A, von Heideken Wågert P. Adherence to and the Maintenance of Self-Management Behaviour in Older People with Musculoskeletal Pain-A Scoping Review and Theoretical Models. J Clin Med 2021; 10:jcm10020303. [PMID: 33467552 PMCID: PMC7830780 DOI: 10.3390/jcm10020303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: Adherence to and the maintenance of treatment regimens are fundamental for pain self-management and sustainable behavioural changes. The first aim was to study older adults’ (>65 years) levels of adherence to and maintenance of musculoskeletal pain self-management programmes in randomized controlled trials. The second aim was to suggest theoretical models of adherence to and maintenance of a behaviour. (2) Methods: The study was conducted in accordance with the recommendations for a scoping review and the PRISMA-ScR checklist. Capability, motivation and opportunity were used to categorize the behavioural change components in the theoretical models. (3) Results: Among the four studies included, components targeting adherence were reported in one study, and maintenance was reported in two studies. Adherence was assessed by the treatment attendance rates, and maintenance was assessed by the follow-up data of outcome measures. For adherence, the capability components were mostly about education and the supervision, grading and mastery of exercise to increase self-efficacy. The motivation components included the readiness to change, self-monitoring and goal setting; and the opportunity components included booster sessions, feedback and social support. For maintenance, the capability components consisted of identifying high-risk situations for relapse and problem-solving skills. The motivation components included self-regulation and self-efficacy for problem solving, and the opportunity components included environmental triggers and problem solving by using social support. (4) Conclusion: There are several behavioural change components that should be used to increase older adults’ levels of adherence to and maintenance of a pain self-management behaviour.
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