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Weber F, Kloek C, Stuhrmann S, Blum Y, Grüneberg C, Veenhof C. Usability and preliminary effectiveness of an app-based physical activity and education program for people with hip or knee osteoarthritis - a pilot randomized controlled trial. Arthritis Res Ther 2024; 26:83. [PMID: 38600607 PMCID: PMC11005282 DOI: 10.1186/s13075-024-03291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/19/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Hip and knee osteoarthritis (OA) are highly prevalent worldwide. The guidelines recommend physical activity and education as the core treatments for osteoarthritis. Digital health has the potential to engage people in physical activity and disease management. Therefore, we conducted a pilot trial to assess the usability and preliminary effectiveness of an app-based physical activity and education program (Join2Move) compared to usual care for people with hip and/or knee OA in Germany. METHODS A randomized controlled pilot study was conducted. Individuals with diagnosed or self-reported knee and hip OA were included. Allocation to the intervention or control group was randomized. The intervention group received the Join2Move program. The Join2Move program was previously developed as a website and evaluated in the Netherlands. For the current study, the program was translated and adapted to the German context and adjusted from a website to an app. The control group received usual care. The primary outcomes were usability and preliminary effectiveness (pain and physical functioning). Measurements were taken at baseline and at twelve weeks. The data analysis was performed using SPSS (IBM SPSS Statistics 29.0). RESULTS Sixty participants, with a mean age of 61.9 (SD ± 7.2) years, were allocated to the intervention (n = 32) or the control group (n = 28) and included in the analysis. The majority of participants had knee OA (68%), and 12% had hip and knee OA. The dropout rate was n = 11 (18%). No adverse events were reported. Usability was rated as acceptable (mean System Usability Scale = 71.3/100) with a wide range (32.5 to 100). Statistically significant between-group differences were found only for pain (mean difference 8.52 (95% CI 1.01 to 16.04), p = 0.027). CONCLUSIONS Join2Move demonstrated acceptable usability. The preliminary results of the pilot trial indicate the potential of a stand-alone app for the treatment of patients with hip or knee OA. However, the acceptable usability of Join2Move limits its recommendation for everyone. There appears to be room for improvement in app usability and in identifying patients for whom the app is suitable and the right time to use a stand-alone app. TRIAL REGISTRATION German Clinical Trials Register DRKS00027164 .
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Affiliation(s)
- F Weber
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, University of Applied Health Sciences, Gesundheitscampus 6-8, Bochum, 44801, Germany.
- Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - C Kloek
- Research Group Innovation of Human Movement Care, Knowledge Centre Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
| | - S Stuhrmann
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, University of Applied Health Sciences, Gesundheitscampus 6-8, Bochum, 44801, Germany
| | - Y Blum
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, University of Applied Health Sciences, Gesundheitscampus 6-8, Bochum, 44801, Germany
| | - C Grüneberg
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit, University of Applied Health Sciences, Gesundheitscampus 6-8, Bochum, 44801, Germany
| | - C Veenhof
- Department of Rehabilitation, Physiotherapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, Knowledge Centre Healthy and Sustainable Living, HU University of Applied Sciences, Utrecht, The Netherlands
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Fandim JV, Hinman RS, Øverås CK, Sharma S, Belton J, Oliveira VC, Dear BF, Parker R, Ghai B, Bennell KL, Ferreira P, Hartvigsen J, Saragiotto BT. One step at a time. Shaping consensus on research priorities and terminology in telehealth in musculoskeletal pain: an international modified e-Delphi study. BMC Musculoskelet Disord 2023; 24:783. [PMID: 37789304 PMCID: PMC10546725 DOI: 10.1186/s12891-023-06866-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Telehealth has emerged as an alternative model for treatment delivery and has become an important component of health service delivery. However, there is inconsistency in the use of terminologies and a lack of research priorities in telehealth in musculoskeletal pain. The purpose of this international, multidisciplinary expert panel assembled in a modified three-round e-Delphi survey is to achieve a consensus on research priorities and for the standard terminology for musculoskeletal pain telehealth practice. METHODS In this international modified e-Delphi survey, we invited an expert panel consisting of researchers, clinicians, consumer representatives, industry partners, healthcare managers, and policymakers to participate in a three-round e-Delphi. Expert panels were identified through the Expertscape website, PubMed database, social media, and a snowball approach. In Round 1, potential research priorities and terminologies were presented to panel members. Panel members rated the agreement of each research priority on a 5-point Likert scale and an 11-point numerical scale, and each terminology on a 5-point Likert scale for the "telehealth in musculoskeletal pain " field over rounds. At least 80% of the panel members were required to agree to be deemed a consensus. We analyzed the data descriptively and assessed the stability of the results using the Wilcoxon matched-pairs signed rank test. RESULTS We performed an international e-Delphi survey from February to August 2022. Of 694 invited people, 160 panel members participated in the first round, 133 in the second round (83% retention), and 134 in the third round (84% retention). Most of the panel members were researchers 76 (47%), clinicians 57 (36%), and consumer representatives 9 (6%) of both genders especially from Brazil 31 (19%), India 22 (14%), and Australia 19 (12%) in the first round. The panel identified fourteen telehealth research priorities spanned topics including the development of strategies using information and communication technology, telehealth implementation services, the effectiveness and cost-effectiveness of telehealth interventions, equity of telehealth interventions, qualitative research and eHealth literacy in musculoskeletal pain conditions from an initial list of 20 research priorities. The consensus was reached for "digital health" and "telehealth" as standard terminologies from an initial list of 37 terminologies. CONCLUSION An international, multidisciplinary expert consensus recommends that future research should consider the 14 research priorities for telehealth musculoskeletal pain reached. Additionally, the terms digital health and telehealth as the most appropriate terminologies to be used in musculoskeletal telehealth research. REGISTER Open Science Framework ( https://osf.io/tqmz2/ ).
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Affiliation(s)
- Junior V Fandim
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno, 448, Tatuapé, CEP 03071-000, São Paulo, SP, Brasil.
| | - Rana S Hinman
- Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
| | - Cecilie K Øverås
- Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Saurab Sharma
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Joletta Belton
- IASP Global Alliance of Partners for Pain Advocacy (GAPPA), Washington D.C, USA
| | - Vinícius C Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal Dos Vales Do Jequitinhonha E Mucuri (UFVJM), Diamantina, MG, Brazil
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Macquarie Park, Australia
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Babita Ghai
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
| | - Paulo Ferreira
- Faculty of Medicine and Health, The University of Sydney, Charles Perkins Centre, Sydney School of Health Sciences, Camperdown, NSW, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Bruno T Saragiotto
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), Rua Cesário Galeno, 448, Tatuapé, CEP 03071-000, São Paulo, SP, Brasil
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Jönsson T, Dell’Isola A, Lohmander LS, Wagner P, Cronström A. Comparison of Face-to-Face vs Digital Delivery of an Osteoarthritis Treatment Program for Hip or Knee Osteoarthritis. JAMA Netw Open 2022; 5:e2240126. [PMID: 36326763 PMCID: PMC9634502 DOI: 10.1001/jamanetworkopen.2022.40126] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Importance Digital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities. Objective To compare mean pain reduction among individuals with osteoarthritis (OA) of the knee or hip who underwent face-to-face vs digital first-line intervention. Design, Setting, and Participants This registry-based cohort study included all persons with knee or hip osteoarthritis who participated in structured first-line treatment for osteoarthritis in a primary care setting in Sweden. Inclusion criteria were as follows: the treatment was delivered face-to-face or digitally between April 1, 2018, and December 31, 2019; patients provided 3-month follow-up data for pain; and patients had program adherence of at least 80%. Data analysis was conducted in March 2021. Exposures Participants completed a 3-month intervention, including education and exercise for hip or knee osteoarthritis, with program adherence of 80% or higher, delivered face-to-face or by a digital application. Main Outcomes and Measures Difference in change in joint pain (11-point numeric rating scale, with 0 indicating no pain and 10, the worst possible pain) between baseline and 3-month follow-up between the 2 intervention modalities. A minimal clinically important difference in pain change between groups was predefined as 1 point. Secondary outcomes were walking difficulties, health-related quality of life, willingness to undergo joint surgery, and fear avoidance behavior. Results A total of 6946 participants (mean [SD] age, 67 [9] years; 4952 [71%] women; 4424 [64%] knee OA; 2504 [36%] hip OA) were included, with 4237 (61%) receiving face-to-face treatment and 2709 (39%) receiving digital treatment. Both the face-to-face (mean change, -1.10 [95% CI -1.17 to -1.02] points) and digital interventions (mean change, -1.87 [95% CI, -1.94 to -1.79] points) resulted in a clinically important pain reduction at 3 months. Participants in the digitally delivered intervention experienced a larger estimated improvement at 3 months (adjusted mean difference, -0.93 [95% CI, -1.04 to -0.81] points). Results of secondary outcomes were broadly consistent with main outcome. Conclusions and Relevance This Swedish national registry-based cohort study showed that people with knee or hip OA participating in first-line intervention experienced clinically relevant improvements in pain, whether delivered face-to-face or digitally. The increased benefit of digital delivery compared with face-to-face delivery was of uncertain clinical importance.
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Affiliation(s)
- Therese Jönsson
- Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden
| | - Andrea Dell’Isola
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - L. Stefan Lohmander
- Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Arthro Therapeutics, Malmö, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Anna Cronström
- Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Rennie K, Taylor C, Corriero AC, Chong C, Sewell E, Hadley J, Ardani S. The Current Accuracy, Cost-Effectiveness, and Uses of Musculoskeletal Telehealth and Telerehabilitation Services. Curr Sports Med Rep 2022; 21:247-260. [PMID: 35801726 DOI: 10.1249/jsr.0000000000000974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Musculoskeletal conditions are a major contributor to global morbidity. During the COVID-19 pandemic, clinicians needed to rapidly meet the evolving requirements of their patients, which resulted in an increased adoption of telehealth services. This area needs more research, as there is currently a paucity of studies, and telehealth practices are continuing to advance and evolve. This study subsequently aims to evaluate the ethics, health economics, and accuracy of current musculoskeletal telehealth services. This article combines three original studies; a telehealth accuracy systematic review; a cost-effectiveness scoping review; and a biopsychosocial narrative review. These studies were combined into one article. This article concludes that telehealth services achieve an average agreement with in-person assessments of 62% for the knee and 31% for the shoulder and that telerehabilitation services incur average cost savings per patient of £38.57 but that these savings are primarily a result of a reduced need to travel.
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Affiliation(s)
| | | | | | | | | | | | - Shina Ardani
- Department of Clinical Research, Sina Medical Technology, Manchester, UNITED KINGDOM
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Cronström A, Nero H, Dahlberg LE. Factors Associated With Patients' Willingness to Consider Joint Surgery After Completion of a Digital Osteoarthritis Treatment Program: A Prospective Cohort Study. Arthritis Care Res (Hoboken) 2019; 71:1194-1201. [PMID: 30298990 PMCID: PMC6771662 DOI: 10.1002/acr.23772] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/25/2018] [Indexed: 12/11/2022]
Abstract
Objective To examine patient willingness and a possible shift in willingness for surgery and to investigate factors associated with this shift, following participation in the digital nonsurgical osteoarthritis (OA) treatment program Joint Academy. Methods A total of 458 individuals (mean ± SD age 62 ± 5.6 years, 67% women) with diagnosed hip or knee OA were evaluated after 6 weeks in the Joint Academy program, comprising education and exercise as well as asynchronous chat with a physical therapist. Data describing joint pain, health‐related quality of life (the EuroQol 5‐domain [EQ‐5D] questionnaire in 3 levels), walking difficulties, the 30‐second chair stand test, and willingness to consider surgery were collected at baseline and at 6 weeks. Results At follow‐up, 31% of those participants willing to consider surgery at baseline no longer considered surgery. Of those participants who were unwilling to consider surgery at baseline, 6% reconsidered and decided in favor of surgery at follow‐up. Less pain and a higher EQ‐5D score at 6 weeks were associated with the change from being willing to unwilling to consider surgery at follow‐up (odds ratio [OR] 0.67–1.64; P < 0.05). Worse pain, a lower EQ‐5D score, and having walking difficulties at 6 weeks, and a lower pain and EQ‐5D score improvement were associated with the change from being unwilling to willing to consider surgery at 6 weeks (OR 0.51–4.30; P < 0.005). Conclusion Evidence‐based nonsurgical OA treatment, at least delivered in a digital format, may reduce the need for surgery and should therefore be offered as the first‐line treatment option to patients with hip and knee OA. The results also support the idea that such treatment programs have the potential to improve selection of patients for total joint replacement.
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Affiliation(s)
| | - Håkan Nero
- Lund University, Lund, and Joint Academy, Malmö, Sweden
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Cronström A, Dahlberg LE, Nero H, Hammarlund CS. "I was considering surgery because I believed that was how it was treated": a qualitative study on willingness for joint surgery after completion of a digital management program for osteoarthritis. Osteoarthritis Cartilage 2019; 27:1026-1032. [PMID: 31002940 DOI: 10.1016/j.joca.2019.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/07/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore, using a qualitative approach, reasons for patients' continued willingness or their shift in willingness for total joint replacement (TJR) surgery, following participation in Joint Academy, a Swedish, digital, non-surgical treatment program for osteoarthritis (OA). DESIGN Nineteen patients with hip or knee OA were interviewed after finishing their first 6 weeks in the treatment program, using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using a systematic text condensation method. RESULTS Analysis of the interview data revealed three main categories of reasons provided for the participants' decisions regarding surgery: 1) Various reasons for participating in Joint Academy with three sub-categories: (a) longstanding pain affects daily life, (b) last chance for improvement and (c) mandatory treatment to be eligible for total joint replacements (TJR); 2) Willingness for TJR following treatment, which included four sub-categories: (a) surgery - the last resort, (b) reduced pain and improved functioning, (c) no perceived improvements after treatment, and (d) trust in healthcare providers; and 3) Expectations of TJR. The shift in willingness towards or away from TJR was mainly due to the perceived success of Joint Academy in improving their functioning. CONCLUSION Several patients reconsidered their options and had changed their attitude to TJR after participation in a digital program aimed at reducing OA symptoms and improving functioning. These results highlight the importance of providing patients with adequate information about non-surgical management options to facilitate shared decision-making, and possibly reduce the need for surgery.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Decision Making, Shared
- Female
- Hip Prosthesis
- Humans
- Interviews as Topic
- Knee Prosthesis
- Male
- Middle Aged
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/surgery
- Patient Education as Topic/methods
- Qualitative Research
- Quality of Life
- Severity of Illness Index
- Sweden
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Affiliation(s)
- A Cronström
- Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - L E Dahlberg
- Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Orthopedics, Skåne University Hospital, Lund, Sweden
| | - H Nero
- Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden; Joint Academy Inc., Malmö, Sweden
| | - C S Hammarlund
- Department of Health Sciences, Lund University, Lund, Sweden; The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
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Cronström A, Dahlberg LE, Nero H, Ericson J, Hammarlund CS. 'I would never have done it if it hadn't been digital': a qualitative study on patients' experiences of a digital management programme for hip and knee osteoarthritis in Sweden. BMJ Open 2019; 9:e028388. [PMID: 31129601 PMCID: PMC6537991 DOI: 10.1136/bmjopen-2018-028388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate the experiences of a digital management programme for hip and knee osteoarthritis (OA), including education and exercises as well as an option to chat with an assigned physical therapist for feedback, questions and support. SETTING This study was conducted at a regional hospital in the southern part of Sweden. METHODS Nineteen patients (10 women), median age of 66 (q1-q3, 57-71) years, with confirmed hip or knee OA were interviewed after completing their first 6 weeks in the programme, using a semistructured interview guide. The interviews were transcribed verbatim and were qualitatively analysed using systematic text condensation. RESULTS Three categories emerged during the interviews:(1) Management options for mitigating the consequences of OA; (2) Experiences of the digital programme and (3) Perceived effects of the digital programme over time. The participants had mostly positive experiences of the programme. Particularly important for these experiences were no waiting list, the flexibility of taking part in the programme with regards to location and time and the possibility to have daily contact with a physical therapist. These aspects were also emphasised as advantages compared with traditional care. CONCLUSIONS Digital management of OA, including education and exercise, was experienced as a valid alternative to traditional treatment in enabling the implementation of OA guidelines in a wider community. Easy access, exercising at one's own convenience, flexible options, daily follow-up and support by a physical therapist were mentioned as the most important features. In addition, the results will contribute to further development and improvement of digital OA management programmes.
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Affiliation(s)
- Anna Cronström
- Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Leif E Dahlberg
- Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Håkan Nero
- Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Catharina Sjödahl Hammarlund
- Department of Health Sciences, Lund University, Lund, Sweden
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
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Mecklenburg G, Smittenaar P, Erhart-Hledik JC, Perez DA, Hunter S. Effects of a 12-Week Digital Care Program for Chronic Knee Pain on Pain, Mobility, and Surgery Risk: Randomized Controlled Trial. J Med Internet Res 2018; 20:e156. [PMID: 29695370 PMCID: PMC5943627 DOI: 10.2196/jmir.9667] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/20/2018] [Accepted: 04/07/2018] [Indexed: 01/22/2023] Open
Abstract
Background Chronic knee pain, most commonly caused by knee osteoarthritis, is a prevalent condition which in most cases can be effectively treated through conservative, non-surgical care involving exercise therapy, education, psychosocial support, and weight loss. However, most people living with chronic knee pain do not receive adequate care, leading to unnecessary use of opiates and surgical procedures. Objective Assess the efficacy of a remotely delivered digital care program for chronic knee pain. Methods We enrolled 162 participants into a randomized controlled trial between January and March 2017. Participants were recruited from participating employers using questionnaires for self-assessment of their knee pain, and randomized into treatment (n=101) and control (n=61) groups. Participants in the treatment group were enrolled in the Hinge Health digital care program for chronic knee pain. This is a remotely delivered, home-based 12-week intervention that includes sensor-guided exercise therapy, education, cognitive behavioral therapy, weight loss, and psychosocial support through a personal coach and team-based interactions. The control group received three education pieces regarding self-care for chronic knee pain. Both groups had access to treatment-as-usual. The primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain subscale and KOOS Physical Function Shortform (KOOS-PS). Secondary outcomes were visual analog scales (VAS) for pain and stiffness respectively, surgery intent, and self-reported understanding of the condition and treatment options. Outcome measures were analyzed by intention to treat (excluding 7 control participants who received the digital care program due to administrative error) and per protocol. Results In an intent-to-treat analysis the digital care program group had a significantly greater reduction in KOOS Pain compared to the control group at the end of the program (greater reduction of 7.7, 95% CI 3.0 to 12.3, P=.002), as well as a significantly greater improvement in physical function (7.2, 95% CI 3.0 to 11.5, P=.001). This was also reflected in the secondary outcomes VAS pain (12.3, 95% CI 5.4 to 19.1, P<.001) and VAS stiffness (13.4, 95% CI 5.6 to 21.1, P=.001). Participants’ self-reported likelihood (from 0% to 100%) of having surgery also reduced more strongly in the digital care program group compared to the control group over the next 1 year (–9.4 percentage points, pp, 95% CI –16.6 to –2.2, P=.01), 2 years (–11.3 pp, 95% CI –20.1 to –2.5, P=.01), and 5 years (–14.6 pp, 95% CI –23.6 to –5.5, P=.002). Interest in surgery (from 0 to 10) also reduced more so in the digital care program compared to control group (–1.0, 95% CI –1.7 to –0.2, P=.01). Participants’ understanding of the condition and treatment options (on a scale from 0 to 4) increased more substantially for participants in the digital care program than those in the control group (0.9, 95% CI 0.6 to 1.3, P<.001). In an analysis on participants that completed the intervention (per protocol analysis) all primary and secondary outcomes remained significant at greater effect magnitudes compared to intention to treat, with those completing the program showing a 61% (95% CI 48 to 74) reduction in VAS pain compared to 21% (95% CI 5 to 38) in the control group (P<.001). Accounting for the cost of administering the program, we estimate net cost savings on surgery alone of US $4340 over 1 year and $7900 over 5 years for those participants completing the digital care program compared to those in the control group receiving treatment-as-usual. In an exploratory subgroup analysis including only participants exhibiting clinical symptoms of osteoarthritis the program proved equally effective. Conclusions This trial provides strong evidence that a comprehensive 12-week digital care program for chronic knee pain, including osteoarthritis, yields significantly improved outcomes for pain, physical function, stiffness, surgery risk, and understanding of the condition, compared to a control group. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 13307390; http://www.isrctn.com/ISRCTN13307390 (Archived by WebCite at http://www.webcitation.org/6ycwjGL73)
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Affiliation(s)
| | | | - Jennifer C Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford University, Stanford, CA, United States
| | | | - Simon Hunter
- Hinge Health, Inc, San Francisco, CA, United States
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Smittenaar P, Erhart-Hledik JC, Kinsella R, Hunter S, Mecklenburg G, Perez D. Translating Comprehensive Conservative Care for Chronic Knee Pain Into a Digital Care Pathway: 12-Week and 6-Month Outcomes for the Hinge Health Program. JMIR Rehabil Assist Technol 2017; 4:e4. [PMID: 28582253 PMCID: PMC5460069 DOI: 10.2196/rehab.7258] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/24/2017] [Accepted: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background Chronic 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. Objective The 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. Methods Individuals 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. Results The 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. Conclusions Participants 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.
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Affiliation(s)
| | | | | | - Simon Hunter
- Hinge Health Inc, San Francisco, CA, United States
| | | | - Daniel Perez
- Hinge Health Inc, San Francisco, CA, United States
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Li L. Clinician's Commentary on Winter Di Cola et al.(1.). Physiother Can 2014; 66:272-3. [PMID: 25125780 DOI: 10.3138/ptc.2012-66-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Linda Li
- Associate Professor, Harold Robinson / Arthritis Society Chair in Arthritic Diseases, and Canada Research Chair in Patient-Oriented Knowledge Translation, Department of Physical Therapy, University of British Columbia; Senior Scientist, Arthritis Research Centre of Canada, Vancouver; Physiotherapist, Mary Pack Arthritis Program, Vancouver General Hospital
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