Applications of Digital Health Technologies in Knee Osteoarthritis: A Narrative Review (Preprint)

BACKGROUND With increasing adoption of high-speed internet and mobile technologies by older adults, digital health (comprising websites, mobile applications, text messaging, tele-health, etc.) is a promising modality to enhance research and clinical care for people with osteoarthritis (OA), including those with knee replacement (KR). OBJECTIVE This narrative review summarizes key digital health technologies and the use of digital health for delivery of patient education, supervised and unsupervised exercise and/or physical activity interventions, psychological interventions, cost-effectiveness of digital health, and clinician and patient perspective toward digital health in the field of knee OA and KR. Remaining challenges and future opportunities for digital health technologies to improve care in knee OA and KR are also discussed. METHODS Search terms such as “mobile health”, “smartphone”, mobile application”, “mobile technology”, “ehealth”, “text message”, “internet”, “knee osteoarthritis” etc. were used in PubMed and EMBASE databases in February 2021. The search was limited to original articles published in English language within the prior ten years. In all, 91 relevant studies were included in this review. RESULTS Digital health technologies such as websites, mobile phone apps, telephone calls, text-messaging, social media, video-conferencing software, and custom multi-technology systems have been used to deliver healthcare in knee OA and KR populations. Digital patient education interventions improved disease related knowledge at shorter follow-up periods, especially when used as an adjunct to traditional methods of patient education. The benefits of digital health for exercise and physical activity interventions in people with knee OA appear mixed. Digital interventions that use more than one technology and/or strategies to engage the participants may be more promising than those that rely on a single modality. Digital interventions for chronic knee pain that include psychological treatments are effective. Digital health appears appropriate for enhancing in-person physical therapy care for people with knee OA but may not serve as replacement for in-person interventions. However, the cost-effectiveness of hybrid (i.e., digital and in-person) interventions needs further investigation for people with knee OA. Finally, both people with knee OA and clinicians had positive views on digital health, but raised privacy and security related concerns, and logistic and training related concerns, respectively. CONCLUSIONS For people with knee OA, blended interventions that integrate digital and in-person care are promising but need further investigations. For people pre- or post-KR, digital health appears to be similar to or better than in-person rehabilitation and cost-effective. Wider implementation of these promising technologies should be considered. Patient and clinician preferences should be incorporated early in the intervention design process for digital health.

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The EPIPHA-KNEE trial: Explaining Pain to target unhelpful pain beliefs to Increase PHysical Activity in KNEE osteoarthritis – a protocol for a multicentre, randomised controlled trial with clinical- and cost-effectiveness analysis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04561-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Tasha R. Stanton ◽

Felicity A. Braithwaite ◽

David Butler ◽

G. Lorimer Moseley ◽

Catherine Hill ◽

...

Keyword(s):

Physical Activity ◽

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Knee Osteoarthritis ◽

Education Program ◽

Controlled Trial ◽

Activity Level ◽

Pain Beliefs ◽

Knee Oa ◽

Randomised Controlled

Abstract Background Despite well-established benefits of physical activity for knee osteoarthritis (OA), nine of ten people with knee OA are inactive. People with knee OA who are inactive often believe that physical activity is dangerous, fearing that it will further damage their joint(s). Such unhelpful beliefs can negatively influence physical activity levels. We aim to evaluate the clinical- and cost-effectiveness of integrating physiotherapist-delivered pain science education (PSE), an evidence-based conceptual change intervention targeting unhelpful pain beliefs by increasing pain knowledge, with an individualised walking, strengthening, and general education program. Methods Two-arm, parallel-design, multicentre randomised controlled trial involving 198 people aged ≥50 years with painful knee OA who do not meet physical activity guideline recommendations or walk regularly for exercise. Both groups receive an individualised physiotherapist-led walking, strengthening, and OA/activity education program via 4x weekly in-person treatment sessions, followed by 4 weeks of at-home activities (weekly check-in via telehealth), with follow-up sessions at 3 months (telehealth) and 5 and 9 months (in-person). The EPIPHA-KNEE group also receives contemporary PSE about OA/pain and activity, embedded into all aspects of the intervention. Outcomes are assessed at baseline, 12 weeks, 6 and 12 months. Primary outcomes are physical activity level (step count; wrist-based accelerometry) and self-reported knee symptoms (WOMAC Total score) at 12 months. Secondary outcomes are quality of life, pain intensity, global rating of change, self-efficacy, pain catastrophising, depression, anxiety, stress, fear of movement, knee awareness, OA/activity conceptualisation, and self-regulated learning ability. Additional measures include adherence, adverse events, blinding success, COVID-19 impact on activity, intention to exercise, treatment expectancy/perceived credibility, implicit movement/environmental bias, implicit motor imagery, two-point discrimination, and pain sensitivity to activity. Cost-utility analysis of the EPIPHA-KNEE intervention will be undertaken, in addition to evaluation of cost-effectiveness in the context of primary trial outcomes. Discussion We will determine whether the integration of PSE into an individualised OA education, walking, and strengthening program is more effective than receiving the individualised program alone. Findings will inform the development and implementation of future delivery of PSE as part of best practice for people with knee OA. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12620001041943 (13/10/2020).

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Digital Interventions for Cardiac Rehabilitation: A Systematic Literature Review (Preprint)

10.2196/preprints.18773 ◽

2020 ◽

Author(s):

Shannon Wongvibulsin ◽

Evagelia E Habeos ◽

Pauline P Huynh ◽

Helen Xun ◽

Rongzi Shan ◽

...

Keyword(s):

Physical Activity ◽

Exercise Training ◽

Literature Review ◽

Cardiac Rehabilitation ◽

Digital Health ◽

Physical Activity Counseling ◽

Health Technologies ◽

Digital Interventions ◽

Activity Counseling ◽

Core Components

BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate. Digital health technologies (i.e. the delivery of care through the use of the internet, wearable devices, and mobile applications) have the potential to address the challenges associated with traditional facility-based CR programs but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, a systematic evaluation of the current literature on digital interventions for CR is lacking. OBJECTIVE The objective of this systematic literature review is to provide an in-depth analysis of the potential for digital health technologies to address the challenges associated with traditional CR. Through this review, we 1) summarize the current literature on digital interventions for CR, 2) identify the key components of CR that have been successfully addressed through digital interventions, and 3) describe gaps in research that need to be addressed for sustainable and scalable digital CR interventions. METHODS Our search strategy for identifying primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of telephone) consisted of querying MEDLINE, Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018 and consulting with an expert in the field of digital CR. RESULTS Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The CR interventions reviewed primarily targeted physical activity counseling (100%; n=31), baseline assessment (97%; n=30) and exercise training (87%; n=27). The most common modalities used were smartphone/mobile devices (65%; n=20), online portals (58%; n=18), and email-SMS (35%; n=11). Approximately one third of studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components including management of lipids, diabetes, smoking cessation, and blood pressure. CONCLUSIONS Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, interventions that have previously been evaluated are primarily focused on physical activity counseling and exercise training without the other core components of CR. Thus, further research is required with more comprehensive CR interventions and long-term follow-up in order to understand the clinical impact of digital interventions. CLINICALTRIAL

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Cost-effectiveness of physical activity interventions in four European countries

European Journal of Public Health ◽

10.1093/eurpub/ckx187.245 ◽

2017 ◽

Vol 27 (suppl_3) ◽

Author(s):

A Lafranconi ◽

G Cesana

Keyword(s):

Physical Activity ◽

Cost Effectiveness ◽

European Countries ◽

Physical Activity Interventions

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Group-mediated Physical Activity Promotion and Mobility in Sedentary Patients with Knee Osteoarthritis: Results from the IMPACT-Pilot Trial

The Journal of Rheumatology ◽

10.3899/jrheum.140054 ◽

2014 ◽

Vol 41 (10) ◽

pp. 2068-2077 ◽

Cited By ~ 12

Author(s):

Brian C. Focht ◽

Matthew J. Garver ◽

Steven T. Devor ◽

Justin Dials ◽

Alexander R. Lucas ◽

...

Keyword(s):

Physical Activity ◽

Knee Osteoarthritis ◽

Exercise Intervention ◽

Pilot Trial ◽

Physical Activity Promotion ◽

Knee Oa ◽

Activity Promotion ◽

Favorable Change ◽

Intent To Treat ◽

The Impact

Objective.To compare the effects of a group-mediated cognitive behavioral exercise intervention (GMCB) with traditional center-based exercise therapy (TRAD) on objectively assessed levels of physical activity (PA) and mobility in sedentary patients with knee osteoarthritis (OA).Methods.The Improving Maintenance of Physical Activity in Knee Osteoarthritis Trial-Pilot (IMPACT-P) was a 12-month, 2-arm, single-blind, randomized controlled pilot study designed to compare the effects of GMCB and TRAD on 80 sedentary patients with knee OA with self-reported difficulty in daily activities [mean age 63.5 yrs, 84% women, mean body mass index (BMI) 32.7 kg/m2]. Objective assessments of PA (LIFECORDER Plus Accelerometer) and mobility (400-m walk) were obtained at baseline, 3 months, and 12 months by study personnel blinded to participants’ treatment assignment.Results.Intent to treat 2 (treatment: GMCB and TRAD) × 2 (time: 3 mos and 12 mos) analyses of covariance of controlling for baseline, age, sex, and BMI-adjusted change in the outcomes demonstrated that the GMCB intervention yielded significantly greater increases in PA (p < 0.01) and a nonsignificant yet more favorable improvement in mobility (p = 0.09) relative to TRAD. Partial correlation analyses also revealed that change in PA was significantly correlated with the 400-m walk performance at 3-month (r = −0.51, p < 0.01) and 12-month (r = −0.40, p < 0.01) followup assessments.Conclusion.Findings from the IMPACT-P trial suggest that the GMCB treatment resulted in significantly greater improvement in PA and nonsignificant yet more favorable change in mobility relative to TRAD.

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Opinions towards physical activity interventions using Facebook or text messaging: Focus group interviews with vocational school‐aged adolescents

Health & Social Care in the Community ◽

10.1111/hsc.12679 ◽

2018 ◽

Vol 27 (3) ◽

pp. 654-664 ◽

Cited By ~ 2

Author(s):

Delfien Van Dyck ◽

Sara D’Haese ◽

Jolien Plaete ◽

Ilse De Bourdeaudhuij ◽

Benedicte Deforche ◽

...

Keyword(s):

Physical Activity ◽

Focus Group ◽

Text Messaging ◽

Vocational School ◽

Focus Group Interviews ◽

Physical Activity Interventions ◽

Group Interviews

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Digital health technologies for long term self-management of osteoporosis: a systematic review and meta-analysis (Preprint)

10.2196/preprints.32557 ◽

2021 ◽

Author(s):

Ghada Alhussein ◽

Leontios Hadjileontiadis

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Digital Health ◽

Meta Analysis ◽

Self Management ◽

Current Status ◽

Future Research ◽

Common Chronic Disease ◽

Health Technologies ◽

Management Interventions

BACKGROUND Osteoporosis is the fourth most common chronic disease in the world. Adopting preventative measures and effective self-management interventions help in improving bone health. Mobile health (mHealth) technologies can play a key role in osteoporosis patient care and self- management. OBJECTIVE This study presents a systematic review and meta-analysis of the currently available mHealth applications targeting osteoporosis self-management, aiming to determine the current status, gaps and challenges the future research could address, proposing appropriate recommendations. METHODS In this systematic review and meta-analysis, we searched PubMed, Scopus, EBSCO, Web of Science, and IEEExplore databases between Jan 1, 2010 and May 31, 2021, for all English publications that describe apps dedicated to or being useful for osteoporosis, targeting self-management, nutrition, physical activity, risk assessment, delivered on smartphone devices for young and older adults. In addition, a survey of all osteoporosis-related apps available in iOS and Android app stores as of May 31, 2021 was also conducted. Primary outcomes of interest were the prevention or reduction of unhealthy behaviours or improvement in healthy behaviours of the six behaviours. Outcomes were summarised in a narrative synthesis and combined using random-effects meta-analysis. RESULTS In total, 3906 unique articles were identified. Of these, 32 articles met the inclusion criteria and were reviewed in depth. The 32 studies were comprising 14 235 participants, of whom on average 69.5% were female, with a mean age of 49.8 years (SD 17.8). The app search identified 23 relevant apps for osteoporosis self-management. The meta-analysis revealed that mHealth supported interventions resulted in a significant reduction in pain (Hedge’s g -1.09, 95%CI -1.68 to -0.45) and disability (Hedge’s g -0.77, 95%CI -1.59 to 0.05). The post-treatment effect of the digital intervention was significant for physical function (Hedge’s g 2.54, 95%CI -4.08 to 4.08); yet nonsignificant for wellbeing (Hedge’s g 0.17, 95% CI -1.84 to 2.17), physical activity (Hedges’ g 0.09, 95%CI -0.59 to 0.50), anxiety (Hedge’s g -0.29, 95%CI -6.11 to 5.53), fatigue (Hedge’s g -0.34, 95%CI -5.84 to 5.16), calcium (Hedge’s g -0.05, 95%CI -0.59 to 0.50) and vitamin D (Hedge’s g 0.10, 95% CI -4.05 to 4.26) intake, and trabecular score (Hedge’s g 0.06, 95%CI -1.00 to 1.12). CONCLUSIONS Osteoporosis apps have the potential to support and improve the management of the disease and its symptoms; they also appear to be a valuable tool for patients and health professionals. However, the majority of the apps that are currently available lack clinically validated evidence of their efficacy and they most focus on a limited number of symptoms. A more holistic and personalized approach, within a co-creation design ecosystem, is needed.

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Experiences of Wearable Technology by Persons with Knee Osteoarthritis Participating in a Physical Activity Counselling Intervention: A Qualitative Study Using a Relational Ethics Lens (Preprint)

10.2196/preprints.30332 ◽

2021 ◽

Author(s):

Jenny Leese ◽

Graham MacDonald ◽

Catherine L Backman ◽

Anne Townsend ◽

Laura Nimmon ◽

...

Keyword(s):

Physical Activity ◽

Qualitative Study ◽

Knee Osteoarthritis ◽

Relational Ethics ◽

Current Evidence ◽

Knee Oa ◽

Everyday Lives ◽

Physical Activity Counselling ◽

Phone Calls ◽

Counselling Intervention

BACKGROUND Current evidence indicates physical activity wearables could support persons with knee osteoarthritis (OA) to be more physically active. Recent evidence also identifies, however, some persons with arthritis experience guilt or worry while using a wearable if they are not as active as they feel they should be. Questions remain around how persons with knee OA experience benefits or downsides in using a wearable in their everyday lives. Better understanding is needed if wearables are to be incorporated in arthritis self-management in ways that are ethically aware. OBJECTIVE Using an ethics lens, describe a range of experiences from persons with knee OA who used a wearable during a physical activity counselling intervention study. METHODS This is a secondary analysis of qualitative interviews (60-90 mins) nested within a randomized controlled trial (RCT). Guided by phenomenography, we explored the experiences of persons with knee OA, following participation in a physical activity counselling intervention. The intervention consisted of a 1.5-hour education session about physical activity, using a Fitbit Flex, and receiving 4 biweekly phone calls for activity counselling with a study physiotherapist (PT) in an 8-week period. All PTs were trained in the Brief Action Planning approach, whereby they guided participants to identify activity goals, develop an action plan, and identify barriers and solutions. Benefits or downsides experienced in participants’ relationships with themselves or the study PT when using the wearable were identified using a relational ethics lens. RESULTS Interviews with 21 participants (12 females, 9 males) aged 40-82 years were analyzed. Education ranged from high school graduate (n=4) to bachelor’s degree or above (n=11). Three categories of description were identified: 1) Participants experienced their wearable as a motivating or nagging influence to be more active, depending on how freely they were able to make autonomous choices about physical activity in their everyday lives; 2) Some participants felt a sense of accomplishment from seeing progress in their wearable data, which fuelled motivation. One participant experienced negative emotions (e.g., self-blame) if his wearable data indicated physical activity goals were not met; 3) For some participants, sharing wearable data helped to build mutual trust in their relationship with the study PT. They also expressed, however, there was potential for sharing wearable data to undermine this trust, particularly if this data was inaccurate. CONCLUSIONS To our knowledge, this is the first qualitative study that uses a relational ethics lens to explore how persons with arthritis experienced changes in their relationship with a health professional when using a wearable during research participation. Findings also provide an early glimpse into positive and negative emotional impacts of using a wearable that can be experienced by participants with knee OA when participating in an RCT to support physical activity.

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