Effects of Messages Delivered by Mobile Phone on Increasing Compliance With Shoulder Exercises Among Patients With a Frozen Shoulder

Effect of Knee Strengthening Exercises and Lifestyle Modifications Through Mobile Phone Support in People Suffering From Knee Osteoarthritis

OBJECTIVE

The study aimed to evaluate the effectiveness of mobile phone-based support in improving exercise adherence and outcomes in knee osteoarthritis.

DESIGNS

A prospective comparative cohort study was conducted with a follow-up at 3, 6, and 12 wks, involving 210 participants allocated into intervention and control groups. The intervention group received knee exercise flyers and mobile phone-based adherence support, while the control group received only standard instructions after physiotherapy. Outcome measures included Western Ontario and McMaster Universities Arthritis Index scores, numeric rating scale pain scores, and quality of life assessments at baseline and follow-ups at 3, 6, and 12 wks.

RESULTS

The intervention group exhibited significant reductions in Western Ontario and McMaster Universities Arthritis Index scores, pain scores, and improvement in quality of life over the 12-wk follow-up compared to baseline. The intervention group exhibited significantly greater improvements in the outcomes as compared to control group.

CONCLUSIONS

A combined intervention of knee exercises leaflets and SMS/phone call adherence support led to significant improvements in pain, functional outcomes, and quality of life among individuals with knee osteoarthritis. These findings underscore the potential of mobile phone-based interventions as effective adjuncts to traditional therapies for knee osteoarthritis.

Behavioral Therapy-Based Digital Interventions for Treating Osteoarthritis: Systematic Review and Meta-Analysis

BACKGROUND

Osteoarthritis (OA) is characterized by pain, functional impairments, muscle weakness, and joint stiffness. Since OA heightens reliance on heath care resources and exacerbates socioeconomic burden, remote OA rehabilitation using digital technologies is rapidly evolving.

OBJECTIVE

The aim of this study was to analyze the efficacy of behavioral therapy-based digital interventions for patients with OA.

METHODS

This study is a systematic review of randomized controlled trials (RCTs) that assessed the effects of behavioral therapy-based digital intervention tools for OA. These RCTs were searched from inception to June 2023 in the Web of Science, Embase, Cochrane Library, Ovid, and PubMed databases.

RESULTS

Ten eligible RCTs comprising 1895 patients with OA were included. Digital tools based on either cognitive behavioral therapy (CBT) or behavior change technique (BCT) were investigated. All studies demonstrated low-to-moderate effects on pain reduction in the short term (standardized mean difference [SMD] -0.20, 95% CI -0.35 to -0.05). Six studies reported improvement in physical function (SMD -0.20, 95% CI -0.41 to 0.00), and 5 confirmed increased pain self-efficacy (SMD 0.22, 95% CI 0.02-0.42). In subgroup analysis, compared with CBT, BCT-based digital interventions demonstrated their effects on pain reduction (SMD -0.25, 95% CI -0.49 to 0.00) and physical function (SMD -0.26, 95% CI -0.54 to -0.01) in the short term. In addition, physiotherapist involvement in treatment had a positive effect on pain control (SMD -0.14, 95% CI -0.27 to -0.02). Furthermore, web-based digital tools improved physical function in the short term (SMD -0.28, 95% CI -0.54 to -0.01).

CONCLUSIONS

Moderate- and low-quality evidence supported that behavioral therapy-based digital tools improved pain intensity, physical function, and self-efficacy in the short term. However, affective interactions between patients and professionals may affect the clinical outcomes.

TRIAL REGISTRATION

PROSPERO CRD42023430716; https://tinyurl.com/yc49vzyy.

The effectiveness of education for people with shoulder pain: A systematic review

OBJECTIVES

To investigate the effectiveness of education for people with shoulder pain.

DESIGN

Systematic review LITERATURE SEARCH: We searched several databases (e.g. MEDLINE, EMBASE, CENTRAL, CINAHL) and trial registries from inception to May 25, 2023.

STUDY SELECTION CRITERIA

Randomised controlled trials investigating any education for people with shoulder pain.

DATA SYNTHESIS

Pain and disability were primary outcomes. The Physiotherapy Evidence Database (PEDro) scale was used to assess methodological quality. Meta-analysis was not appropriate due to heterogeneity.

RESULTS

We included 14 trials (8 had high methodological quality). The one trial on rotator-cuff related shoulder pain did not assess pain or disability but found best practice education (vs. structure-focused education) increased reassurance and intentions to stay active. The one trial on adhesive capsulitis found daily reminders, encouragement, and education about exercise via text did not improve pain and disability compared to no education. For post-operative shoulder pain, two (of four) trials found education reduced some measure of pain, but none found an effect on disability or any other outcomes. For 'shoulder complaints' (i.e. mixed or unclear diagnosis), no trials found education was more effective than home exercise or no education for improving pain or disability.

CONLUSION

Some forms of education appear to improve reassurance, treatment intentions, perceived treatment needs, recovery expectations, and knowledge, but their effect on pain and disability is unclear. High-quality trials are needed to resolve uncertainty surrounding the benefit of education for shoulder pain, particularly rotator-cuff related shoulder pain and adhesive capsulitis.

Impact of Remote Symptom Management on Exercise Adherence After Video-Assisted Thoracic Surgery for Lung Cancer in a Tertiary Hospital in China: Protocol for a Prospective Randomized Controlled Trial

BACKGROUND

Regular pulmonary rehabilitation exercises are crucial for patients with lung cancer after surgery. However, poor adherence to outpatient exercises is difficult to address due to inadequate supervision. The integration of remote symptom management through electronic patient-reported outcomes (ePROs) offers a potential solution to improve adherence by enabling more effective monitoring and intervention.

OBJECTIVE

This study aims to evaluate the impact of ePRO-based remote symptom management on enhancing adherence to outpatient pulmonary rehabilitation exercises following video-assisted thoracic surgery for lung cancer.

METHODS

In this single-center, prospective, randomized controlled trial, 736 patients undergoing minimally invasive lung resection will be recruited. All patients will use a smartphone app for perioperative management, allowing periodic PRO measurement and recording of exercise participation. Upon discharge, patients will be randomly assigned 1:1 into either an intervention or control group. The intervention group will complete the Perioperative Symptom Assessment for Patients Undergoing Lung Surgery (PSA-Lung) scale on the day of discharge and postdischarge days 3, 7, 14, 21, and 28. Alerts will be triggered at the provider side if any of the 5 core symptoms (pain, cough, shortness of breath, sleep disturbance, and fatigue) scored ≥4, prompting remote symptom management. The control group will complete the PRO measures without triggering alerts. The primary outcome is the rehabilitation exercise adherence rate. Secondary outcomes include postdischarge pulmonary complication rate, 30-day readmission rate, trajectory of symptom severity changes, exercise participation rate, and patient satisfaction.

RESULTS

The enrollment of study participants started in December 2023 and is expected to end in March 2025. The final comprehensive analysis of the results is planned for May 2025, after all data have been collected and thoroughly reviewed.

CONCLUSIONS

This study is among the first to investigate the feasibility and effectiveness of ePRO-based remote symptom management in enhancing rehabilitation adherence after video-assisted thoracic surgery for lung cancer. If successful, this approach could significantly influence postoperative care practices and potentially be adopted in similar settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05990946; https://clinicaltrials.gov/study/NCT05990946.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/60420.

Development and Use of Mobile Messaging for Individuals With Musculoskeletal Pain Conditions: Scoping Review

BACKGROUND

Population studies show that musculoskeletal conditions are a leading contributor to the total burden of healthy life lost, second only to cancer and with a similar burden to cardiovascular disease. Prioritizing the delivery of effective treatments is necessary, and with the ubiquity of consumer smart devices, the use of digital health interventions is increasing. Messaging is popular and easy to use and has been studied for a range of health-related uses, including health promotion, encouragement of behavior change, and monitoring of disease progression. It may have a useful role to play in the management and self-management of musculoskeletal conditions.

OBJECTIVE

Previous reviews on the use of messaging for people with musculoskeletal conditions have focused on synthesizing evidence of effectiveness from randomized controlled trials. In this review, our objective was to map the musculoskeletal messaging literature more broadly to identify information that may inform the design of future messaging interventions and summarize the current evidence of efficacy, effectiveness, and economics.

METHODS

Following a prepublished protocol developed using the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted a comprehensive scoping review of the literature (2010-2022; sources: PubMed, CINAHL, Embase, and PsycINFO) related to SMS text messaging and app-based messaging for people with musculoskeletal conditions. We described our findings using tables, plots, and a narrative summary.

RESULTS

We identified a total of 8328 papers for screening, of which 50 (0.6%) were included in this review (3/50, 6% previous reviews and 47/50, 94% papers describing 40 primary studies). Rheumatic diseases accounted for the largest proportion of the included primary studies (19/40, 48%), followed by studies on multiple musculoskeletal conditions or pain sites (10/40, 25%), back pain (9/40, 23%), neck pain (1/40, 3%), and "other" (1/40, 3%). Most studies (33/40, 83%) described interventions intended to promote positive behavior change, typically by encouraging increased physical activity and exercise. The studies evaluated a range of outcomes, including pain, function, quality of life, and medication adherence. Overall, the results either favored messaging interventions or had equivocal outcomes. While the theoretical underpinnings of the interventions were generally well described, only 4% (2/47) of the papers provided comprehensive descriptions of the messaging intervention design and development process. We found no relevant economic evaluations.

CONCLUSIONS

Messaging has been used for the care and self-management of a range of musculoskeletal conditions with generally favorable outcomes reported. However, with few exceptions, design considerations are poorly described in the literature. Further work is needed to understand and disseminate information about messaging content and message delivery characteristics, such as timing and frequency specifically for people with musculoskeletal conditions. Similarly, further work is needed to understand the economic effects of messaging and practical considerations related to implementation and sustainability.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2021-048964.

The Feasibility and Efficacy of Remote App-Guided Home Exercises for Frozen Shoulder: A Pilot Study

Home exercise programs are beneficial in managing frozen shoulder (FS), yet adherence remains challenging. This pilot study introduces the remote app, Defrozen, designed for home exercises and assesses its feasibility and clinical outcomes in FS patients undergoing intra-articular and sub-acromial corticosteroid treatment. Over a four-week period, patients used the Defrozen-app, engaging in guided exercises. The feasibility of the intervention was assessed through several measurement scales, including adherence, the Technology Acceptance Model 2 (TAM2), the System Usability Scale (SUS), and User Satisfaction and Engagement (USE). Clinical outcomes included pain scale, Oxford Shoulder Score (OSS), Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) Score, and passive range of motion. The TAM2 results indicated high perceived usefulness (4.5/5), ease of use (4.8/5), and intention to use (4.4/5); the SUS score was high at 81.7/100, complemented by USE scores reflecting ease of learning (4.9/5) and satisfaction (4.3/5). Clinical outcomes showed significant pain reduction, improved shoulder function, reduced shoulder-related disability, and increased shoulder range of motion. These findings suggest the Defrozen-app as a promising solution for FS, significantly improving adherence and showing potential to enhance clinical outcomes. However, these clinical outcome results are preliminary and necessitate further validation through a large-scale randomized controlled trial to definitively confirm efficacy and assess long-term benefits.

The Role of Wearable Technology in Measuring and Supporting Patient Outcomes Following Total Joint Replacement: Review of the Literature

BACKGROUND

The incidence rate of total joint replacement (TJR) continues to increase due to the aging population and the surgery that is very successful in providing pain relief to and improving function among patients with advanced knee or hip arthritis. Improving patient outcomes and patient satisfaction after TJR remain important goals. Wearable technologies provide a novel way to capture patient function and activity data and supplement clinical measures and patient-reported outcome measures in order to better understand patient outcomes after TJR.

OBJECTIVE

We examined the current literature to evaluate the potential role of wearable devices and compare them with existing methods for monitoring and improving patient rehabilitation and outcomes following TJR.

METHODS

We performed a literature search by using the research databases supported by the University of Massachusetts Chan Medical School's Lamar Soutter Library, including PubMed and Scopus, supplemented with the Google Scholar search engine. A specific search strategy was used to identify articles discussing the use of wearable devices in measuring and affecting postoperative outcomes of patients who have undergone TJR. Selected papers were organized into a spreadsheet and categorized for our qualitative literature review to assess how wearable data correlated with clinical measures and patient-reported outcome measures.

RESULTS

A total of 9 papers were selected. The literature showed the impact of wearable devices on evaluating and improving postoperative functional outcomes. Wearable-collected data could be used to predict postoperative clinical measures, such as range of motion and Timed Up and Go times. When predicting patient-reported outcomes, specifically Hip Disability and Osteoarthritis Outcome Scores/Knee Injury and Osteoarthritis Outcome Scores and Veterans RAND 12-Item Health Survey scores, strong associations were found between changes in sensor-collected data and changes in patient-reported outcomes over time. Further, the step counts of patients who received feedback from a wearable improved over time when compared to those of patients who did not receive feedback.

CONCLUSIONS

These findings suggest that wearable technology has the potential to remotely measure and improve postoperative orthopedic patient outcomes. We anticipate that this review will facilitate further investigation into whether wearable devices are viable tools for guiding the clinical management of TJR rehabilitation.

Expanding access to rehabilitation using mobile health to address musculoskeletal pain and disability

Introduction

Musculoskeletal (MSK) disorders such as low back pain and osteoarthritis are a leading cause of disability and the leading contributor to the need for rehabilitation services globally. This need has surpassed the availability of trained clinicians; even in urban areas where services and providers are thought to be more abundant, access can be challenged by transportation options and financial costs associated with travel, care and lost time from work. However, continuing standard of fully in-person rehabilitation care for MSK-associated pain and disability may no longer be necessary. With increased ownership or access to even a basic mobile phone device, and evidence for remote management by trained clinicians, some individuals with MSK disorders may be able to continue their rehabilitation regimen predominantly from home after initial evaluation in primary care or an outpatient clinic.

Methods

This manuscript describes application of a framework we used to culturally and contextually adapt an evidence-based approach for leveraging digital health technology using a mobile phone (mHealth) to expand access to rehabilitation services for MSK-associated pain and disability. We then conducted a multi-level analysis of policies related to the adapted approach for rehabilitation service delivery to identify opportunities to support sustainability.

Results

Our study was conducted in Tanzania, a lower-middle income country with their first National Rehabilitation Strategic Plan released in 2021. Lessons learned can be applied even to countries with greater infrastructure or fewer barriers. The seven-step adaptation framework used can be applied in other regions to improve the likelihood of local mHealth adoption and implementation. Our practice and policy assessment for Tanzania can be applied in other regions and used collaboratively with government officials in support of building or implementing a national rehabilitation strategic plan.

Conclusion

The work described, lessons learned and components of the plan are generalizable globally and can improve access to rehabilitation services using mHealth to address the significant and increasing burden of disability.

Patient Trust in Physicians Matters-Understanding the Role of a Mobile Patient Education System and Patient-Physician Communication in Improving Patient Adherence Behavior: Field Study

BACKGROUND

The ultimate goal of any prescribed medical therapy is to achieve desired outcomes of patient care. However, patient nonadherence has long been a major problem detrimental to patient health and, thus, is a concern for all health care providers. Moreover, nonadherence is extremely costly for global medical systems because of unnecessary complications and expenses. Traditional patient education programs often serve as an intervention tool to increase patients' self-care awareness, disease knowledge, and motivation to change patient behaviors for better adherence. Patient trust in physicians, patient-physician relationships, and quality of communication have also been identified as critical factors influencing patient adherence. However, little is known about how mobile patient education technologies help foster patient adherence.

OBJECTIVE

This study aimed to empirically investigate whether and how a mobile patient education system (MPES) juxtaposed with patient trust can increase patient adherence to prescribed medical therapies.

METHODS

This study was conducted based on a field survey of 125 patients in multiple states in the United States who have used an innovative mobile health care system for their health care education and information seeking. Partial least squares techniques were used to analyze the collected data.

RESULTS

The results revealed that patient-physician communication and the use of an MPES significantly increase patients' trust in their physicians. Furthermore, patient trust has a prominent effect on patient attitude toward treatment adherence, which in turn influences patients' behavioral intention and actual adherence behavior. Based on the theory of planned behavior, the results also indicated that behavioral intention, response efficacy, and self-efficacy positively influenced patients' actual treatment adherence behavior, whereas descriptive norms and subjective norms do not play a role in this process.

CONCLUSIONS

Our study is one of the first that examines the relationship between patients who actively use an MPES and their trust in their physicians. This study contributes to this context by enriching the trust literature, addressing the call to identify key patient-centered technology determinants of trust, advancing the understanding of patient adherence mechanisms, adding a new explanation of the influence of education mechanisms delivered via mobile devices on patient adherence, and confirming that the theory of planned behavior holds in this patient adherence context.

Digital Rehabilitation Programs Improve Therapeutic Exercise Adherence for Patients With Musculoskeletal Conditions: A Systematic Review With Meta-Analysis

OBJECTIVE: To investigate the effects of digital rehabilitation for improving adherence to therapeutic exercise in people with musculoskeletal conditions. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Five databases were searched from their inception to March 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials evaluating digital rehabilitation programs to improve adherence to therapeutic exercise for people with musculoskeletal conditions. DATA SYNTHESIS: We calculated standardized mean differences (SMDs) or mean differences (MDs) and 95% confidence intervals (CIs). Certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Bias was assessed using the Cochrane risk of bias tool. RESULTS: Eleven trials were included in the meta-analysis (n = 1144 participants). At short-term follow-up, digital rehabilitation was no better than nondigital rehabilitation (3 trials, adherence rate of prescribed exercise test SMD 0.50, 95% CI: -0.13, 1.13; 2 trials, self-reported exercise adherence test MD 1.07, 95% CI: 0.58, 1.56; 2 trials, assessor-reported exercise adherence test SMD -0.10, 95% CI: -0.56, 0.36). At intermediate-term follow-up, digital rehabilitation improved exercise adherence compared with nondigital rehabilitation (6 trials, adherence rate of prescribed exercise test SMD 0.53, 95% CI: 0.35, 0.70; 2 trials, self-reported exercise adherence test MD 1.50, 95% CI: 0.76, 2.25; 2 trials, Exercise Adherence Rating Scale test MD 5.86, 95% CI: 0.08, 11.65). At long-term follow-up, there was no clinically important difference between digital and nondigital rehabilitation (2 trials, adherence rate of prescribed exercise test SMD 0.28, 95% CI: -0.14, 0.70; 1 trial, self-reported exercise adherence test MD 0.20, 95% CI: -0.91, 1.31). CONCLUSION: Digital rehabilitation was effective at improving therapeutic exercise adherence in musculoskeletal conditions at mid-term follow-up, but not at short- and long-term follow-up. J Orthop Sports Phys Ther 2022;52(11):726-739. Epub: 12 August 2022. doi:10.2519/jospt.2022.11384.

Effect of a Text Message-Based Support Program on Outcomes of Patients After Flexor Tendon Injury Repair

PURPOSE

Although the effectiveness of using text messages in home-based rehabilitation programs has been investigated, its ability to engage patients in home rehabilitation exercises and, as a result, improve hand outcomes, specifically in patients with flexor tendon injuries, has not been evaluated. The aim of this study was to determine whether the addition of a text message-based intervention to usual care is effective in improving hand outcomes in patients with flexor tendon injuries after repair.

METHODS

In this 2-arm parallel randomized controlled trial, 40 patients were randomly assigned to either the intervention group (usual care plus the support program) or the control group (usual care only). Intervention included an automated package of instructional text messages containing links to a secure website for instructional rehabilitation videos delivered over 12 weeks. The Quick Disabilities of the Arm, Shoulder, and Hand and visual analog scale for pain scores were assessed at 6 and 12 weeks. Physician-reported grip strength and total active motion were assessed after 12 weeks.

RESULTS

The study was completed by 90% (36 of 40) of the patients who were enrolled. There were statistically significant differences between the 2 groups with respect to Quick Disabilities of the Arm, Shoulder, and Hand and visual analog scale scores at the 6-week and 12-week assessments. In addition, there were statistically significant differences between the 2 groups with respect to total active motion and grip strength at 12 weeks. Finally, a high level of satisfaction with the intervention was reported.

CONCLUSIONS

The text message-based program was associated with improved outcomes over the first 12 weeks after flexor tendon repair.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic II.

Do digital interventions increase adherence to home exercise rehabilitation? A systematic review of randomised controlled trials

BACKGROUND

Home exercise regimes are a well-utilised rehabilitation intervention for many conditions; however, adherence to prescribed programmes remains low. Digital interventions are recommended as an adjunct to face-to-face interventions by the National Health Service in the UK and may offer increased exercise adherence, however the evidence for this is conflicting.

METHOD

A systematic review was undertaken using MEDLINE and CINAHL databases using the PRISMA guidelines. Randomised controlled trials in any clinical population evaluating the adherence to prescribed home exercise interventions with and without additional digital interventions were included. Publication quality was assessed using the Cochrane Risk of Bias tool.

RESULTS

The search strategy returned a total of 1336 articles, of which 10 randomised controlled trials containing data for 1117 participants were eligible for inclusion. 565 participants were randomised to receive the interventions, and 552 to the control. Seven of the ten trials reported a significant difference in adherence between the control and intervention groups favouring an additional digital intervention. Three trials reported equivalent findings. These three reported longer-term outcomes, suggesting an interaction between adherence and duration of intervention. There was substantial heterogeneity in outcome assessment metrics used across the trials prohibiting formal meta-analysis. This included studies were of low to moderate quality in terms of risk of bias.

CONCLUSION

The addition of a digital interventions to prescribed home exercise programmes can likely increase exercise adherence in the short term, with longer term effects less certain.

Sociodemographic Factors Associated With Decreased Compliance to Prescribed Rehabilitation After Surgical Treatment of Knee Injuries in Pediatric Patients

Background:

Rehabilitation is an important component of care in postsurgical knee patients, especially as it pertains to return to preinjury activity level. Despite the established significance of rehabilitation in improving outcomes after certain surgical procedures, there is a lack of investigation into compliance rates and factors that affect compliance in pediatric patients.

Purpose/Hypothesis:

The purpose of this study was to evaluate sociodemographic factors associated with noncompliance in pediatric patients after knee surgery to characterize health disparities in this population. Our hypothesis was that certain sociodemographic factors would be associated with decreased compliance.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A retrospective review of medical records was used to gather data on compliance rate, demographics, and socioeconomic factors for pediatric patients undergoing rehabilitation after knee surgery. Compliance rate was determined by counting the total scheduled appointments, cancellations, and no-shows (defined as visits for which patients did not show up and did not provide notification of cancellation). Various types of knee injuries were included in this study. Data were evaluated using bivariate analyses in addition to hierarchical linear and binary logistic regression to assess for associations between sociodemographic factors and compliance rate.

Results:

Our total sample size was 186 patients. When compared with patients from non–single-parent households, patients from single-parent households were found to have a lower rate of physical therapy compliance (72.2% vs 80.1%; P < .001), were less likely to reach the 85% compliance threshold (9.1% vs 42.4%; P < .001), and had an increased amount of cancellations and no-shows (16.7 vs 11.7 visits; P = .02). Although a small sample size, Hispanic/Latino patients were shown to have a lower achievement of the 85% compliance threshold compared with non-Hispanic/Latino patients (0% vs 38.2%; P = .04). Increased distance from the rehabilitation clinic was associated with lower achievement of the 85% compliance threshold (P = .033).

Conclusion:

Overall, there were several significant demographic and socioeconomic variables associated with rehabilitation compliance, specifically single-parent status, distance to rehabilitation clinic, and ethnicity. These results suggest potential predictors of decreased compliance that warrant prospective investigation.

An overview of effective and potential new conservative interventions in patients with frozen shoulder

Frozen shoulder (FS) is a pathology that is difficult to understand and difficult to manage. Over the last ten years, contradictory and new evidence is provided regarding the recovery and its natural course. This narrative review provides new information about the diagnosis and conservative treatment of patients with FS and ongoing research hypotheses that might provide new insights in the pathology and treatment options. FS has a characteristic course. People with Diabetes Mellitus and thyroid disorders have a higher risk of developing a FS. The diagnosis FS is based on pattern recognition and physical examination. Additionally, 'rule-in' and 'rule-out' criteria can be used to increase the likelihood of the frozen shoulder diagnosis. Recommended and most common physical therapy interventions are mobilization techniques and exercises, in which tissue irritability can guide its intensity. In addition, physical therapy is often complementary with patient education and pharmacotherapy. The latest evidence-based practice related to FS is proprioceptive neuromuscular facilitation and mirror therapy. In addition, interventions like pain neuroscience education, high-intensity interval training and lifestyle changes are still hypothetical. Finally, better insight in the involvement of biochemical processes, function of myofibroblasts and matrix metalloproteinases can provide better understanding in the pathophysiology and will be addressed in current review.

Development and use of mobile messaging for individuals with musculoskeletal pain conditions: a scoping review protocol

INTRODUCTION

Previous reviews of mobile messaging for individuals with musculoskeletal pain have shown positive effects on pain and disability. However, the configuration of digital content, method of presentation and interaction, dose and frequency needed for optimal results remain unclear. Patient preferences concerning such systems are also unclear. Addressing these knowledge gaps, incorporating evidence from both experimental and observational studies, may be useful to understand the extent of the relevant literature, and to influence the design and outcomes of future messaging systems. We aim to map information that could be influential in the design of future mobile messaging systems for individuals with musculoskeletal pain conditions, and to summarise the findings of efficacy, effectiveness, and economics derived from both experimental and observational studies.

METHODS AND ANALYSIS

We will include studies describing the development and/or use of mobile messaging to support adults (≥18 years) with acute or chronic musculoskeletal pain. We will exclude digital health studies that lack a mobile messaging component, or those targeted at other health conditions unrelated to the bones, muscles and connective tissues, or involving surgical or patients with cancer, or studies involving solely healthy individuals. Our sources of information will be online databases and reference lists of relevant papers. We will include papers published in English in the last 10 years. Two pairs of independent reviewers will screen, select and extract the data, with any disagreements mediated by a third reviewer. We will report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. We will synthesise the findings in a tabular format and provide a descriptive summary.

ETHICS AND DISSEMINATION

Formal ethical approval is not required. We will disseminate the findings through publication in a peer-reviewed journal, relevant conferences, and relevant consumer forums.

TRIAL REGISTRATION

Open Science Framework https://osf.io/8mzya; DOI: 10.17605/OSF.IO/8MZYA.

TEXT4myBACK - The Development Process of a Self-Management Intervention Delivered Via Text Message for Low Back Pain

OBJECTIVE

To develop a bank of text messages for a lifestyle-based self-management intervention for people with low back pain (LBP).

DESIGN

Iterative development process.

SETTING

Community and primary care.

PARTICIPANTS

Fifteen researchers, clinicians, and consumer representatives participated in the concept and initial content development phase. Twelve experts (researchers and clinicians) and 12 consumers participated in the experts and consumers review phase. Full study sample of participants was N=39.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

We first conducted two 2-hour workshops to identify important domains for people with LBP, sources of content, appropriate volume, and timing of the messages. The messages were then drafted by a team of writers. Second, we invited expert researchers and clinicians to review and score the messages using a 5-item psychometric scale according to (1) the appropriateness of the content and (2) the likelihood of clinical effectiveness and to provide written feedback. Messages scoring ≤8 out of 10 points would be modified accordingly. Consumers were invited to review the messages and score them using a 5-item psychometric scale according to the utility of the content, the understanding of the content, and language acceptability and to provide feedback. Messages scoring ≤12 out of 15 points would be improved.

RESULTS

Exercise, education, mood, sleep, use of care, and medication domains were identified and 82 domain-specific evidence-based messages were written. Messages received a mean score of 8.3 out of 10 points by experts. Twenty-nine messages were modified accordingly. The mean score of the messages based on consumers feedback was of 12.5 out of 15 points. Thirty-six messages were improved.

CONCLUSIONS

We developed a bank of text messages for an evidence-based self-management intervention using a theory-based, iterative, codesign process with researchers, consumers, and clinicians. This article provides scientific support for future development of text message interventions within the pain field.

Do behaviour change techniques increase adherence to home exercises in those with upper extremity musculoskeletal disorders? A systematic review

OBJECTIVES

To investigate whether behaviour change techniques (BCTs) can influence adherence to home exercise in people with upper extremity musculoskeletal disorders (UEMD).

DESIGN

A systematic review of randomised control trials, non-randomised control trials, case-control studies and cohort studies. Results were presented narratively. Participants were those with UEMD. The intervention was any home exercise programme, alongside a BCT designed to increase exercise adherence. Any duration of intervention was accepted. The main outcome sought was adherence to home exercise. A systematic search was performed on four online databases. Grey literature was searched.

RESULTS

The search resulted in 28,755 titles. 77 full-text articles were assessed for eligibility. Six studies were included in the qualitative synthesis. Four studies had Some Concern of Bias, whilst two studies had High Risk of Bias. Three studies found statistically significant differences in exercise adherence (p < 0.05) between the Intervention group and Control group. The BCT 'Social Support (unspecified)' was used within all studies that found significant differences in adherence levels at outcome. However, multiple BCTs were received by the Intervention groups within all studies, making it impossible to identify the effects of any single BCT upon adherence levels.

CONCLUSION

Social support may be relevant in patients' adherence levels to HEPs. However, confidence in the results is uncertain given the small number of studies found, and their High RoB. Future studies should validate their measurement and definition of adherence, as well as the number of BCTs they use, to provide reproducible evidence.

Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial

Background

Exercise is a core recommended treatment for knee osteoarthritis (OA), yet adherence declines, particularly following cessation of clinician supervision.

Objective

This study aims to evaluate whether a 24-week SMS intervention improves adherence to unsupervised home exercise in people with knee OA and obesity compared with no SMS.

Methods

A two-group superiority randomized controlled trial was performed in a community setting. Participants were people aged 50 years with knee OA and BMI ≥30 kg/m² who had undertaken a 12-week physiotherapist-supervised exercise program as part of a preceding clinical trial. Both groups were asked to continue their home exercise program unsupervised three times per week for 24 weeks and were randomly allocated to a behavior change theory–informed, automated, semi-interactive SMS intervention addressing exercise barriers and facilitators or to control (no SMS). Primary outcomes were self-reported home exercise adherence at 24 weeks measured by the Exercise Adherence Rating Scale (EARS) Section B (0-24, higher number indicating greater adherence) and the number of days exercised in the past week (0-3). Secondary outcomes included self-rated adherence (numeric rating scale), knee pain, physical function, quality of life, global change, physical activity, self-efficacy, pain catastrophizing, and kinesiophobia.

Results

A total of 110 participants (56 SMS group and 54 no SMS) were enrolled and 99 (90.0%) completed both primary outcomes (48/56, 86% SMS group and 51/54, 94% no SMS). At 24 weeks, the SMS group reported higher EARS scores (mean 16.5, SD 6.5 vs mean 13.3, SD 7.0; mean difference 3.1, 95% CI 0.8-5.5; P=.01) and more days exercised in the past week (mean 1.8, SD 1.2 vs mean 1.3, SD 1.2; mean difference 0.6, 95% CI 0.2-1.0; P=.01) than the control group. There was no evidence of between-group differences in secondary outcomes.

Conclusions

An SMS program increased self-reported adherence to unsupervised home exercise in people with knee OA and obesity, although this did not translate into improved clinical outcomes.

Trial Registration

Australian New Zealand Clinical Trials Registry 12617001243303; https://tinyurl.com/y2ud7on5

International Registered Report Identifier (IRRID)

RR2-10.1186/s12891-019-2801-z

Computer- and Telephone-Delivered Interventions on Patient Outcomes and Resource Utilization in Patients With Orthopaedic Conditions: A Systematic Review and Narrative Synthesis

BACKGROUND

As the number of patients with orthopaedic conditions has risen continuously, hospital-based healthcare resources have become limited. Delivery of additional services is needed to adapt to this trend.

PURPOSE

The purpose of this study was to describe the current literature of computer- and telephone-delivered interventions on patient outcomes and resource utilization in patients with orthopaedic conditions.

METHODS

The systematic review was conducted in January 2019. The standardized checklist for randomized controlled trials was used to assess the quality of the relevant studies. A meta-analysis was not possible due to heterogeneity in the included studies, and a narrative synthesis was conducted to draw informative conclusions relevant to current research, policy, and practice.

RESULTS

A total of 1,173 articles were retrieved. Six randomized controlled trials met the inclusion criteria, providing evidence from 434 individuals across four countries. Two studies reported findings of computer-delivered interventions and four reported findings of telephone-delivered interventions. The patients who received both computer- and telephone-delivered interventions showed improvements in patient outcomes that were similar or better to those of patients receiving conventional care. This was without any increase in adverse events or costs.

CONCLUSION

Computer- and telephone-delivered interventions are promising and safe alternatives to conventional care. This review, however, identifies a gap in evidence of high-quality studies exploring the effects of computer- and telephone-delivered interventions on patient outcomes and resource utilization. In future, these interventions should be evaluated from the perspective of intervention content, self-management, and patient empowerment. In addition, they should consider the whole care journey and the development of the newest technological innovations. Additionally, future surgery studies should take into account the personalized needs of special, high-risk patient groups and focus on patient-centric care to reduce postdischarge health problems and resource utilization in this population.

Digital interventions for promoting exercise adherence in chronic musculoskeletal pain: a systematic review and meta-analysis

BACKGROUND

Chronic musculoskeletal disorders are the second largest contributor to disability globally. Exercise is typically recommended by physiotherapists to manage symptoms. However, adherence to the prescribed exercise programme is often poor. Adjunctive digital interventions offer potential to enhance exercise adherence.

OBJECTIVES

To review evidence on the effectiveness of digital interventions for improving exercise adherence in people with chronic musculoskeletal conditions. The study is reported in line with PRISMA guidance and was registered with PROSPERO (CRD42019124502).

DATA SOURCES

MEDLINE, Embase and PsycInfo were searched using a comprehensive search strategy. The reference lists of all included papers and relevant systematic reviews identified during the search were scanned for relevant articles.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two researchers independently checked articles for inclusion and extracted data.

RESULTS

The search returned a total of 4257 results of which five trials were included in the review and two studies were included in a random effects meta-analysis. There was no statistically significant difference in exercise adherence (SMD: 0.23; 95% CI: -0.10, 0.57). Studies that were not suitable for inclusion in the meta-analysis reported similar results. Heterogeneity of effects was high and study quality ranged from low to moderate. All of the meta-analysed data related to osteoarthritis of the hip and/or knee.

CONCLUSION

We found no evidence that digital interventions enhance adherence to therapeutic exercise in patients with chronic musculoskeletal disorders. However, further, high quality research is required to draw definitive conclusions on their effectiveness and to identify key components that are associated with effectiveness.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019124502.

Wearable Motion Sensor Device to Facilitate Rehabilitation in Patients With Shoulder Adhesive Capsulitis: Pilot Study to Assess Feasibility

BACKGROUND

Adhesive capsulitis (AC) of the shoulder is a common disorder that painfully reduces the shoulder range of motion (ROM) among middle-aged individuals. Although physical therapy with home-based exercises is widely advised to restore ROM in the treatment of AC, clinical results vary owing to inconsistent patient compliance.

OBJECTIVE

In this study, we aimed to verify the feasibility of a treatment model that involves applying a wearable motion sensor device to assist patients conduct home-based exercises to improve training compliance and the accuracy of exercises, with the ultimate goal of improving the functional recovery of patients with AC.

METHODS

The motion sensor device was comprised of inertial measurement unit-based sensors and mobile apps for patients and physicians, offering shoulder mobility tracing, home-based exercise support, and progress monitoring. The interrater reliability of shoulder mobility measurement using the motion sensor device on 10 healthy participants and 15 patients with AC was obtained using an intraclass correlation coefficient analysis and compared with the assessments performed by two highly experienced physicians. A pilot prospective control trial was then carried out to allocate the 15 patients with AC to two groups: home-based exercise group and motion sensor-assisted rehabilitation group. Changes in active and passive shoulder ROM, pain and functional scores, and exercise completion rates were compared between the groups during a treatment period of 3 months.

RESULTS

Shoulder ROM, as measured using the motion sensor device, exhibited good to excellent reliability based on the comparison with the measurements of two physicians (intraclass correlation coefficient range, 0.771 to 0.979). Compared with patients with AC in the home-based exercise group, those in the motion sensor-assisted rehabilitation group exhibited better shoulder mobility and functional recovery and a higher exercise completion rate during and after 3 months of rehabilitation.

CONCLUSIONS

Motion sensor device-assisted home-based rehabilitation for the treatment of AC is a useful treatment model for telerehabilitation that enhances the compliance of patients through training, thus improving functional recovery. This helps overcome important obstacles in physiotherapy at home by providing comprehensible and easily accessible exercise instructions, enhancing compliance, ensuring the correctness of exercise, and monitoring the progress of patients.

[Mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder]

OBJECTIVE

To evaluate mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder.

METHODS

Between January 2013 and December 2017, 33 patients of primary frozen shoulder were treated with manipulation under anesthesia combined with 360° arthroscopic capsular release and subacromial debridement. There were 10 males and 23 females, aged from 37 to 65 years, with a mean age of 50.9 years. The affected shoulder on left side in 17 cases and on right side in 16 cases. The disease duration was 6-13 months (mean, 8.4 months). Before and after operation, the visual analogue scale (VAS) score was used to evaluate the shoulder joint pain, Constant score was used to evaluate the shoulder joint function, and the flexion, abduction, and external rotation of shoulder joint were recorded. The internal rotation function was assessed based on the vertebral plane that the thumb could reach after internal rotation of the affected shoulder joint (the rank of internal rotation vertebra). X-ray film was taken to measure the distance of the subacromial space.

RESULTS

There was no fracture or labrum tear in all patients, and all the incisions healed by first intention. All the 33 patients were followed up 20-31 months, with an average of 24.1 months. During the follow-up, there was no complication such as wound infection and nerve injury. At last follow-up, the range of motion of shoulder flexion, abduction, and external rotation, the rank of internal rotation vertebra, the VAS score, Constant score, and subacromial space were significantly improved when compared with preoperative ones ( P<0.05).

CONCLUSION

Manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement can achieve a good mid-term effectiveness without complication for primary frozen shoulder.

Usage Evaluation of a Mobile App to Help Understand the Rehabilitation Process of Shoulder Surgery

Objective  The present paper aims to evaluate the quality of a mobile phone application (app) designed to guide patients after shoulder surgical procedures. Methods  A free and easily accessible app was developed to help patients at home. Patients were monitored for app use and adaptation before physical therapy started. At the end of 6 weeks, a qualitative questionnaire was employed to determine the usability of the app. Results  In total, 97% of the respondents reported that the app was easy to download, the exercises were readily understood, and they would recommend the app. Ninety-three percent of the participants agreed that the app made them feel a greater degree of participation in the treatment of their illness, while 90% considered the app self-explanatory. Conclusion  The virtual platform helps the patients to understand the treatment, aiding the medical prescription of postoperative exercises to be performed at home.

The Utilization of Physician Cell Phone Numbers by Patients in an Orthopaedic Surgery Practice

Introduction

Orthopaedic surgeons choose to manage communication with their patients outside of official visits and interactions in a variety of ways, with some choosing to provide their personal cell phone number in order to provide patients with direct accessibility. The objective of this prospective study is to explore to what extent patients utilize the cell phone numbers of orthopaedic surgeons in the immediate period after it is provided to them.

Methods

Seven fellowship-trained orthopaedic surgeons from five different subspecialties in a single private, multi-site group each provided his/her personal cell phone number to 30 consecutive patients. The surgeon’s phone number was written down on a business card, and the surgeons themselves provided the card to the patient. Phone calls and voice mail messages received in the 30 days following the patient receiving the phone number were recorded, and the reasons for these calls were categorized as being “appropriate” (e.g. acute postoperative issues, unclear instructions) or “inappropriate” (e.g. administrative issues, medication refills, advanced imaging-related inquires).

Results

Two-hundred seven patients with an average age of 51.5 years were provided cell phone numbers. During the 30 days following administration of cell phone numbers to each patient, 21 patients (10.1%) made calls to their surgeons, for an average of 0.15 calls per patient. Six patients (2.9%) called their surgeons more than once. Seventeen calls (54.8%) were deemed appropriate, while 14 calls (45.2%) were inappropriate. Logistic regression analysis did not reveal patient age, sex, type of visit, or surgeon subspecialty to be independently associated with calling.

Conclusion

Our study has demonstrated a low rate of patient utilization of surgeon cell phone number when provided to them. If surgeons choose to provide their cell phone number to patients, we recommend specifying appropriate reasons to call in order to maximize the effectiveness of this communication method.

Effects of mobile text messaging on breast cancer and breast self-examination (BSE) knowledge, BSE self-efficacy, and BSE frequency: a randomised controlled trial

AIMS

Educating women regarding breast cancer and increasing breast self-examination uptake continues to remain a major challenge despite the intensive campaigns. An innovative, cost-effective and easily customised intervention is needed especially in under-resourced and hard to reach communities. This paper is a report examining the effects of mobile text messaging on women's knowledge of breast cancer and BSE, BSE self-efficacy and frequency of BSE.

METHODS

A randomised controlled trial design was used. The study sample consisted of 128 women of reproductive age (WRA) (64 in the experimental group and 64 in the control group) from two communities in the Philippines during the months of August to October 2018. Three to five short messages were sent to the participants in the experimental group daily for one month while the control group did not receive the messages.

RESULTS

Women who received mobile text messages had higher knowledge of breast cancer (F = 21.756, p = 0.001) and breast self-examination (F = 6.776, p = 0.010) than the control group. However, no significant improvements were seen in the BSE self-efficacy (F = 1.446, p = 0.232) and frequency of BSE (F = 3.374, p = 0.69).

CONCLUSION

Mobile text messaging significantly improved the knowledge on breast cancer and breast self-examination among women; however, it did not affect their breast self-examination self-efficacy and frequency. Mobile text messaging can be a viable tool that can be used by healthcare workers in order to educate women regarding breast cancer and breast self-examination.

The digital patient journey solution for patients undergoing elective hip and knee arthroplasty: Protocol for a pragmatic randomized controlled trial

AIM

To describe a randomized controlled trial (RCT) protocol that will evaluate the effectiveness of a digital patient journey (DPJ) solution in improving the outcomes of patients undergoing total hip and knee arthroplasty.

BACKGROUND

There is an urgent need for novel technologies to ensure sustainability, improve patient experience, and empower patients in their own care by providing information, support, and control.

DESIGN

A pragmatic RCT with two parallel arms.

METHODS

The participants randomized assigned to the intervention arm (N = 33) will receive access to the DPJ solution. The participants in the control arm (N = 33) will receive conventional care, which is provided face to face by using paper-based methods. The group allocations will be blinded from the study nurse during the recruitment and baseline measures, as well as from the outcome assessors. Patients with total hip arthroplasty will be followed up for 8-12 weeks, whereas patients with total knee arthroplasty will be followed up for 6-8 weeks. The primary outcome is health-related quality of life, measured by the EuroQol EQ-5D-5L scale. Secondary outcomes include functional recovery, pain, patient experience, and self-efficacy. The first results are expected to be submitted for publication in 2020.

IMPACT

This study will provide information on the health effects and cost benefits of using the DPJ solution to support a patient's preparation for surgery and postdischarge surgical care. If the DPJ solution is found to be effective, its implementation into clinical practice could lead to further improvements in patient outcomes. If the DPJ solution is found to be cost effective for the hospital, it could be used to improve hospital resource efficiency.

A Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel

Background

Knee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design.

Objective

The study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework.

Methods

The intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program.

Results

The target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ≥3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported &lt;3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence.

Conclusions

This study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise.

A pilot study of ultrasound-guided acupotomy for the treatment of frozen shoulder

This study retrospectively analyzed the feasible effectiveness of ultrasound-guided acupotomy (USGAP) for the treatment of frozen shoulder (FS). A total of 36 patients with FS were analyzed in this retrospective study. All 36 patients received extracorporeal shock-wave therapy (ESWT). In addition, 18 of them also underwent USGAP intervention and were assigned to a treatment group, while the other 18 patients did not receive such intervention and were assigned to a control group. The primary efficacy endpoint was pain intensity, as measured by the Numeric Rating Scale (NRS). The secondary efficacy endpoint was assessed by the score of shoulder pain and disability index (SPADI). Furthermore, the adverse events were also documented during the treatment period. All efficacy endpoints were measured after the treatment. After treatment, patients who received USGAP exerted better efficacy endpoints in pain relief, as measured by NRS scale (P < .01), and shoulder disorders, as evaluated by SPADI (P < .01), than subjects who did not receive USGAP. Additionally, no adverse events occurred in either group. The results of this study indicated that USGAP may be used for the treatment of FS effectively. More studies are still needed to warrant the present results.

Mobile Health Interventions for Physical Activity, Sedentary Behavior, and Sleep in Adults Aged 50 Years and Older: A Systematic Literature Review

We provide a systematic review of interventions utilizing mobile technology to alter physical activity, sedentary behavior, and sleep among adults aged 50 years and older. A systematic search identified 52 relevant articles (randomized control trial [RCT], quasi-experimental, pre/post single-group design). Of 50 trials assessing physical activity, 17 out of 29 RCTs and 13 out of 21 trials assessed for pre/post changes only supported the effectiveness of mobile interventions to improve physical activity, and 9 studies (five out of 10 RCTs and all four pre/post studies) out of 14 reduced sedentary behavior. Only two of five interventions improved sleep (one out of two RCTs and one out of three pre/post studies). Text messaging was the most frequently used intervention (60% of all studies) but was usually used in combination with other components (79% of hybrid interventions included SMS, plus either web or app components). Although more high-quality RCTs are needed, there is evidence supporting the effectiveness of mHealth approaches in those aged 50 years and older.

Effectiveness of internet-delivered education and home exercise supported by behaviour change SMS on pain and function for people with knee osteoarthritis: a randomised controlled trial protocol

BACKGROUND

Knee osteoarthritis (OA) is a prevalent and chronic condition with no known cure. Exercise is advocated in all clinical guidelines due to its positive effects on symptoms. Despite this, exercise participation is often poor in people with knee OA with access to exercise treatments a known barrier. Internet-delivered exercise interventions have the potential to improve access to evidence-based exercise treatments and can benefit OA outcomes, although non-usage and low adherence potentially limit their effectiveness. Short message services (SMS) show promise in facilitating exercise adherence and may be one solution to improve adherence to internet-delivered exercise interventions. The combination of internet-delivered exercise and SMS adherence support has not been specifically evaluated in people with knee OA.

METHODS

This protocol reports a two-arm parallel-design, assessor- and participant-blinded randomised controlled trial. This trial is recruiting 206 people aged 45 years and older, with a clinical diagnosis of knee OA from the Australian-wide community. Eligible and consenting participants are enrolled and randomised to receive access to either i) 'My Knee Education', an education control website containing OA and exercise information only or ii) a combined intervention that includes a website, 'My Knee Exercise', containing the same educational information as the control, guidance to increase general physical activity, and the prescription of a 24-week self-directed home-based lower-limb strengthening program in addition to a 24-week behaviour change SMS exercise adherence program. Outcome measures are being collected at baseline and 24-weeks. Primary outcomes are self-reported knee pain and physical function. Secondary outcomes include another self-reported measure of knee pain, function in sport and recreation, quality-of-life, physical activity, self-efficacy, participant satisfaction and perceived global change.

DISCUSSION

This randomised controlled trial will provide evidence about the effectiveness of a combined intervention of internet-delivered OA and exercise education, physical activity guidance and prescription of a 24-week lower-limb strengthening exercise program supported by a behaviour change SMS program compared to internet delivered OA and exercise education alone.

TRIAL REGISTRATION

ACTRN12618001167257/13th July 2018.

A randomized controlled trial of ultrasound-guided pulsed radiofrequency for patients with frozen shoulder

BACKGROUND

This study assessed the effectiveness and safety of ultrasound-guided pulsed radiofrequency (UGPRF) for patients with frozen shoulder (FS).

METHODS

This study was designed as a randomized, double-blind, sham control trial. A total of 136 patients with FS were recruited and then were equally randomly allocated into a treatment group (n = 68) and a sham group (n = 68). The patients in the treatment group received UGPRF, while the subjects in the sham group underwent sham UGPRF. Patients in both groups were treated for a total of 12 weeks. The primary outcome was the pain intensity, measured by the visual analog scale (VAS). The secondary outcomes consisted of shoulder disorder, measured by the score of shoulder pain and disability index (SPADI); quality of life, assessed by the Short Form-36 questionnaire (SF-36); and any adverse events (AEs) during the treatment period. All outcomes were measured at baseline, at the end of 6-week, and 12-week treatment.

RESULTS

At the end of 6 weeks, and 12 weeks, UGPRF showed more promising outcome results in pain relief, as measured by VAS (P <.01), improvement of shoulder disorder, as assessed by SPADI score (pain, P <.01; disability, P <.01; total, P <.01), and enhancement of quality of life, as measured by the SF-36 scale (PCS, P <.01; MCS, P <.01), compared with sham UGPRF in this study.

CONCLUSION

The findings of this study showed that UGPRF may benefit for patients with FS after 12 weeks treatment.

Providing exercise instructions using multimedia may improve adherence but not patient outcomes: a systematic review and meta-analysis

OBJECTIVE:

To determine whether patients have better outcomes when exercise instructions are provided using multimedia approaches compared with verbal or written instructions.

DATA SOURCES:

Electronic databases (MEDLINE, EMBASE, CINAHL, and PsychInfo) searched up to October 2018.

STUDY SELECTION:

Randomized controlled trials exploring exercise-based interventions for health conditions, and comparing instructions provided using multimedia approaches with conventional verbal or written instructions.

RESULTS:

Fourteen trials from seven countries were included, with a total of 2156 participants. Diagnoses included orthopaedic, neurological, pulmonary, cardiac, and women's health conditions. A meta-analysis of three trials (140 participants) provided very low-quality evidence that multimedia exercise instructions may be more effective than written instructions in improving exercise adherence (standardized mean difference (SMD) 0.60, 95% confidence interval (CI) -0.06 to 1.25). Two of nine trials that could not be included in the meta-analysis for adherence due to heterogeneity reported that multimedia exercise instructions were more effective than written instructions in improving exercise adherence. Four other meta-analyses (three trials each) found low- to high-quality evidence that provision of exercise instructions using multimedia is no more beneficial than paper-based instructions for patient-related outcomes of pain intensity (SMD 0.09, 95% CI -0.47 to 0.28); uptake of physical activity (SMD 0.07, 95% CI -0.08 to 0.23); or physical (SMD 0.21, -0.21 to 0.64) or emotional (SMD 0.16, 95% CI -0.04 to 0.36) domains of health-related quality of life.

CONCLUSION:

Multimedia approaches to exercise instruction may result in increased adherence compared with instructions provided in written or verbal format, but there is insufficient evidence to determine whether this results in improved patient outcomes.

Effect of smartphone application-supported self-rehabilitation for frozen shoulder: a prospective randomized control study

Objectives:

To evaluate the clinical efficacy of smartphone-assisted self-rehabilitation in patients with frozen shoulder.

Design:

A single-center, randomized controlled trial.

Setting:

Orthopedic department of a university hospital.

Subjects:

A total of 84 patients with frozen shoulder were recruited.

Intervention:

Patients were randomly divided into two groups: a smartphone-assisted exercise group ( n = 42) and a conventional self-exercise group ( n = 42). The study was performed over three months, during which each group performed home-based rehabilitation.

Main measures:

Visual analogue scale for pain and passive shoulder range of motion were assessed at baseline and after 4, 8, and 12 weeks of treatment. Technology Acceptance Model–2 and Usefulness, Satisfaction, and Ease of Use scores were evaluated in the smartphone group.

Results:

Initial visual analogue scale for pain of the smartphone group was 6.0 ± 2.2 and ended up with 1.8 ± 2.5 after 12 weeks, whereas the self-exercise group showed 5.8 ± 2.3 for the baseline visual analogue scale for pain and 2.2 ± 1.7 at the end. Significant time-dependent improvements in all measured values were observed in both groups (all Ps < 0.001), but no significant intergroup difference was observed after 4, 8, or 12 weeks of treatment. In the smartphone group, Technology Acceptance Model–2 and Usefulness, Satisfaction, and Ease of Use scores showed high patient satisfaction with smartphone-assisted exercise.

Conclusion:

There was no difference between home-based exercise using a smartphone application and a conventional self-exercise program for the treatment of frozen shoulder in terms of visual analogue scale for pain and range of motions.

Using text message reminders in health care services: A narrative literature review

INTRODUCTION

Despite the extensive use of mHealth behavior change interventions, questions remain about the use of technology-based reminders in delivering health care services. Text messaging, or short message service (SMS), is one reminder method that has been extensively researched. Most SMS-reminder research is distributed across a range of health care outcomes. The aim of this article is to systematically review the aggregate impact of these reminders on overall health care outcomes.

METHODS

A systematic literature review was conducted and yielded 2316 articles. Studies were included if they used SMS reminders to support patient health care outcomes. Study methodology was aligned with the PRISMA guidelines for systematic reviews.

RESULTS

Following screening, 162 articles met inclusion criteria. Of these studies, 93 investigated medical compliance reminders and 56 investigated appointment reminders. The review found that nearly all the SMS-reminder studies helped improve patient medical compliance and appointment reminders. Additionally, researchers reported numerous benefits from using SMS reminders, including ease of use, relative inexpensiveness, and rapid and automated message delivery. Minimal risks were reported and most participants found the reminders to be acceptable.

DISCUSSION

Text messages appear to be an effective reminder mechanism to promote improved patient appointment and medical compliance. Reminders should continue to be evaluated and improved to determine the most effective timing and frequency of messages for improving outcomes.