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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fan I, Govil D, King MG, Scholes MJ, Semciw AI. How effective are exercises delivered digitally (requiring internet), amongst patients with hip or knee osteoarthritis? A systematic review and meta-analysis. Osteoarthritis Cartilage 2024; 32:254-265. [PMID: 38030118 DOI: 10.1016/j.joca.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis is to describe the effect of digitally delivered exercise on pain, physical function and quality of life (QoL) for people with knee or hip osteoarthritis (OA). METHODS Articles were eligible for inclusion if they were of a randomized control trial that evaluated the prescription of digitally delivered exercise (requiring the internet) in people with symptomatic primary hip and/or knee OA. Risk of bias was assessed using the Physiotherapy Evidence Database scale, and levels of evidence were assessed according to Grading of Recommendations Assessment, Development and Evaluation. RESULTS Digitally delivered exercise was delivered via synchronous and asynchronous methods (or a combination of both). Digitally delivered exercise was superior to education only for pain and physical function, with high-quality evidence for quality-of-life outcomes in the long-term (standardized mean difference -0.35, 95% confidence interval -0.59 to -0.12, P = 0.003) in people with knee OA. Furthermore, there was very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery in the short and long-term for people with hip or knee OA and comparable in the medium-term for people with knee OA only. DISCUSSION The review demonstrated very low to low-quality evidence that digitally delivered exercise was comparable to face-to-face delivery for pain, function and QoL. In the absence of higher-level evidence, we would provisionally recommend that healthcare providers offer the choice of face-to-face or digitally delivered exercise intervention for people with hip or knee OA. Further work is required to understand these programs' reach, access, uptake and implementation across diverse population groups.
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Affiliation(s)
- Iryoung Fan
- Allied Health, Northern Health, Epping, Victoria, Australia; Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Dhruv Govil
- Bass Coast Health, Wonthaggi, Victoria, Australia.
| | - Matthew G King
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Mark J Scholes
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
| | - Adam I Semciw
- Allied Health, Northern Health, Epping, Victoria, Australia; Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
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Xiang W, Wang JY, Ji BJ, Li LJ, Xiang H. Effectiveness of Different Telerehabilitation Strategies on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e40735. [PMID: 37982411 PMCID: PMC10728785 DOI: 10.2196/40735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 06/30/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a chronic, degenerative bone and joint disease. It can lead to major pressure to the quality of life and mental health of patients, and also brings a serious economic burden to society. However, it is difficult for patients with knee OA to access rehabilitation when discharging from the hospital. Internet-based rehabilitation is one of the promising telemedicine strategies for the improvement of knee OA, but the effect of different telerehabilitation strategies on knee OA is not clear. OBJECTIVE The aim of this systematic review and meta-analysis was to identify telerehabilitation strategies attributing to the improvement of pain and physical function outcomes in patients with knee OA. METHODS We reviewed and analyzed telerehabilitation strategies from randomized controlled trials (RCTs) comparing telerehabilitation with conventional treatment or usual care. For each strategy, we examined whether RCTs that applied the telerehabilitation strategy resulted in a significant improvement in pain or physical function compared with conventional treatment or usual care. RESULTS We included 6 RCTs (n=734) incorporating 8 different telerehabilitation strategies. The duration of the interventions ranged from 1 to 48 weeks, and sample sizes ranged from 20 to 350 patients. The results showed that RCTs that provided telerehabilitation were found to be more effective than conventional treatments for improving pain (P=.003; standardized mean difference [SMD] -0.21, 95% CI -0.35 to -0.07), but not physical function (P=.24; SMD -0.09, 95% CI -0.25 to 0.06). Furthermore, this systematic review and meta-analysis indicated that there is no significant correlation between different telerehabilitation strategies and the pain and physical function of patients with knee OA. CONCLUSIONS This systematic review and meta-analysis showed that telerehabilitation programs could relieve pain but not improve physical function for patients with knee OA. These results indicated that telerehabilitation is beneficial for the implementation of home rehabilitation exercises for patients with knee OA, thereby reducing the economic burden of health. However, there were limitations in terms of the number of search results and the number of studies that were eligible for this review and meta-analysis. Therefore, the results need to be interpreted with caution, and more high-quality studies with large samples are needed to focus on the long-term outcomes of telerehabilitation for patients with knee OA to address this limitation.
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Affiliation(s)
- Wu Xiang
- Department of Rehabilitation, Beibei Traditional Chinese Medical Hospital, Chongqing, China
- Department of Rehabilitation Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Jun-Yu Wang
- Department of Rehabilitation Medicine, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Bing-Jin Ji
- Department of Rehabilitation, Beibei Traditional Chinese Medical Hospital, Chongqing, China
| | - Li-Jun Li
- Department of Rehabilitation, Beibei Traditional Chinese Medical Hospital, Chongqing, China
| | - Han Xiang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
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Bowden JL, Hunter DJ, Mills K, Allen K, Bennell K, Briggs AM, Dziedzic K, Hinman RS, Kim JS, Martinez N, Quicke JG, Tan Yijia B, van der Esch M, Verges J, Eyles J. The OARSI Joint Effort Initiative: Priorities for osteoarthritis management program implementation and research 2024-2028. Osteoarthr Cartil Open 2023; 5:100408. [PMID: 37771392 PMCID: PMC10522998 DOI: 10.1016/j.ocarto.2023.100408] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
Objective The Joint Effort Initiative (JEI) is an international collaboration of clinicians, researchers, and consumer organisations with a shared vision of improving the implementation of osteoarthritis management programs (OAMPs). This study aimed to identify JEI's future priorities and guide direction. Design A two-part international survey to prioritise topics of importance to our membership and research stakeholders. Survey one presented a list of 40 topics under 5 themes. Consenting participants were asked to choose their top three topics in each theme. A short list of 25 topics was presented in survey two. Participants were asked to rank the importance (100-point NRS scale, 100 = highest priority). Response frequency (median, IQR) was used to rank the top priorities by theme. Results Ninety-five participants completed survey one (61% female, 48% clinicians) and 57 completed survey two. The top ranked topic/s were:i. Promotion and advocacy: support training for health professionals (median 85, IQR 24).ii. Education and training: incorporating behaviour change into OAMPs (80, 16), advanced OA skills (80, 30), and integration of OA education into clinical training (80, 36).iii. Improving OAMPs delivery: regular updates on changes to best-evidence OA care (84, 24).iv. Future research: improve uptake of exercise, physical activity, and weight-loss (89, 16).v. Enhancing relationships, alliances, and shared knowledge: promote research collaborations (81, 30), share challenges and opportunities for OAMP implementation (80, 23). Conclusions These topics will set the JEI's research and collaboration agenda for the next 5 years and stimulate ideas for others working in the field.
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Affiliation(s)
- Jocelyn L. Bowden
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Kathryn Mills
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia
| | - Kelli Allen
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA
- Durham Department of Veterans Affairs Health Care System, USA
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M. Briggs
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - K. Dziedzic
- Impact Accelerator Unit, School of Medicine and Health Sciences, Keele University, Keele, Staffordshire, UK
| | - Rana S. Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nina Martinez
- Department of Research and Development, Osteoarthritis Foundation International, Barcelona, Spain
| | - Jonathan G. Quicke
- Chartered Society of Physiotherapy, Chancery Exchange, London, UK
- School of Medicine, Keele University, Keele, UK
| | - Bryan Tan Yijia
- Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, Singapore
| | - Martin van der Esch
- Faculty of Health, Amsterdam University of Applied Sciences, Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands
| | - Josep Verges
- President of the Osteoarthritis Foundation International, Barcelona, Spain
| | - Jillian Eyles
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Rheumatology Department, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
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Jang S, Lee B, Lee E, Kim J, Lee JI, Lim JY, Hwang JH, Jang S. A Systematic Review and Meta-Analysis of the Effects of Rehabilitation Using Digital Healthcare on Musculoskeletal Pain and Quality of Life. J Pain Res 2023; 16:1877-1894. [PMID: 37284324 PMCID: PMC10239626 DOI: 10.2147/jpr.s388757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Rehabilitation using digital healthcare (DHC) has the potential to enhance the effectiveness of treatment for musculoskeletal disorders (MSDs) and associated pain by improving patient outcomes, while being cost-effective, safe, and measurable. This systematic review and meta-analysis aimed to evaluate the effectiveness of musculoskeletal rehabilitation using DHC. We searched PubMed, Ovid-Embase, Cochrane Library, and PEDro Physiotherapy Evidence Database from inception to October 28, 2022 for controlled clinical trials comparing DHC to conventional rehabilitation. We used a random-effects model for the meta-analysis, pooling the effects of DHC on pain and quality of life (QoL) by calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs) between DHC rehabilitation and conventional rehabilitation (control). Fifty-four studies with 6240 participants met the inclusion criteria. The sample size ranged from 26 to 461, and the average age of the participants ranged from 21.9 to 71.8 years. The majority of the included studies focused on knee or hip joint MSD (n = 23), and the most frequently utilized DHC interventions were mobile applications (n = 26) and virtual or augmented reality (n = 16). Our meta-analysis of pain (n = 45) revealed that pain reduction was greater in DHC rehabilitation than in conventional rehabilitation (SMD: -0.55, 95% CI: -0.74, -0.36), indicating that rehabilitation using DHC has the potential to ameliorate MSD pain. Furthermore, DHC significantly improved health-related QoL and disease-specific QoL (SMD: 0.66, 95% CI: 0.29, 1.03; SMD: -0.44, 95% CI: -0.87, -0.01) compared to conventional rehabilitation. Our findings suggest that DHC offers a practical and flexible rehabilitation alternative for both patients with MSD and healthcare professionals. Nevertheless, further researches are needed to elucidate the underlying mechanisms by which DHC affects patient-reported outcomes, which may vary depending on the type and design of the DHC intervention.
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Affiliation(s)
- Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Boram Lee
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Eunji Lee
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Jungbin Kim
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
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Buis L, Moral-Munoz JA, Salazar A, Failde I. mHealth Intervention for Improving Pain, Quality of Life, and Functional Disability in Patients With Chronic Pain: Systematic Review. JMIR Mhealth Uhealth 2023; 11:e40844. [PMID: 36729570 PMCID: PMC9936365 DOI: 10.2196/40844] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/24/2022] [Accepted: 12/14/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Chronic pain (CP) is 1 of the leading causes of disability worldwide and represents a significant burden on individual, social, and economic aspects. Potential tools, such as mobile health (mHealth) systems, are emerging for the self-management of patients with CP. OBJECTIVE A systematic review was conducted to analyze the effects of mHealth interventions on CP management, based on pain intensity, quality of life (QoL), and functional disability assessment, compared to conventional treatment or nonintervention. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to conduct a systematic review of randomized controlled trials (RCTs) published in PubMed, Web of Science, Scopus, and Physiotherapy Evidence Database (PEDro) databases from February to March 2022. No filters were used. The eligibility criteria were RCTs of adults (≥18 years old) with CP, intervened with mHealth systems based on mobile apps for monitoring pain and health-related outcomes, for pain and behavioral self-management, and for performing therapeutic approaches, compared to conventional treatments (physical, occupational, and psychological therapies; usual medical care; and education) or nonintervention, reporting pain intensity, QoL, and functional disability. The methodological quality and risk of bias (RoB) were assessed using the Checklist for Measuring Quality, the Oxford Centre for Evidence-Based Medicine Levels of Evidence, and the Cochrane RoB 2.0 tool. RESULTS In total, 22 RCTs, involving 2641 patients with different CP conditions listed in the International Classification of Diseases 11th Revision (ICD-11), including chronic low back pain (CLBP), chronic musculoskeletal pain (CMSP), chronic neck pain (CNP), unspecified CP, chronic pelvic pain (CPP), fibromyalgia (FM), interstitial cystitis/bladder pain syndrome (IC/BPS), irritable bowel syndrome (IBS), and osteoarthritis (OA). A total of 23 mHealth systems were used to conduct a variety of CP self-management strategies, among which monitoring pain and symptoms and home-based exercise programs were the most used. Beneficial effects of the use of mHealth systems in reducing pain intensity (CNP, FM, IC/BPS, and OA), QoL (CLBP, CNP, IBS, and OA), and functional disability (CLBP, CMSP, CNP, and OA) were found. Most of the included studies (18/22, 82%) reported medium methodological quality and were considered as highly recommendable; in addition, 7/22 (32%) studies had a low RoB, 10/22 (45%) had some concerns, and 5/22 (23%) had a high RoB. CONCLUSIONS The use of mHealth systems indicated positive effects for pain intensity in CNP, FM, IC/BPS, and OA; for QoL in CLBP, CNP, IBS, and OA; and for functional disability in CLBP, CMSP, CNP, and OA. Thus, mHealth seems to be an alternative to improving pain-related outcomes and QoL and could be part of multimodal strategies for CP self-management. High-quality studies are needed to merge the evidence and recommendations of the use of mHealth systems for CP management. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022315808; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=315808.
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Affiliation(s)
| | - Jose A Moral-Munoz
- Observatory of Pain, University of Cádiz, Cádiz, Spain.,Department of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cádiz, Spain
| | - Alejandro Salazar
- Observatory of Pain, University of Cádiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Inmaculada Failde
- Preventive Medicine and Public Health Area, Department of Biomedicine, Biotechnology and Public Health, University of Cádiz, Cádiz, Spain.,Observatory of Pain, University of Cádiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), Cádiz, Spain
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Thompson D, Rattu S, Tower J, Egerton T, Francis J, Merolli M. Mobile app use to support therapeutic exercise for musculoskeletal pain conditions may help improve pain intensity and self-reported physical function: a systematic review. J Physiother 2023; 69:23-34. [PMID: 36528508 DOI: 10.1016/j.jphys.2022.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
QUESTION What is the effect of therapeutic exercise or tailored physical activity programs supported by a mobile app (compared with exercise or physical activity programs delivered using other modes) for people with musculoskeletal pain conditions? DESIGN Systematic review of published randomised controlled trials with meta-analysis. PARTICIPANTS People of all ages with musculoskeletal pain conditions. INTERVENTION Therapeutic exercise or tailored physical activity programs supported by a mobile app. OUTCOME MEASURES Pain intensity, pain interference, self-reported physical function, physical performance, adherence, psychosocial outcomes, health-related quality of life, work participation, physical activity, goal attainment and satisfaction. RESULTS Eleven studies were eligible for inclusion, with a total of 845 participants. There was low certainty evidence that using mobile apps to deliver exercise programs helps to reduce pain intensity to a worthwhile extent (SMD -0.60, 95% CI -0.93 to -0.27). There was low certainty evidence that using mobile apps to deliver exercise programs helps to improve self-reported physical function to a worthwhile extent (SMD -0.92, 95% CI -1.57 to -0.27). Although the effect of using mobile apps to deliver exercise programs on pain interference was also estimated to be a worthwhile benefit (SMD -0.66), this estimate came with marked uncertainty (95% CI -1.52 to 0.19) so the effect remains unclear. The remainder of the outcomes were unclear due to sparse evidence. The most common behaviour change intervention functions in the mobile app interventions were: training, enablement and environmental restructuring. CONCLUSION Mobile apps supporting therapeutic exercise or tailored physical activity programs for musculoskeletal pain conditions may help in reducing pain intensity and improving physical function. The mobile apps utilised a limited range of behaviour change intervention functions. REGISTRATION CRD42021248046.
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Affiliation(s)
- Debra Thompson
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Samuel Rattu
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jared Tower
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Thorlene Egerton
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jill Francis
- School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia; Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, Canada
| | - Mark Merolli
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia; Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
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Zhang ZY, Tian L, He K, Xu L, Wang XQ, Huang L, Yi J, Liu ZL. Digital Rehabilitation Programs Improve Therapeutic Exercise Adherence for Patients With Musculoskeletal Conditions: A Systematic Review With Meta-Analysis. J Orthop Sports Phys Ther 2022; 52:726-39. [PMID: 35960507 DOI: 10.2519/jospt.2022.11384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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Östlind E, Ekvall Hansson E, Eek F, Stigmar K. Experiences of activity monitoring and perceptions of digital support among working individuals with hip and knee osteoarthritis - a focus group study. BMC Public Health 2022; 22:1641. [PMID: 36042425 PMCID: PMC9426251 DOI: 10.1186/s12889-022-14065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/23/2022] [Indexed: 11/11/2022] Open
Abstract
Background Mobile health (mHealth), wearable activity trackers (WATs) and other digital solutions could support physical activity (PA) in individuals with hip and knee osteoarthritis (OA), but little is described regarding experiences and perceptions of digital support and the use of WAT to self-monitor PA. Thus, the aim of this study was to explore the experiences of using a WAT to monitor PA and the general perceptions of mHealth and digital support in OA care among individuals of working age with hip and knee OA. Methods We conducted a focus group study where individuals with hip and knee OA (n = 18) were recruited from the intervention group in a cluster-randomized controlled trial (C-RCT). The intervention in the C-RCT comprised of 12-weeks use of a WAT with a mobile application to monitor PA in addition to participating in a supported OA self-management program. In this study, three focus group discussions were conducted. The discussions were transcribed and qualitative content analysis with an inductive approach was applied. Results The analysis resulted in two main categories: A WAT may aid in optimization of PA, but is not a panacea with subcategories WATs facilitate PA; Increased awareness of one’s limitations and WATs are not always encouraging, and the second main category was Digital support is an appreciated part of OA care with subcategories Individualized, early and continuous support; PT is essential but needs to be modernized and Easy, comprehensive, and reliable digital support. Conclusion WATs may facilitate PA but also aid individuals with OA to find the optimal level of activity to avoid increased pain. Digital support in OA care was appreciated, particularly as a part of traditional care with physical visits. The participants expressed that the digital support should be easy, comprehensive, early, and continuous. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14065-0.
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Affiliation(s)
- Elin Östlind
- Department of Health Sciences, Lund University, Lund, Sweden. .,Dalby Health Care Center, Region Skåne, Sweden.
| | - Eva Ekvall Hansson
- Department of Health Sciences, Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | - Frida Eek
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Kjerstin Stigmar
- Department of Health Sciences, Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
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