Combined digital intervention may be effective for osteoarthritis pain

1. Following total knee replacement (TKR) for osteoarthritis, patients randomized to a combined digital intervention experienced less pain, less disability, and increased physical activity at 12 months follow-up, compared to care usual.

Evidence Rating Level: 1 (Excellent)

Patients who undergo total knee replacement (TKR) for osteoarthritis (OA) may continue to have ongoing pain and limited function, with some reports showing that 10% of patients are dissatisfied at 2 years of follow-up. Digital interventions are one strategy shown to improve pain and increase activity after TKR. However, it is unclear whether combining multiple digital interventions confers a functional benefit. Therefore, this multicentre clinical trial based in Australia aimed to compare patients’ post-TKR pain, randomized to undergo either a combined digital technology intervention or care as usual. The study population consisted of 102 patients post-TKR for OA, admitted for rehabilitation to a hospital, and randomized 1:1 to the control and intervention. The digital intervention was a 6-month package consisting of an iPad app program with exercises developed by physiotherapists and surgeons, a Fitbit tracker, and 3 months of health coaching every second week. The outcomes were measured at 3, 6, and 12 months, with the primary outcome being pain measured by the Numeric Pain Rating Scale (from 0-10). Secondary outcomes included the Pain Disability Index score (from 0-70), physical activity participation, sedentary behaviour in hours per week, and quality of life. The results demonstrated a clinically significant reduction in pain in the intervention group: The mean NRS difference between groups was 0.94 (95% CI -1.70 to -0.20, p = 0.01). The reduction was largest at 12 months (MD -4.91, 95% CI -5.63 to -4.19). Additionally, the intervention group was associated with a lower mean Pain Disability Index score (MD -5.42, 95% CI -10.00 to -0.83), mean 1572 more steps per day (95% CI 345-2798 steps), and a mean 19.85 more minutes of stepping time per day (95% CI 6.31-33.38 minutes). Overall, this study showed that for patients over 12 months post-TKR, a combined digital intervention was associated with improved pain, less disability, and more physical activity than care as usual.

Click to read the study in JAMA Network Open

Image: PD

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