1. Among a cohort of patients with knee osteoarthritis, a web-based intervention of self-directed strengthening exercises and activity guidance supported with automated text messaging improved both pain and functional capacity at 24 weeks.
Evidence Rating Level: 1 (Excellent)
Osteoarthritis (OA) of the knee is highly prevalent and has no known cure; symptoms are often managed with strengthening exercises. This randomized trial evaluated the efficacy of a 24-week self-directed intervention consisting of a website and automated text messages to support home exercise therapy using behavioral change theory. 103 patients (mean [SD] age = 60.3 [8.2] years, 58% female) were randomized to the intervention cohort – consisting of website access, guidance to increase physical activity, automated text messaging support, and home exercise programming – and 103 (mean [SD] age = 59.0 [8.5] years, 64% female) to the control cohort – consisting only of website access. The primary outcomes were pain using the 11-point Numeric Rating Scale and limitations with functional capacity using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). At 24 weeks, there was evidence that adherence to knee exercises favored the intervention cohort. With regards to the primary outcomes, there was evidence of both greater improvement in overall pain (mean difference 1.6 units, 95% CI 0.9 to 2.2 units, p < 0.001) and in functional capacity (mean difference 5.2 units, 95% CI 1.9 to 8.5 units, p = 0.002) favoring the intervention cohort. The use of pain medications and other treatments for the knee was similar across the two groups, except that more participants in the control cohort used massage, heat or cold, and topical anti-inflammatory drugs. Overall, this study provides robust evidence that a self-directed exercise regimen augmented by automated text messaging support significantly improves both pain and functional capacity for patients with knee OA. This easily scalable intervention may have a significant impact on population health and aid to reduce the burden of disease associated with knee OA.
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