The Effectiveness of a Web-Based Physical Activity Intervention in Patients with Knee And/or Hip Osteoarthritis: A Randomized Controlled Trial
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Abstract
Background: Patients with knee and/or hip osteoarthritis (OA) are less physically active than the general population, while benefits of physical activity (PA) have been well documented. Studies have shown the potential of web-based interventions for change in PA behavior. Therefore, we developed a web-based intervention to improve PA levels in patients with knee and/or hip OA, entitled Join2move. The Join2move intervention is a self-paced nine week PA program in which patients’ favourite recreational activity is gradually increased in a time-contingent way.
Objective: To investigate whether a fully automated web-based PA intervention in patients with knee and/or hip OA would result in improved levels of physical activity, physical function and self-perceived effect compared with a waiting list control group.
Methods: The study design was a randomized, unblinded, controlled, two-armed trial. Ethics approval was obtained from the medical ethics committee of the VU University Medical Center Amsterdam. Sedentary volunteers with knee and/or hip OA were recruited via articles in newspapers and health-related websites. Eligibility criteria for participants were 1) age 50-75, 2) self-reported OA in knee and/or hip, 3) self-reported sedentary behaviour (<30 minutes of moderate PA on fewer than 4 days per week, 4) no face to face consults with a healthcare provider, other than GP, for OA in the last 6 months, 5) ability to access the internet weekly. Baseline, 3 and 12 months follow-up data were collected through online questionnaires. We used Actigraph accelerometers to measure objective PA. Primary outcomes were PA, physical function and self-perceived effect. Secondary outcomes were pain, fatigue, anxiety, depression, OA related symptoms, quality of life, self-efficacy, pain coping and locus of control.
Results: Of the 581 interested respondents, 199 eligible participants were randomly assigned to the intervention (n=100) or waiting list control group (n=99). Response rates of questionnaires were 84.4% after 3 months and 75.4% after 12 months. In this study, 94 (94%) participants actually started the program and 46 users (46%) reached the adherence threshold of 6 out of 9 modules completed. At 3 months, participants in the intervention group reported a significantly improved physical function status (p=<0.02, d=0.23) and a positive self-perceived effect (p=<0.01, OR=10.7) compared with the control group. However, no effect was found for self-reported PA (p=0.9, d=0) and PA measured with an accelerometer (p=0.83, d=0.05). After 12 months, the intervention group showed higher levels of subjective and objective PA (p=0.02, d=0.29 and p=<0.05,d=0.45) compared with the control group. After 12 months, no effect was found for physical function (p=0.1, d=0.18) and self-perceived effect (p=0.5, OR=1.2). For secondary endpoints, the intervention group consistently demonstrated significant improvements in favor of the intervention group.
Conclusion: The web-based intervention Join2move resulted in changes in the desired direction for several primary and secondary outcomes. Given the clinically relevant benefits and its self-help format, Join2move could be a key component in the effort to enhance PA in sedentary patients with knee and/or hip OA.
Objective: To investigate whether a fully automated web-based PA intervention in patients with knee and/or hip OA would result in improved levels of physical activity, physical function and self-perceived effect compared with a waiting list control group.
Methods: The study design was a randomized, unblinded, controlled, two-armed trial. Ethics approval was obtained from the medical ethics committee of the VU University Medical Center Amsterdam. Sedentary volunteers with knee and/or hip OA were recruited via articles in newspapers and health-related websites. Eligibility criteria for participants were 1) age 50-75, 2) self-reported OA in knee and/or hip, 3) self-reported sedentary behaviour (<30 minutes of moderate PA on fewer than 4 days per week, 4) no face to face consults with a healthcare provider, other than GP, for OA in the last 6 months, 5) ability to access the internet weekly. Baseline, 3 and 12 months follow-up data were collected through online questionnaires. We used Actigraph accelerometers to measure objective PA. Primary outcomes were PA, physical function and self-perceived effect. Secondary outcomes were pain, fatigue, anxiety, depression, OA related symptoms, quality of life, self-efficacy, pain coping and locus of control.
Results: Of the 581 interested respondents, 199 eligible participants were randomly assigned to the intervention (n=100) or waiting list control group (n=99). Response rates of questionnaires were 84.4% after 3 months and 75.4% after 12 months. In this study, 94 (94%) participants actually started the program and 46 users (46%) reached the adherence threshold of 6 out of 9 modules completed. At 3 months, participants in the intervention group reported a significantly improved physical function status (p=<0.02, d=0.23) and a positive self-perceived effect (p=<0.01, OR=10.7) compared with the control group. However, no effect was found for self-reported PA (p=0.9, d=0) and PA measured with an accelerometer (p=0.83, d=0.05). After 12 months, the intervention group showed higher levels of subjective and objective PA (p=0.02, d=0.29 and p=<0.05,d=0.45) compared with the control group. After 12 months, no effect was found for physical function (p=0.1, d=0.18) and self-perceived effect (p=0.5, OR=1.2). For secondary endpoints, the intervention group consistently demonstrated significant improvements in favor of the intervention group.
Conclusion: The web-based intervention Join2move resulted in changes in the desired direction for several primary and secondary outcomes. Given the clinically relevant benefits and its self-help format, Join2move could be a key component in the effort to enhance PA in sedentary patients with knee and/or hip OA.
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