None listed
Conditions
Brief summary
Persistent knee pain, in people over 50 years, is usually attributable to knee osteoarthritis (OA), a common health problem that causes physical and psychological dysfunction. Exercise, delivered by physiotherapists, and pain coping skills training (PCST), normally delivered by psychologists, can help reduce the symptoms and impact of persistent knee pain. Access to specialised health professionals is not always available, however. Usual care, especially to those living in remote areas, often involves hand-out educational information alone. In a time of advancing technology and increasing access to the internet, remotely delivered internet-based treatment approaches, may provide novel alternatives for healthcare delivery of exercise and PCST. This study will evaluate whether a physiotherapy-guided home exercise program, delivered via the internet, combined with an online PCST program (PainCOACH) is more effective in improving pain and function than a control intervention (on-line provision of educational material alone).
Interventions
13 week intervention: A package of on-line pain coping skills training (PCST), physiotherapy guided exercise delivered on-line via SKYPE and on-line general education. On-line pain coping skills training and online general education will commence in week 1. Physiotherapy SKYPE sessions will commence after this in week 2 in order for participants to complete 1-2 PainCOACH sessions prior to commencing the physiotherapy intervention.
PCST program - participants will complete on-line pain coping s
13 week intervention: A package of on-line pain coping skills training (PCST), physiotherapy guided exercise delivered on-line via SKYPE and on-line general education. On-line pain coping skills training and online general education will commence in week 1. Physiotherapy SKYPE sessions will commence after this in week 2 in order for participants to complete 1-2 PainCOACH sessions prior to commencing the physiotherapy intervention. PCST program - participants will complete on-line pain coping skills training (PCST) in the form of the PainCOACH program consisting of 8 interactive modules, each taking approximately 45 minutes. Participants will be asked to complete one module per week. At the completion of the 8 week modules participants will be asked to continue applying their pain coping skills. General education made available on-line - The on-line education component will consist of short fact sheets covering topics such as what is OA, healthy eating, importance of exercise, sleep etc. There will be 18 fact sheets in total which will be available to access online through a password protected site. There is no required access schedule. Participants may access the fact sheets at any time throughout the duration of the trial, 36weeks. They will take approximately 5 minutes each to read. Physiotherapy guided exercise delivered on-line via SKYPE - participants will complete 7 Physiotherapy exercise based sessions using Skype over the 13 week intervention, commencing in week 2 at intervals of approximately 2 weeks. Session one will be 45 minutes in duration and all subsequent sessions will be 30 minutes. Participants will be prescribed a home exercise program of 4-6 exercises for knee strength and range of motion. Home exercises are to be completed 3 times a week and will take approximately 15 minutes. Participants will commence their home exercise program in week 2 and are encouraged to continue their exercise program until the end of the trial at 36 weeks. We will monitor adherence to the home exercise program through participant log books. Pain coping skills training will be monitored using a PainCOACH specific logbook.
Sponsors
The University of Melbourne
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator)
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Aged 50 years and over Persistent knee pain for more than 3 months and for most days of the past month Self-reported average walking pain level over the past week of equal to or greater than 4 out of 10 on a numeric rating scale WOMAC physical function score of >20 (at least mild-moderate dysfunction) Current email address and access to a computer with broadband internet connection Able to commit approximately 12 months to the study and willing to do regular home exercises and pain coping skills training practice if allocated to the combined intervention or education only groups.
Exclusion criteria
Have had or on the waiting list for a knee or hip joint replacement on the painful knee side Have had or are planning knee joint surgery, intra-articular injection therapy on the painful knee within the past/next 6 months Have seen a health practitioner and had treatment (e.g. physiotherapy, chiropractic, osteopathy, acupuncture etc) for knee pain, or participated in a muscle strengthening exercise program or a pain coping skills program, in the past 6 months Systemic arthritic condition Any neurological conditions such as a stroke, Multiple sclerosis, polio, neuropathy, peripheral nerve disease or Parkinson’s disease that affects the lower-limb and limits the ability to exercise safely Any other major joint pain (e.g. back, hip or ankle) that currently limits the ability to exercise Self-reported high-level depression (score of >21 on the depression subscale of the Depression, Anxiety and Stress Scale (DASS-21) People without a good level of written and spoken English
Outcome results
None listed