None listed
Conditions
Brief summary
Knee osteoarthritis (KOA) is a leading contributor to burden of disease in Australia. Pain and impaired function are characteristic symptoms leading to physical disability, inactivity and reduced quality of life all of which further perpetuate functional decline. Guidance to facilitate self-management is key in the treatment of KOA with physical activity and exercise advocated by all clinical guidelines as the cornerstone of conservative management irrespective of disease severity. Unfortunately, many people suffering with KOA are not receiving the advice or behaviour change support required to incorporate regular exercise and physical activity into their daily routines. A combination of factors may be responsible including financial, geographical, and personal barriers. To overcome these barriers innovative, novel and cost-effective approaches to exercise education, prescription and exercise behaviour change are needed to increase exercise uptake and reduce physical inactivity in the KOA population and ultimately reduce both the individual and societal burden of OA in Australia. Electronically delivered physical activity and exercise interventions may be one solutions. Several OA specific internet resources already exist within Australia. These resources provide only general exercise and physical activity advice to people with KOA, with minimal evidence supporting their positive effect on clinical outcomes. It can be speculated that the effectiveness of such resources may be enhanced by the addition of higher quality, detailed and specific physical activity and exercise instruction and guidance. This trial will, therefore, investigate whether the addition of “My Knee Exercise” (an Internet delivered 24-week exercise program with mobile phone text message exercise adherence support) to Internet delivered exercise education enhances clinical outcomes at 24-weeks in people with KOA. Participants will be randomly assigned to one of two groups; i) My Knee Education (control condition): participants will be provided access to “My Knee Education”, a website containing information about KOA and exercise benefits plus general exercise and physical activity recommendations, similar to those provided in current Australian OA consumers resources. ii) My Knee Exercise (intervention): participants will be provided access to “My Knee Exercise”, a website containing the same information provided to the control condition in addition to a 24-week Internet delivered exercise program, supported by mobile phone text message exercise adherence support and detailed physical activity guidance. Data collection will be self-reported questionnaires relating to knee pain, physical function, global rating of change, health-related quality of life, physical activity levels, self-efficacy and satisfaction, collected at baseline and 24-weeks after commencement of the intervention.
Interventions
My Knee Exercise Intervention
Participants will be provided a URL to access “My Knee Exercise”, a website containing information to assist in the self-management of knee pain. Over 24 weeks they will be asked to access the website at home, on their own device, read the educational information provided and complete a self-directed, home-based, exercise program. Participants can view the website as often as they require.
Specifically, they will be asked to access the 4 website sections. All secti
My Knee Exercise Intervention Participants will be provided a URL to access “My Knee Exercise”, a website containing information to assist in the self-management of knee pain. Over 24 weeks they will be asked to access the website at home, on their own device, read the educational information provided and complete a self-directed, home-based, exercise program. Participants can view the website as often as they require. Specifically, they will be asked to access the 4 website sections. All sections can be accessed concurrently. These sections are: 1) My Knee Education. This section contains information about knee OA and exercise benefits. Participants will be directed to view the written and visual educational material prior to commencing a home-based exercise program. The material provided has been specifically developed for this study. 2) My Knee Strength. This section prescribes a 24-week, self-directed, home-based, exercise program. Over the 24 weeks participants will complete three consecutive exercise programs, each eight-week duration. Each program will contain five-six strength based exercises for the hip, knee and ankle, for example seated knee extension, walk squats, hip abduction, calf raises. The prescribed exercises in each program will vary to increase the exercise challenge overtime and add variety. Prescription of each exercise is: ten repetitions; three sets; three times a week; at an exercise intensity of hard (5-6) in program one and very hard (7-8) in program two and three, as rated on a 11-point scale of Rated Perceived Exertion (RPE). Intensity will be increased for each exercise by adding ankle weights and/or changing body position. Each exercise session is estimated to be 20-30 minutes duration. Written instructions will be provided for each exercise as well as photographic and video demonstrations. Participants will be encouraged to purchase their own ankle weights to progress their exercises throughout the 24-week intervention, following detailed instructions. During the intervention, adherence to the strength based program will be encouraged via mobile phone text message support. Participants will receive both facilitator and barrier to exercise participation text messages. Facilitator messages will come from a standard set. Barrier messages will be semi-personalised and address participants self-selected barrier to exercise participation if low adherence is reported for the previous week (less than 3 exercise sessions/week). Participants will select the barrier from a pre-determined list of common barriers including lack of time, forgetfulness, pain. Text messages will also be personalised using participants first names. Participants will be encouraged, but not mandated, to keep an exercise log book to record their weekly exercise practice. 3) My Knee Physical Activity. This section contains information and guidance to assist participants to increase their general physical activity over the 24-week intervention period. 4) My Knee Tools: This section contains a range of resources to help participants complete their strength based exercise program and increase their physical activity. Resources include downloadable templates of exercise logbooks, action plan development and goal setting.
Sponsors
University of Melbourne
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
45 Years to No maximum
Healthy volunteers
No
Inclusion criteria
a) Meet the National Institute for Health and Care Excellence (NICE) osteoarthritis clinical criteria: - aged 45 years and over - activity related knee joint pain - morning stiffness of 30 minutes or less; b) History of knee pain on most days for 3 months or more; c) Overall average knee pain in past week self-rated as equal to or greater than 4 out of 10 on an 11-point numeric rating scale (NRS); d) Able to give informed consent and to participate fully in the interventions and assessment procedures; d) Have a mobile phone with text message functioning and be willing to use it during the study to receive and send text messages; e)Have a home Internet connection and a device that enables access to the Internet.
Exclusion criteria
· Booked for knee joint replacement surgery; · Have had a knee joint replacement in the most painful knee; · Have participated in a structured knee exercise program within the past 6 months; · Self-reported diagnosis of rheumatoid arthritis or other inflammatory arthritis; · Have had a fall within the last 12 months and do not receive clearance from a General Practitioner to participate in an unsupervised home exercise program; · Are housebound requiring assistance from another person to leave the house in the previous month and do not receive medical clearance from a General Practitioner to participate in an unsupervised home exercise program by a General Practitioner; · Fail pre-exercise screening (Adult Pre-exercise Screening Questionnaire) and do not receive medical clearance from a General Practitioner to participate in an unsupervised home exercise program; · Unable to speak or read English;
Outcome results
None listed