Reducing non-steroidal anti-inflammatory drug use in people with knee osteoarthritis

The intervention will involve participants receiving 6 individualised physiotherapy consultations and exercise via a web-application (Physitrack) over 12 week, following 6 weeks of usual care (total duration of study will be 18 weeks). An experienced and registered physiotherapist will be delivering one-on-one sessions for each participant. As the intervention will be delivered using a video-conferencing web-application, the sessions will be conducted at the participants’ homes. The first session (week 7) will be the longest and be approximately 60 minutes. The subsequent five sessions (week 8, 10, 12, 14, and 16) will be shorter and be approximately 30-40 minutes. The physiotherapy intervention will involve 1) an individually-tailored progressive-resistance exercise program; 2) health coaching to a) reduce medication and b) increase physical activity; and 3) online pain coping skills training (via Pain Trainer). During the intervention, the physiotherapist will also deliver education about osteoarthritis and non-steroidal anti-inflammatory drugs, and guideline-recommended. The home-based exercise program will be designed and administered according to the participants’ goals, abilities and preferences, using resistance bands. As per the ACSM guidelines for physical activity, participants will perform two to three sets of 6-10 repetitions of each exercise. This will be tailored to each participant. Exercise intensity will be set at equal to or more than 5 (hard) on the Modified Borg Rating of Perceived Exertion Scale. Participants will also receive health coaching via motivational interviewing to guide them towards reducing their reliance on NSAIDs and improving their physical activity levels to managing their condition. More specifically, participants will undergo motivational interviewing with their physiotherapist to address their goals and barriers, as well as assist participants in creating strategies to meet these goals and overcome their barriers. The therapist providing the intervention will be trained to be proficient in the health coaching process. Health coaching will be integrated in the six telephysiotherapy sessions, and should last approximately 20 minutes per session. All participants will also have access to an online pain coping skills training program, the Pain Trainer. This includes eight 40-minute modules focusing on different skills of pain coping. These modules will be introduced at the initial session but will be left to the patient to complete in their own time before the end of the study. The skills they learn will also be practiced in the scheduled sessions. Adherence to exercise will be monitored using a log book. We will also be asking participants to record any adverse events related to the exercise intervention, as well as any medication they are taking.