None listed
Conditions
Brief summary
Despite all treatment guidelines recommending exercise, 9 of 10 Australians with knee osteoarthritis (OA) are inactive. Most undergo surgery without trying exercise, despite evidence that exercise can delay/prevent surgery. However, exercise often hurts, reducing initial/sustained exercise engagement. Clinicians promise that pain will reduce over time as fitness increases/weight reduces. While evidence supports this promise, sustaining exercise is difficult. Arthritis Australia's Exercise Report identifies improving exercise engagement as key to improving osteoarthritis outcomes and Australia's National Arthritis Strategic Action Plan calls for new ways to increase uptake of exercise in people with arthritis. New virtual reality technology holds promise and may assist with reducing exercise barriers to increase exercise uptake/engagement. Using a parallel-group, randomised controlled trial, participants will be randomised to one of two active treatment groups. Both groups will receive 2 weekly in-person treatment sessions with a physiotherapist for a period of 6 weeks. Primary outcomes include the WOMAC and perceptually-regulated exercise.
Interventions
Participants randomised to this group will attend 12, 30-minute, one-on-one sessions with a Physiotherapist over 6-weeks. During these sessions they will receive a VR-enhanced cycling intervention. They will ride a stationary bike while wearing a head-mounted display (Occulus Quest) that provides the VR experience. The aim of the VR program is to provide enhanced visual feedback that promotes cycling engagement and enjoyment. During each session participants will ride the stationary bike for as
Participants randomised to this group will attend 12, 30-minute, one-on-one sessions with a Physiotherapist over 6-weeks. During these sessions they will receive a VR-enhanced cycling intervention. They will ride a stationary bike while wearing a head-mounted display (Occulus Quest) that provides the VR experience. The aim of the VR program is to provide enhanced visual feedback that promotes cycling engagement and enjoyment. During each session participants will ride the stationary bike for as long as they are able/comfortable doing or for a maximum of 30minutes, under the supervision of the Physiotherapist. Participants will be instructed to cycle at a self-selected, individualised pace and resistance level (individualisation detailed below). The stationary bike will be mounted on a Wahoo Kickr Smart Trainer, and a bespoke VR program has been developed using Steam VR. The Wahoo Kickr provides continuous monitoring of the participants work (cadence, watts) over the course of the cycling sessions. Additionally, the customised program allows for control of the electromagnetic resistance applied to the trainer’s flywheel (via the Wahoo Kickr); thus, the bike’s level of resistance can be controlled through the VR program. In the VR program, participants will be in a virtual world, where they are riding a bike (first-person perspective) on a wide road. The road will be surrounded by varying scenery (e.g., nature/forest, cityscape), which the participant will travel through over the course of their ride. The road will also travel up and downhill, with resistance changing via the Wahoo Kickr to be congruent with the visual feedback (e.g., increased resistance while riding uphill). However, throughout the program, participants will receive altered (deceptive) visual feedback of their cycling speed, that is they will appear to be moving faster than they are really cycling. The gain (amount that that visual feedback is altered), can be adjusted by the Physiotherapist to be consistent with participant preferences and improve exercise engagement. For example, in the initial sessions the gain may be set higher, as this has been shown to improve enjoyment and cycling duration in people with knee osteoarthritis. The visual gain then may then be tapered off over the course of the intervention, as the participant is able to ride for longer. The Physiotherapist will also be able to control the level of resistance that the participant is experiencing and will be instructed to individualise this setting to the participants preferences. For example, the Physiotherapist may reduce the resistance towards the end of the session if they notice that the participant is getting fatigued. In addition to the Physiotherapist, the participant will also be able to control the level of resistance at which they are cycling throughout the intervention. This will be done through buttons mounted on the bike’s handlebars. The participant will receive visual feedback within the program that displays what level they have set the resistance, and they will be able to control this throughout the cycling session.
Sponsors
The University of South Australia
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
45 Years to No maximum
Healthy volunteers
No
Inclusion criteria
i) Aged greater than or equal to 45 years ii) Average knee pain intensity of at least 4/10 (overall and/or while walking) over past week using a 0-10 numerical rating scale, where 0 = no pain at all and 10 = worst pain possible iii) Painful knee osteoarthritis at least 6 months duration that meets the National Institute for Health Care Excellence diagnostic criteria for symptomatic knee osteoarthritis (age criteria above, activity-related joint pain, no morning stiffness or stiffness lasting less than 30 minutes)
Exclusion criteria
i) Conditions that prevent safe participation in physical activity as listed in the American College of Sports Medicine guidelines (e.g., cardiac or lung disease) ii) Pain in other body areas that limits cycling ability (e.g., back pain, foot pain, hip pain) iii) Neurological disorders affecting lower limb movement (e.g., multiple sclerosis, stroke) iv) Inflammatory arthritis (including rheumatoid arthritis) v) Fibromyalgia vi) Previous knee replacement (on most painful knee) or planned knee replacement/surgery (next 6 months) or recent knee replacement on the non- or less-painful knee (<6 months) vii) Previously operated knee is the most painful knee viii) Intra-articular therapy use in the 12 weeks preceding enrolment ix) Any condition impacting decision-making/memory (e.g., Alzheimer’s, dementia) x) Current purposeful exercise of 30 mins or more per day on 5 or more days per week. xi) Unable to commit to study requirements (unable to attend study appointments or complete study outcomes)
Outcome results
None listed