The PEEKO study - Patient education to enhance exercise outcomes in people with knee osteoarthritis: a randomised controlled trial

Verbal OA information + strengthening exercise PLUS patient e-learning course (Experimental intervention) Participants in this group will receive two consultations of 30 minutes each, one-on-one with a physiotherapist over Zoom videoconferencing software over 6 weeks. Appointments will be in approximately week 1 and the second in week 6. The purpose of the consults will be for the physiotherapist to provide verbal OA information and to prescribe a home-based strengthening exercise program. In addition, participants in this group will be given access to the free e-learning course, Taking Control of your Knee and Hip Osteoarthritis, available on the online education platform FutureLearn. Participants will be provided an information booklet for reference about how to prepare for the first consultation and a booklet of strength exercises, as well as 4 coloured therabands (red, green, blue, and black) for performing strengthening exercises at home. The physiotherapist will provide verbal information about OA and its recommended management and address any related participant questions. The verbal information provided will be scripted. The physiotherapist will answer participant questions based on their clinical knowledge. The physiotherapists will prescribe 4 strengthening exercises to be performed at home three times/week, including two quadriceps exercises (from 17 options including weightbearing such as squats and non-weightbearing exercises such as seated knee extensions), one hip (from a list of `13 options such as crab walking or bridges) and one calf (from a list of 4 options including claf raises), selected as most suitable for the participant from a range of options for each. These exercises are described in the booklet sent out to participants. The intensity for the strengthening exercises will aim for 5-7 out of ten (hard to very hard) on the modified Borg Rating of Perceived Exertion CR-10 scale for strength training. During the second physiotherapy consultation, participants will also be advised how to independently progress their exercise program, and encouraged to continue with their strengthening exercises (three times per week) until the 24-week re-assessment. In addition, participants in this group will be provided access to the eLearning course that provides more in-depth information about OA and recommended self-management approaches. The physiotherapist will encourage participants to trial any of the management approaches recommended within the e-learning course that they may be interested in pursuing. The information is presented in four modules using written text, videos, infographics, downloadable resources (including physical activity/exercise logbook and action plan templates) and learning activities. In total, the time required to complete all four modules and learning activities is approximately four hours (one hour per module). The four modules are: (1) Learning about osteoarthritis; (2) Physical activity and exercise for osteoarthritis; (3) Body weight and osteoarthritis; (4) Additional management strategies and conclusion. Each module includes a range of learning activities (e.g. non-moderated discussion boards to promote learner interaction, poll questions enabling learner comparison, quizzes aligned with learning objectives, action plan templates to facilitate turning learnings into action). Physiotherapists will record attendance at each session to monitor adherence. Participants will also answer survey questions about how often they completed the exercises at 24-weeks. Participants will be asked whether they completed each of the 4 online course modules at 8-weeks, and about subsequent use of the online resource at 24-weeks.