Knee Osteoarthritis
Conditions
Brief summary
Knee osteoarthritis (OA) is highly prevalent and a leading cause of pain that limits physical functioning in older adults. Clinical practice guidelines recommend physical exercise for managing symptoms of knee OA. As a result, several evidence-based exercise programs have been implemented in community centers. However, access to these programs is severely limited in rural settings. Considering that rural communities have a higher disease burden and higher proportion of older adults than non-rural areas, there is a critical need to (1) adapt evidence-based exercise programs for remote delivery to increase access for rural older adults and (2) develop pathways to implement exercise programs in rural health care systems that consistently reach and engage patients with knee OA. Accordingly, we aim to engage rural primary care practices (including medical directors, clinicians, and staff) to develop a clinical pathway that refers patients to an evidence-based exercise program, called Enhance Fitness® (EF), which we have adapted for remote delivery (tele-EF). Enhance Fitness is a group exercise program that is recommended by the CDC for OA management. It is available in over 800 sites nationally and is covered by Medicare Advantage plans, but it is generally not available in rural communities. In addition, we will assess the feasibility and acceptability of implementing the clinical pathway that identifies physically inactive older patients with knee OA, facilitates exercise prescription, and streamlines referral to tele-EF in a rural primary care clinic over a 5-month period.
Interventions
BEHAVIORALTele-EnhanceFitness
Livestream, instructor-led tele-exercise classes, involving balance, endurance, and strength training
Sponsors
University of Washington
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥65 years * Community-dwelling * English-speaking * Physician diagnosed knee osteoarthritis * Physically inactive as determined by the 2-item Physical Activity Vital Sign questionnaire
Exclusion criteria
* Cognitive impairment determined by a Mini Montreal Cognitive Assessment score of \<11 * Significant, non-corrected visual or hearing impairment * Plans to move out of the area in the next 6 months * Cancer requiring treatment (except for non-melanoma skin cancer) in the past 6 months * Heart attack in the past 6 months * Stroke in the past 6 months * Hip fracture in the past 6 months * Hip/knee replacement in the past 6 months * Spinal surgery in the past 6 months * Heart surgery in the past 6 months * Deep vein thrombosis in the past 6 months * Pulmonary embolus in the past 6 months * Hospitalization within the last month * ≥3 falls within the past month
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Active minutes per day | Change from Baseline Active Minutes at 12 weeks | Average number of minutes spent in moderate to vigorous physical activity as measured by the activPAL accelerometer |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function 8-item Short Form | Change from Baseline PROMIS Physical Function score at 12 weeks | Patient-reported physical functioning |
| Knee injury and Osteoarthritis Outcome Score (KOOS) Physical Function Subscale | Change from Baseline KOOS Physical Function Subscale score at 12 weeks | Patient-reported knee pain-related interference with physical functioning |
Countries
United States
Contacts
Primary ContactKushang V Patel, PhD
Backup ContactElise V Hoffman, BS
Outcome results
None listed