Mobile Technology to Support Physical Therapy Exercise
Condition: Osteoarthritis of Knee; Osteoarthritis Of Hip
MeSH terms: Osteoarthritis; Osteoarthritis, Knee; Osteoarthritis, Hip
Study type: Interventional

Summary: 
      Osteoarthritis is the leading cause of disability in the U.S, particularly in older adults.
      Exercise is an evidence-based treatment option that improves pain and disability outcomes in
      adults with osteoarthritis, but adherence to prescribed exercise is generally low. Technology
      such as mobile applications (apps) for smartphones and tablets offers the potential to
      support exercise adherence through evidence-based components and enhanced communication
      between physical therapists and patients. The investigators aim to test mobile app-supported
      physical therapy exercise prescription compared to standard care. The investigators propose
      to use a two-arm randomized control trial with subjects in the intervention receiving mobile
      app-supported physical therapy exercise prescription and the control group receiving usual
      care physical therapy exercise prescription (paper handouts and verbal instruction). No known
      studies have assessed the impact of technological integration on adherence with PT exercises
      for OA. Current approaches such as therapist drawn pictures, hand-written or print-ready
      instructions do not account for patient communication preferences or ability to translate
      drawings into physical action. Mobile technology offers a potential solution to
      patient-centered care but has not been evaluated. This study will provide valuable
      information on effectiveness and user perspectives to key stakeholders such as patients,
      health care administrators, physical therapists and app designers.
    

Detailed description: 
      Osteoarthritis (OA) is the leading cause of disability in the U.S. The rate of activity
      limitation due to OA is progressing faster than expected while prevalence is projected to
      increase as a result of the obesity epidemic and population aging, making it a major public
      health problem. Exercise is an evidence-based treatment option that improves pain and
      disability outcomes in adults with osteoarthritis, but previous research has shown that
      adherence to prescribed exercise is low. Referral to physical therapy is common for people
      with OA with the standard of care including exercise prescription through paper handouts with
      brief instruction and static pictures. Such approaches do not incorporate known determinants
      of behavior change related to exercise adherence.

      Recent technology products such as mobile applications (apps) for phones and tablets offer
      the potential to enhance communication between physical therapists and patients. The
      investigators aim to test a pragmatic intervention focused on supporting people with
      osteoarthritis to remain engaged with an exercise program. The specific aims of the project
      are to:

        1. Compare the effectiveness of mobile app supported exercise prescription to usual care
           (paper exercise prescription) on exercise adherence among mid-life and older adults
           receiving similarly dosed physical therapy for lower extremity OA. The investigators
           will also examine secondary outcomes of exercise self-efficacy, physical function,
           stiffness, and pain.

        2. Examine the feasibility and acceptability of mobile app supported exercise prescription
           through recruitment and retention rates, satisfaction with care ratings, and qualitative
           feedback.
    

Intervention name(s): Mobile Application
Intervention type(s): Device
Intervention description(s): Participants will receive usual care physical therapy guided by Clinical Practice Guidelines and based on individual symptoms and need over 7 in-person visits. Measures will be collected by the physical therapist related to leg strength, balance, fitness, and mobility as part of the usual care physical therapy evaluation and follow-up. The treating physical therapist will negotiate the physical therapy intervention based on patient preferences and goals and assessment findings. Using clinical practice guidelines, the intervention for the research participants is expected to address deficits in strength, mobility, balance, and cardiovascular endurance. Exercise prescription will be provided using the Wellpepper physical therapy exercise prescription mobile app.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Exercise, mhealth, physical therapy