Implementation of Tele-Exercise for Management of Knee Osteoarthritis in Older Rural Primary Care Patients

Study Overview
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Brief Summary
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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.

Official Title
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Implementation of Tele-Exercise for Management of Knee Osteoarthritis in Older Rural Primary Care Patients

Conditions
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Knee Osteoarthritis

Intervention / Treatment
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* Behavioral: Tele-EnhanceFitness


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Tele-EF<br>Tele-EnhanceFitness | Behavioral: Tele-EnhanceFitness<br>* Livestream, instructor-led tele-exercise classes, involving balance, endurance, and strength training<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Active minutes per day | Average number of minutes spent in moderate to vigorous physical activity as measured by the activPAL accelerometer | Change from Baseline Active Minutes at 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function 8-item Short Form | Patient-reported physical functioning | Change from Baseline PROMIS Physical Function score at 12 weeks | 
| Knee injury and Osteoarthritis Outcome Score (KOOS) Physical Function Subscale | Patient-reported knee pain-related interference with physical functioning | Change from Baseline KOOS Physical Function Subscale score at 12 weeks |