Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis
Authors: Sameer Akram Gohir, Frida Eek, Anthony Kelly, Abhishek Abhishek, Ana M. Valdes
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Osteoarthritis is a prevalent, debilitating, and costly chronic disease for which recommended first-line treatment is underused. <h3>Objective</h3> To compare the effect of an internet-based treatment for knee osteoarthritis vs routine self-management (ie, usual care). <h3>Design, Setting, and Participants</h3> This randomized clinical trial was conducted from October 2018 to March 2020. Participants included individuals aged 45 years or older with a diagnosis of knee osteoarthritis recruited from an existing primary care database or from social media advertisements were invited. Data were analyzed April to July 2020. <h3>Interventions</h3> The intervention and control group conformed to first-line knee osteoarthritis treatment. For the intervention group, treatment was delivered via a smartphone application. The control group received routine self-management care. <h3>Main Outcomes and Measures</h3> The primary outcome was change from baseline to 6 weeks in self-reported pain during the last 7 days, reported on a numerical rating scale (NRS; range, 0-10, with 0 indicating no pain and 10, worst pain imaginable), compared between groups. Secondary outcomes included 2 physical functioning scores, hamstring and quadriceps muscle strength, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quantitative sensory testing. <h3>Results</h3> Among a total of 551 participants screened for eligibility, 146 were randomized and 105 were analyzed (mean [SD] age, 66.7 [9.2] years, 71 [67.1%] women), including 48 participants in the intervention group and 57 participants in the control group. There were no significant differences in baseline characteristics between the groups. At the 6-week follow-up, the intervention group showed a greater NRS pain score reduction than the control group (between-group difference, −1.5 [95% CI, −2.2 to −0.8];<i>P</i> &lt; .001). Similarly, the intervention group had better improvements in the 30-second sit-to-stand test (between-group difference, 3.4 [95% CI, 2.2 to 4.5];<i>P</i> &lt; .001) and Timed Up-and-Go test (between-group difference, −1.8 [95% CI, −3.0 to −0.5] seconds;<i>P</i> = .007), as well as the WOMAC subscales for pain (between-group difference, −1.1 [95% CI, −2.0 to −0.2];<i>P</i> = .02), stiffness (between-group difference, −1.0 [95% CI, −1.5 to −0.5];<i>P</i> &lt; .001), and physical function (between-group difference, −3.4 [95% CI, −6.2 to −0.7];<i>P</i> = .02). The magnitude of within-group changes in pain (<i>d</i> = 0.83) and function outcomes (30 second sit-to-stand test<i>d</i> = 1.24; Timed Up-and-Go test<i>d</i> = 0.76) in the intervention group corresponded to medium to very strong effects. No adverse events were reported. <h3>Conclusions and Relevance</h3> These findings suggest that this internet-delivered, evidence-based, first-line osteoarthritis treatment was superior to routine self-managed usual care and could be provided without harm to people with osteoarthritis. Effect sizes observed in the intervention group corresponded to clinically important improvements. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT03545048