Potential, low-cost approach to improve exercise adherence in knee osteoarthritis patients

Oct 28 2013

New research presented at the American College of Rheumatology Annual Meeting in San Diego describes an exciting novel tool utilizing telephone linked technology that shows potential as a low cost approach to improving exercise adherence in patients with knee osteoarthritis. The telephone- linked technology acts as an automated physical trainer and behavior therapist to improve adherence to a strengthening protocol for knee osteoarthritis.

Osteoarthritis, or OA as it is commonly called, is the most common joint disease affecting middle-age and older people. It is characterized by progressive damage to the joint cartilage—the cushioning material at the end of long bones—and causes changes in the structures around the joint. These changes can include fluid accumulation, bony overgrowth, and loosening and weakness of muscles and tendons, all of which may limit movement and cause pain and swelling.

Knee osteoarthritis is a common form of osteoarthritis and is caused by cartilage breakdown in the knee joint. Factors that increase the risk of knee osteoarthritis include being overweight, age, injury or stress to the joints, and family history.

Researchers at Boston University investigated what resources might help patients with osteoarthritis of the knee continue muscle-strengthening resistance training programs that help them manage their pain. Past studies have shown that when patients stop receiving instruction from a physical trainer or social support, perhaps due to cost or lack of coverage for long-term support, many stop participating in these exercise programs. The researchers are testing a low-cost, telephone-based system that provides interactive assessment of the patient's current exercise regimen and motivational support for continued activity. The system, Boston Osteoarthritis Strengthening Telephone-Linked Communication (BOOST TLC), is automated and stores users' responses to questions in a database for future use. Using the self- reported exercise adherence data for each participant, the system provides encouragement or advice tailored to the person's needs.

"Research has consistently supported the benefits of exercise, especially strength training, for knee osteoarthritis," says Kristin Baker, PhD; assistant research professor; Center for Enhancing Activity and Participation among Persons with Arthritis (EMNACT); Boston University; and lead investigator in the study. "Knee osteoarthritis is frequently progressive and not always responsive to surgery or pharmacological interventions. In addition, many individuals with knee osteoarthritis prefer to avoid pharmaceutical intervention and delay or not have surgery. However, the key barrier to the effectiveness of exercise is the low adherence to exercise protocols, especially in the long term. We were interested in utilizing a tool that has been shown to be effective in other settings to change behavior, telephone linked communication, to see if it could improve adherence to our strengthening protocol in people with knee osteoarthritis."

In an ongoing study, 62 participants with painful knee OA have been recruited to participate in a twice- weekly muscle-strengthening class for six weeks. Following the class period participants are randomized to one of two groups for 2 years of follow up. The first group, the BOOST TLC receives automated phone calls from the previously described system bimonthly for six months and monthly for the remaining 18 months. The control group receives an automated message once per month, reminding them to strength train and record their progress in their logs. Outcomes include self-reported questionnaires on the participants' pain and physical function levels, timed physical function tasks and isokinetic muscle strength.

The researchers feel strongly that telephone support is a low-cost option for delivering continued exercise instruction that will improve adherence rates in this population.

"The study is ongoing and we are presenting the development of the TLC system with some pilot data, baseline data from our long-term randomized controlled trial, and usage of the TLC by the subjects in the randomized controlled trial up to this point in the study," Dr. Baker explains. "Success can be notated in that the subjects are engaging with the TLC system. We will not have outcome data until data collection is complete in 2015."

SOURCE American College of Rheumatology