Aussie trial shows telehealth programs effective for knee OA

Osteoarthritis

By Mardi Chapman

30 Nov 2021

Telehealth-delivered exercise and diet programs can improve pain and function in people with chronic knee pain consistent with osteoarthritis and overweight or obesity (BMI >28).

The magnitudes of the benefits were consistent with those reported with exercise and diet plus exercise programs in non-telehealth settings, as well as those with osteoarthritis medications. However, they are less than the effects achieved with knee arthroplasty.

The Australian study randomised 415 participants to either a control group receiving osteoarthritis information only, an exercise program delivered by telehealth, or a diet and exercise program delivered by telehealth.

Physiotherapists and dieticians delivered their respective components of the six-month telehealth programs via Zoom videoconference.

The study found both programs led to greater improvements in pain (between-group mean difference in change on NRS: diet and exercise, 1.5 [95% CI, 2.1 to 0.8]; exercise, 0.8 [CI, 1.5 to 0.2]) and function (between-group mean difference in change on WOMAC: diet and exercise, 9.8 [CI, 12.5 to 7.0]; exercise, 7.0 [CI, 9.7 to 4.2]) compared with controls at 6 months.

“The diet and exercise program was also superior to exercise for both primary outcomes (pain, 0.6 [CI, 1.1 to 0.2]; function, 2.8 [CI, 4.7 to 0.8]).”

“More participants in the diet and exercise group than in the control group achieved the pain minimal clinically important difference (MCID), and more participants in both programs than in the control group achieved the function MCID.”

In secondary outcomes, both programs resulted in greater improvements in quality of life and physical activity level at 6 months than control. The diet and exercise program also outperformed control for weight loss and depressive symptoms.

“At 12 months, the diet and exercise program was superior to control for physical activity levels and quality of life. In addition, diet and exercise showed greater weight loss than exercise, with both programs outperforming control.”

In addition, participants in the telehealth programs who were unwilling to consider surgery at baseline maintained their attitude through to 6 and 12 months, while participants who were willing to consider surgery at baseline became less willing.

The study, led by Professor Kim Bennell from the University of Melbourne, said diet and exercise participants lost an average of 9 kg more weight than exercise participants and had greater improvements in quality of life, with more reporting overall improvement and fewer using oral pain medications.

“The finding that fewer diet and exercise participants used pain medications, including opioids, is also important given known adverse effects of such medications.”

“Benefits of both programs were largely maintained at 12 months,” the investigators said.

The study was published in the Annals of Internal Medicine.

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