Effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE The study sought to examine the effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain by a systematic review and meta-analysis of randomized controlled trials. MATERIALS AND METHODS We searched MEDLINE, EMBASE, CINAHL Plus, and the Cochrane Library from database inception to August 2020. A meta-analysis and subgroup analyses, stratified by technology type and program feature, were conducted. RESULTS Twelve randomized controlled trials were reviewed, all of which implemented the programs for 4 weeks to 6 months. Telephone, Web, mobile app, computer, and virtual reality were used to deliver the programs. The meta-analysis showed that these programs were associated with significant improvements in knee pain (standardized mean difference [SMD] = -0.29; 95% confidence interval [CI], -0.48 to -0.10; P = .003) and quality of life (SMD = 0.25; 95% CI, 0.04 to 0.46; P = .02) but not with significant improvement in physical function (SMD = 0.22; 95% CI, 0 to 0.43; P = .053). Subgroup analyses showed that some technology types and program features were suggestive of potential benefits. CONCLUSIONS Using technology to deliver the exercise programs appears to offer benefits. The technology types and program features that were associated with health values have been identified, based on which suggestions are discussed for the further research and development of such programs.

[1]  R. Dellavalle,et al.  Mobile medical and health apps: state of the art, concerns, regulatory control and certification , 2014, Online journal of public health informatics.

[2]  Steven R Feldman,et al.  The effect of reminder systems on patients’ adherence to treatment , 2012, Patient preference and adherence.

[3]  Da Tao,et al.  A 3-Month Randomized Controlled Pilot Trial of a Patient-Centered, Computer-Based Self-Monitoring System for the Care of Type 2 Diabetes Mellitus and Hypertension , 2016, Journal of Medical Systems.

[4]  G. Guyatt,et al.  GRADE: an emerging consensus on rating quality of evidence and strength of recommendations , 2008, BMJ : British Medical Journal.

[5]  B. Heiderscheit,et al.  Physical therapy vs internet-based exercise training for patients with knee osteoarthritis: results of a randomized controlled trial. , 2018, Osteoarthritis and cartilage.

[6]  Catherine Sherrington,et al.  Older people's perspectives on participation in physical activity: a systematic review and thematic synthesis of qualitative literature , 2015, British Journal of Sports Medicine.

[7]  P A Dieppe,et al.  Knee pain and disability in the community. , 1992, British journal of rheumatology.

[8]  Emily Gerth-Guyette,et al.  Impact of mHealth Chronic Disease Management on Treatment Adherence and Patient Outcomes: A Systematic Review , 2015, Journal of medical Internet research.

[9]  Mike K. P. So,et al.  Usability Testing of a Smartphone Application for Delivering Qigong Training , 2018, Journal of Medical Systems.

[10]  M. So,et al.  Improving Self-Care in Patients With Coexisting Type 2 Diabetes and Hypertension by Technological Surrogate Nursing: Randomized Controlled Trial , 2020, Journal of medical Internet research.

[11]  Matthew W Kreuter,et al.  Tailored and targeted health communication: strategies for enhancing information relevance. , 2003, American journal of health behavior.

[12]  Hailiang Wang,et al.  An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension , 2020, BMC Public Health.

[13]  M. Larsson,et al.  Patients with chronic pain may need extra support when prescribed physical activity in primary care: a qualitative study , 2017, Scandinavian journal of primary health care.

[14]  K. Chakravarty,et al.  Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee--the MOVE consensus. , 2005, Rheumatology.

[15]  M. Mansournia,et al.  Prevalence of Chronic Neck Pain, Low Back Pain, and Knee Pain and Their Related Factors in Community-Dwelling Adults in Iran: A Population-based National Study , 2017, The Clinical journal of pain.

[16]  Hui Xie,et al.  A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study , 2017, JMIR mHealth and uHealth.

[17]  Won Hyuk Chang,et al.  Robot-assisted Therapy in Stroke Rehabilitation , 2013, Journal of stroke.

[18]  Exercise Prescription for Older Adults With Osteoarthritis Pain: Consensus Practice Recommendations , 2001, Journal of the American Geriatrics Society.

[19]  Jiayin Chen,et al.  Assessing the use of immersive virtual reality, mouse and touchscreen in pointing and dragging-and-dropping tasks among young, middle-aged and older adults. , 2017, Applied ergonomics.

[20]  Alejandro R. Jadad,et al.  Can pain be managed through the Internet? A systematic review of randomized controlled trials , 2011, PAIN®.

[21]  Da Tao,et al.  Usability Study of a Computer-Based Self-Management System for Older Adults with Chronic Diseases , 2012, JMIR research protocols.

[22]  A. Odole,et al.  Is Telephysiotherapy an Option for Improved Quality of Life in Patients with Osteoarthritis of the Knee? , 2014, International journal of telemedicine and applications.

[23]  Shyama Prasad Mandal,et al.  Prevalence of Chronic Pain, Impact on Daily Life, and Treatment Practices in India , 2014, Pain practice : the official journal of World Institute of Pain.

[24]  S. Brauer,et al.  Effectiveness of a video-based exercise programme to reduce falls and improve health-related quality of life among older adults discharged from hospital: a pilot randomized controlled trial , 2009, Clinical rehabilitation.

[25]  Patricia Flatley Brennan,et al.  Factors affecting home care patients' acceptance of a web-based interactive self-management technology , 2011, J. Am. Medical Informatics Assoc..

[26]  P. Jennum,et al.  The efficacy of motivational counselling and SMS reminders on daily sitting time in patients with rheumatoid arthritis: a randomised controlled trial , 2017, Annals of the rheumatic diseases.

[27]  Joseph Tan,et al.  Understanding Critical Barriers to Implementing a Clinical Information System in a Nursing Home Through the Lens of a Socio-Technical Perspective , 2014, Journal of Medical Systems.

[28]  R. Andersen,et al.  Prevalence of Significant Knee Pain Among Older Americans: Results From the Third National Health and Nutrition Examination Survey , 1999, Journal of the American Geriatrics Society.

[29]  Michele Tarsilla Cochrane Handbook for Systematic Reviews of Interventions , 2010, Journal of MultiDisciplinary Evaluation.

[30]  Christopher Wee Keong Kuah,et al.  Innovating With Rehabilitation Technology in the Real World , 2017, American journal of physical medicine & rehabilitation.

[31]  John Hansen,et al.  Telerehabilitation for Patients With Knee Osteoarthritis: A Focused Review of Technologies and Teleservices , 2020, JMIR Biomedical Engineering.

[32]  Kim Delbaere,et al.  Adherence to Technology-Based Exercise Programs in Older Adults: A Systematic Review , 2018, Journal of geriatric physical therapy.

[33]  J. Woo,et al.  Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. , 2009, Public health.

[34]  Beatrix Vereijken,et al.  Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy , 2016, Int. J. Medical Informatics.

[35]  Arden,et al.  EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) , 2003, Annals of the rheumatic diseases.

[36]  C. Jinks,et al.  Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) , 2002, Pain.

[37]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[38]  Felipe Fregni,et al.  The efficacy of Web-based cognitive behavioral interventions for chronic pain: a systematic review and meta-analysis. , 2010, The journal of pain : official journal of the American Pain Society.

[39]  L. Kazis,et al.  The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. , 1987, Arthritis and rheumatism.

[40]  Declines in strength and balance in older adults with chronic knee pain: a 30-month longitudinal, observational study. , 2002 .

[41]  R. Hinman,et al.  Effectiveness of an Internet-Delivered Exercise and Pain-Coping Skills Training Intervention for Persons With Chronic Knee Pain , 2017, Annals of Internal Medicine.

[42]  C. Or,et al.  Effectiveness of Mobile App-Assisted Self-Care Interventions for Improving Patient Outcomes in Type 2 Diabetes and/or Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials , 2020, JMIR mHealth and uHealth.

[43]  Linda C. Li,et al.  Efficacy of a Community-Based Technology-Enabled Physical Activity Counseling Program for People With Knee Osteoarthritis: Proof-of-Concept Study , 2018, Journal of medical Internet research.

[44]  Jun-hyeok Jang,et al.  Clinical Feasibility of Exercise Game for Depression Treatment in Older Women with Osteoarthritis: a Pilot Study , 2013 .

[45]  Christopher G. Maher,et al.  Exercise for Osteoarthritis of the Knee , 2010, Physical Therapy.

[46]  D. McKenzie,et al.  Home‐based telerehabilitation via real‐time videoconferencing improves endurance exercise capacity in patients with COPD: The randomized controlled TeleR Study , 2017, Respirology.

[47]  R. Altman,et al.  Assessing the Impact of a Novel Smartphone Application Compared With Standard Follow-Up on Mobility of Patients With Knee Osteoarthritis Following Treatment With Hylan G-F 20: A Randomized Controlled Trial , 2017, JMIR mHealth and uHealth.

[48]  Shawn Marshall,et al.  Experimental Studies of Virtual Reality-Delivered Compared to Conventional Exercise Programs for Rehabilitation , 2003, Cyberpsychology Behav. Soc. Netw..

[49]  R. McCarney,et al.  Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care , 2001, Annals of the rheumatic diseases.

[50]  F. Rannou,et al.  Risk factors and burden of osteoarthritis. , 2016, Annals of physical and rehabilitation medicine.

[51]  C. S. Bickel,et al.  Current Trends in Exercise Intervention Research, Technology, and Behavioral Change Strategies for People With Disabilities: A Scoping Review , 2017, American journal of physical medicine & rehabilitation.

[52]  Calvin Or,et al.  Factors in the 4-week Acceptance of a Computer-Based, Chronic Disease Self-Monitoring System in Patients with Type 2 Diabetes Mellitus and/or Hypertension. , 2018, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[53]  Beth Chaney,et al.  Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review , 2013, Journal of medical Internet research.

[54]  Quansheng Ge,et al.  East Asian warm season temperature variations over the past two millennia , 2018, Scientific reports.

[55]  S. Bierma-Zeinstra,et al.  Osteoarthritis , 2006, The Lancet.

[56]  Giacomo Severini,et al.  The effects of video game therapy on balance and attention in chronic ambulatory traumatic brain injury: an exploratory study , 2017, BMC Neurology.

[57]  S D Walter,et al.  A comparison of methods to detect publication bias in meta‐analysis , 2001, Statistics in medicine.

[58]  N. Foster,et al.  Therapeutic alliance facilitates adherence to physiotherapy-led exercise and physical activity for older adults with knee pain: a longitudinal qualitative study. , 2019, Journal of physiotherapy.

[59]  O. Celik,et al.  Systematic review of Kinect applications in elderly care and stroke rehabilitation , 2014, Journal of NeuroEngineering and Rehabilitation.

[60]  Paul Dieppe,et al.  Osteoarthritis: New Insights. Part 2: Treatment Approaches , 2000, Annals of Internal Medicine.

[61]  Alan Bauck,et al.  Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. , 2008, JAMA.

[62]  N. Lane,et al.  Management of osteoarthritis in the primary-care setting: an evidence-based approach to treatment. , 1997, The American journal of medicine.

[63]  Joseph Tan,et al.  Themed issue on matching policies and socio-technical challenges to enhance the uptake of health information technologies , 2015 .

[64]  Ben-Tzion Karsh,et al.  Review Paper: A Systematic Review of Patient Acceptance of Consumer Health Information Technology , 2009, J. Am. Medical Informatics Assoc..

[65]  N. Taylor,et al.  Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: a randomized controlled trial , 2017, Clinical rehabilitation.

[66]  Hein de Vries,et al.  The long-term efficacy of two computer-tailored physical activity interventions for older adults: main effects and mediators. , 2011, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[67]  Thomas J. Schnitzer,et al.  Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update , 2000 .

[68]  Mian Yan,et al.  A 12-week pilot study of acceptance of a computer-based chronic disease self-monitoring system among patients with type 2 diabetes mellitus and/or hypertension , 2019, Health Informatics J..

[69]  Linda C. Li,et al.  Effects of a 12-Week Multifaceted Wearable-Based Program for People With Knee Osteoarthritis: Randomized Controlled Trial , 2020, JMIR mHealth and uHealth.

[70]  Kendall Ho,et al.  The Use of eHealth Applications in Hong Kong: Results of a Random-Digit Dialing Survey , 2019, Journal of Medical Systems.

[71]  F Angst,et al.  Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. , 2001, Arthritis and rheumatism.

[72]  R. Hinman,et al.  Patellofemoral joint osteoarthritis: an important subgroup of knee osteoarthritis. , 2007, Rheumatology.

[73]  R. Hinman,et al.  Does telephone-delivered exercise advice and support by physiotherapists improve pain and/or function in people with knee osteoarthritis? Telecare randomised controlled trial , 2019, British Journal of Sports Medicine.

[74]  D. Tate,et al.  Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study , 2006, BMJ : British Medical Journal.

[75]  T. Hall,et al.  The Efficacy of Electronic Health–Supported Home Exercise Interventions for Patients With Osteoarthritis of the Knee: Systematic Review , 2018, Journal of medical Internet research.

[76]  Bengisu Tulu,et al.  mHealth technologies for osteoarthritis self-management and treatment: A systematic review , 2017, Health Informatics J..

[77]  N. Foster,et al.  Role of exercise for knee pain: What do older adults in the community think? , 2012, Arthritis care & research.

[78]  A. Rizzo,et al.  The application of virtual reality technology in rehabilitation. , 2001 .

[79]  M. Jan,et al.  Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis , 2007, Clinical Rheumatology.

[80]  Antonio C. H. Sek,et al.  Private primary care physicians' perspectives on factors affecting the adoption of electronic medical records: a qualitative pre-implementation study. , 2014, Work.

[81]  R. Hinman,et al.  Telephone Coaching to Enhance a Home‐Based Physical Activity Program for Knee Osteoarthritis: A Randomized Clinical Trial , 2017, Arthritis care & research.

[82]  D. Scott Guidelines for the Diagnosis, Investigation and Management of Osteoarthritis of the Hip and Knee , 1993, Journal of the Royal College of Physicians of London.

[83]  A. Odole,et al.  A Telephone-based Physiotherapy Intervention for Patients with Osteoarthritis of the Knee , 2013, International journal of telerehabilitation.

[84]  C. Terwee,et al.  Knee Injury and Osteoarthritis Outcome Score (KOOS): systematic review and meta-analysis of measurement properties. , 2016, Osteoarthritis and cartilage.

[85]  Simon Hunter,et al.  Effects of a 12-Week Digital Care Program for Chronic Knee Pain on Pain, Mobility, and Surgery Risk: Randomized Controlled Trial , 2018, Journal of medical Internet research.

[86]  M. Nevitt,et al.  Radiographic Knee Osteoarthritis and Knee Pain: Cross-sectional study from Five Different Racial/Ethnic Populations , 2018, Scientific Reports.

[87]  Jillian P. Fry,et al.  Periodic Prompts and Reminders in Health Promotion and Health Behavior Interventions: Systematic Review , 2009, Journal of medical Internet research.

[88]  Kai Zheng,et al.  Development and validation of a survey instrument for assessing prescribers' perception of computerized drug-drug interaction alerts , 2011, J. Am. Medical Informatics Assoc..

[89]  Gaetano Tieri,et al.  Virtual reality in cognitive and motor rehabilitation: facts, fiction and fallacies , 2018, Expert review of medical devices.

[90]  D. Moher,et al.  Statistical power, sample size, and their reporting in randomized controlled trials. , 1994, JAMA.

[91]  Bonnie A. Clough,et al.  Technological adjuncts to increase adherence to therapy: a review. , 2011, Clinical psychology review.

[92]  Paul Karoly,et al.  A randomized controlled evaluation of an online chronic pain self management program , 2012, PAIN.

[93]  N. Foster,et al.  The attitudes, beliefs and behaviours of GPs regarding exercise for chronic knee pain: a systematic review , 2010, BMC family practice.

[94]  Richard K. Jones,et al.  Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis. , 2013, JAMA.

[95]  S. Dyrstad,et al.  Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors. , 2013, Journal of clinical nursing.

[96]  Ana Rita Pereira Azevedo,et al.  Future perspectives of Smartphone applications for rheumatic diseases self-management , 2015, Rheumatology International.

[97]  R A Winett,et al.  Walking to meet health guidelines: the effect of prompting frequency and prompt structure. , 1995, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[98]  Calvin Or,et al.  Prevalence, Demographic Correlates, and Perceived Impacts of Mobile Health App Use Amongst Chinese Adults: Cross-Sectional Survey Study , 2018, JMIR mHealth and uHealth.