Telehealth-supported exercise/physical activity programs for knee osteoarthritis: A systematic review and meta-analysis

Telehealth-supported program has been increasingly integrated into chronic disease management, but it is unknown if this benefit applies to populations with knee osteoarthritis. This study aimed to assess the effectiveness of telehealth-supported exercise/physical activity programs in individuals with knee osteoarthritis. A comprehensive literature search was conducted in September 2022 on randomized controlled trials investigating the effects compared to a control condition. Twenty-three studies met eligibility criteria, of which 20 studies included in meta-analysis. Telehealth-supported exercise/physical activity programs resulted in reduced pain (g = -0.39, CI -0.67 to -0.11, I2 = 83%), better physical activity (g = 0.13, CI 0.03 to 0.23, I2 = 0%) and better physical function (g = -0.51, CI -0.98 to -0.05, I2 = 87%). In addition, better improvements in quality of life, self-efficacy for pain, and global improvement were observed, but with non-significant improvements for self-efficacy for physical function. These findings suggested that telehealth-supported exercise/physical activity program might be an effective treatment for knee osteoarthritis. Future research with standardized components and wearables should evaluate the effects.

[1]  R. Hinman,et al.  Effectiveness of an Unsupervised Online Yoga Program on Pain and Function in People With Knee Osteoarthritis , 2022, Annals of Internal Medicine.

[2]  Shaomei Shang,et al.  Effectiveness of telehealth-based exercise interventions on pain, physical function and quality of life in patients with knee osteoarthritis: A meta-analysis. , 2022, Journal of clinical nursing.

[3]  K. Donelan,et al.  Impact of a Virtual Professional Development Coaching Program on the Professional Fulfillment and Well-Being of Women Surgery Residents , 2022, Annals of surgery.

[4]  R. Hinman,et al.  Comparative effect of two educational videos on self-efficacy and kinesiophobia in people with knee osteoarthritis: An online randomised controlled trial. , 2022, Osteoarthritis and cartilage.

[5]  T. McCoy,et al.  Efficacy of App-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder with Coach Support: Initial Randomized Controlled Clinical Trial , 2022, Psychotherapy and Psychosomatics.

[6]  E. Losina,et al.  Effectiveness of remote exercise programs in reducing pain for patients with knee osteoarthritis: A systematic review of randomized trials , 2022, Osteoarthritis and cartilage open.

[7]  R. Hinman,et al.  COMPARING VIDEO-BASED TELEHEALTH-DELIVERED EXERCISE AND WEIGHT LOSS PROGRAMS WITH ONLINE EDUCATION ON OUTCOMES OF KNEE OSTEOARTHRITIS: A RANDOMIZED TRIAL , 2022, Osteoarthritis and Cartilage.

[8]  S. McLean,et al.  Patient Perceptions of Wearable and Smartphone Technologies for Remote Outcome Monitoring in Patients Who Have Hip Osteoarthritis or Arthroplasties. , 2022, The Journal of arthroplasty.

[9]  E. Hafiz,et al.  The effect of rehabilitation protocol using mobile health in overweight and obese patients with knee osteoarthritis: a clinical trial , 2021, Advances in Rheumatology.

[10]  F. Casanueva,et al.  Inflammatory markers are associated with quality of life, physical activity, and gait speed but not sarcopenia in aged men (40–79 years) , 2021, Journal of cachexia, sarcopenia and muscle.

[11]  H. Saadati,et al.  The effect of mobile-app-based instruction on the physical function of female patients with knee osteoarthritis: a parallel randomized controlled trial , 2021, BMC Women's Health.

[12]  S. Charoensiriwath,et al.  Development of a mobile application to improve exercise accuracy and quality of life in knee osteoarthritis patients: a randomized controlled trial , 2021, Archives of Orthopaedic and Trauma Surgery.

[13]  E. Hansson,et al.  Promoting work ability with a wearable activity tracker in working age individuals with hip and/or knee osteoarthritis: a randomized controlled trial , 2021, BMC Musculoskeletal Disorders.

[14]  Chia-Lun Lee,et al.  Effects of Diet Control and Telemedicine-Based Resistance Exercise Intervention on Patients with Obesity and Knee Osteoarthritis: A Randomized Control Trial , 2021, International journal of environmental research and public health.

[15]  Y. In,et al.  The Minimal Clinically Important Difference (MCID) for the WOMAC and Factors Related to Achievement of the MCID After Medial Opening Wedge High Tibial Osteotomy for Knee Osteoarthritis , 2021, The American journal of sports medicine.

[16]  M. Danila,et al.  Disruptions in Rheumatology Care and the Rise of Telehealth in Response to the COVID‐19 Pandemic in a Community Practice–Based Network , 2021, Arthritis care & research.

[17]  R. Hinman,et al.  Effects of a Self-directed Web-Based Strengthening Exercise and Physical Activity Program Supported by Automated Text Messages for People With Knee Osteoarthritis: A Randomized Clinical Trial. , 2021, JAMA internal medicine.

[18]  P. Devita,et al.  Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults With Knee Osteoarthritis: The START Randomized Clinical Trial. , 2021, JAMA.

[19]  A. Valdes,et al.  Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis , 2021, JAMA network open.

[20]  Shivan J. Mehta,et al.  Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy , 2021, JAMA network open.

[21]  Su-Hang Xie,et al.  Effect of Internet-Based Rehabilitation Programs on Improvement of Pain and Physical Function in Patients with Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Controlled Trials , 2020, Journal of medical Internet research.

[22]  James Brian Byrd,et al.  Stepped Exercise Program for Patients With Knee Osteoarthritis , 2020, Annals of Internal Medicine.

[23]  H. Roschel,et al.  Health Coaching Strategies for Weight Loss: A Systematic Review and Meta-Analysis. , 2020, Advances in nutrition.

[24]  Shivan J. Mehta,et al.  Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty , 2020, JAMA network open.

[25]  L. Kaye,et al.  The impact of patient self-monitoring via electronic medication monitor and mobile app plus remote clinician feedback on adherence to inhaled corticosteroids: A randomized controlled trial. , 2020, The journal of allergy and clinical immunology. In practice.

[26]  M. Almarwani,et al.  The effect of innovative smartphone application on adherence to a home-based exercise programs for female older adults with knee osteoarthritis in Saudi Arabia: a randomized controlled trial , 2020, Disability and rehabilitation.

[27]  R. Hinman,et al.  Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial , 2020, Journal of medical Internet research.

[28]  C. Murray,et al.  Fertility, mortality, migration, and population scenarios for 195 countries and territories from 2017 to 2100: a forecasting analysis for the Global Burden of Disease Study , 2020, The Lancet.

[29]  H. Nose,et al.  Internet of Things (IoT) System and Field Sensors for Exercise Intensity Measurements. , 2020, Comprehensive Physiology.

[30]  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.

[31]  D. Felson,et al.  Efficacy of Computer‐Based Telephone Counseling on Long‐Term Adherence to Strength Training in Elderly Patients With Knee Osteoarthritis: A Randomized Trial , 2020, Arthritis care & research.

[32]  G. Guyatt,et al.  Evaluating the credibility of anchor based estimates of minimal important differences for patient reported outcomes: instrument development and reliability study , 2020, BMJ.

[33]  Sue Romanick-Schmiedl,et al.  Telemedicine — maintaining quality during times of transition , 2020, Nature Reviews Disease Primers.

[34]  Elham Monaghesh,et al.  The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence , 2020, BMC Public Health.

[35]  B. Abramoff,et al.  Osteoarthritis: Pathology, Diagnosis, and Treatment Options. , 2020, The Medical clinics of North America.

[36]  D. Whelan,et al.  Physiotherapy as an Initial Treatment Option for Femoroacetabular Impingement: A Systematic Review of the Literature and Meta-analysis of 5 Randomized Controlled Trials , 2019, The American journal of sports medicine.

[37]  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.

[38]  G. Collins,et al.  Global, regional and national burden of osteoarthritis 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017 , 2019, Annals of the Rheumatic Diseases.

[39]  C. Cooper,et al.  Gut microbiota and osteoarthritis management: An expert consensus of the European society for clinical and economic aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO) , 2019, Ageing Research Reviews.

[40]  J H Abbott,et al.  OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. , 2019, Osteoarthritis and cartilage.

[41]  J. Kvedar,et al.  Reported Cases of Medical Malpractice in Direct-to-Consumer Telemedicine , 2019, JAMA.

[42]  H. Chu,et al.  When continuous outcomes are measured using different scales: guide for meta-analysis and interpretation , 2019, British Medical Journal.

[43]  C. Juhl,et al.  Effects of exercise and physical activity promotion: meta-analysis informing the 2018 EULAR recommendations for physical activity in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis , 2018, RMD Open.

[44]  C. Rissel,et al.  Telephone-based weight loss support for patients with knee osteoarthritis: a pragmatic randomised controlled trial. , 2018, Osteoarthritis and cartilage.

[45]  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.

[46]  Thomas H. Lee,et al.  In-Person Health Care as Option B. , 2018, The New England journal of medicine.

[47]  Jennifer Abbasí Can Exercise Prevent Knee Osteoarthritis? , 2017, JAMA.

[48]  K. Allen,et al.  Gaps in appropriate use of treatment strategies in osteoarthritis. , 2017, Best practice & research. Clinical rheumatology.

[49]  K. Azma,et al.  Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: A randomized clinical trial , 2017, Journal of telemedicine and telecare.

[50]  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.

[51]  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.

[52]  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.

[53]  R. Poolman,et al.  Return to Sports and Physical Activity After Total and Unicondylar Knee Arthroplasty: A Systematic Review and Meta-Analysis , 2016, Sports Medicine.

[54]  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.

[55]  M. V. van Tulder,et al.  Therapeutic ultrasound for chronic low-back pain. , 2014, The Cochrane database of systematic reviews.

[56]  T. Furukawa,et al.  Which is more generalizable, powerful and interpretable in meta-analyses, mean difference or standardized mean difference? , 2014, BMC Medical Research Methodology.

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

[58]  David T Felson,et al.  Increasing Prevalence of Knee Pain and Symptomatic Knee Osteoarthritis: Survey and Cohort Data , 2011, Annals of Internal Medicine.

[59]  F. Berenbaum,et al.  Osteoarthritis: an update with relevance for clinical practice , 2011, The Lancet.

[60]  Sigridur Halldorsdottir,et al.  Facilitators and Barriers to Exercising Among People With Osteoarthritis: A Phenomenological Study , 2010, Physical Therapy.

[61]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration , 2009, BMJ : British Medical Journal.

[62]  Nikolaos A Patsopoulos,et al.  Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. , 2008, International journal of epidemiology.

[63]  L. Gask Role of specialists in common chronic diseases , 2005, BMJ : British Medical Journal.

[64]  G. Norman,et al.  Randomized controlled trials. , 2004, AJR. American journal of roentgenology.

[65]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[66]  T. Coughlin Knee osteoarthritis. , 2011, American family physician.