Randomized Controlled Trial

. 2018 Mar;26(3):383-396.

doi: 10.1016/j.joca.2017.12.008. Epub 2018 Jan 5.

Physical therapy vs internet-based exercise training for patients with knee osteoarthritis: results of a randomized controlled trial

K D Allen¹, L Arbeeva², L F Callahan³, Y M Golightly⁴, A P Goode⁵, B C Heiderscheit⁶, K M Huffman⁷, H H Severson⁸, T A Schwartz⁹

Affiliations

¹ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA; Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA. Electronic address: kdallen@email.unc.edu.
² Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA. Electronic address: liubov_arbeeva@med.unc.edu.
³ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA. Electronic address: leigh_callahan@med.unc.edu.
⁴ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: golight@email.unc.edu.
⁵ Duke Clinical Research Institute, Durham, NC, USA; Department of Orthopedic Surgery, Division of Physical Therapy, Duke University Medical Center, USA. Electronic address: adam.goode@duke.edu.
⁶ Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA. Electronic address: heiderscheit@ortho.wisc.edu.
⁷ Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA; Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, NC, USA. Electronic address: kim.huffman@duke.edu.
⁸ Oregon Research Institute, Eugene, OR, USA. Electronic address: herb@ori.org.
⁹ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: Todd_Schwartz@unc.edu.

PMID: 29307722
PMCID: PMC6021028
DOI: 10.1016/j.joca.2017.12.008

Randomized Controlled Trial

Physical therapy vs internet-based exercise training for patients with knee osteoarthritis: results of a randomized controlled trial

K D Allen et al. Osteoarthritis Cartilage. 2018 Mar.

. 2018 Mar;26(3):383-396.

doi: 10.1016/j.joca.2017.12.008. Epub 2018 Jan 5.

Authors

K D Allen¹, L Arbeeva², L F Callahan³, Y M Golightly⁴, A P Goode⁵, B C Heiderscheit⁶, K M Huffman⁷, H H Severson⁸, T A Schwartz⁹

Affiliations

¹ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA; Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA. Electronic address: kdallen@email.unc.edu.
² Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA. Electronic address: liubov_arbeeva@med.unc.edu.
³ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall, CB# 7005 Chapel Hill, NC 27599, USA. Electronic address: leigh_callahan@med.unc.edu.
⁴ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: golight@email.unc.edu.
⁵ Duke Clinical Research Institute, Durham, NC, USA; Department of Orthopedic Surgery, Division of Physical Therapy, Duke University Medical Center, USA. Electronic address: adam.goode@duke.edu.
⁶ Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA. Electronic address: heiderscheit@ortho.wisc.edu.
⁷ Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA; Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, NC, USA. Electronic address: kim.huffman@duke.edu.
⁸ Oregon Research Institute, Eugene, OR, USA. Electronic address: herb@ori.org.
⁹ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB# 7280, Chapel Hill, NC 27599, USA; Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: Todd_Schwartz@unc.edu.

PMID: 29307722
PMCID: PMC6021028
DOI: 10.1016/j.joca.2017.12.008

Abstract

Objective: To compare the effectiveness of physical therapy (PT, evidence-based approach) and internet-based exercise training (IBET), each vs a wait list (WL) control, among individuals with knee osteoarthritis (OA).

Design: Randomized controlled trial of 350 participants with symptomatic knee OA, allocated to standard PT, IBET and WL control in a 2:2:1 ratio, respectively. The PT group received up to eight individual visits within 4 months. The IBET program provided tailored exercises, video demonstrations, and guidance on progression. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, range 0 [no problems]-96 [extreme problems]), assessed at baseline, 4 months (primary time point) and 12 months. General linear mixed effects modeling compared changes in WOMAC among study groups, with superiority hypotheses testing differences between each intervention group and WL and non-inferiority hypotheses comparing IBET with PT.

Results: At 4-months, improvements in WOMAC score did not differ significantly for either the IBET or PT group compared with WL (IBET: -2.70, 95% Confidence Interval (CI) = -6.24, 0.85, P = 0.14; PT: -3.36, 95% (CI) = -6.84, 0.12, P = 0.06). Similarly, at 12-months mean differences compared to WL were not statistically significant for either group (IBET: -2.63, 95% CI = -6.37, 1.11, P = 0.17; PT: -1.59, 95% CI = -5.26, 2.08, P = 0.39). IBET was non-inferior to PT at both time points.

Conclusions: Improvements in WOMAC score following IBET and PT did not differ significantly from the WL group. Additional research is needed to examine strategies for maximizing benefits of exercise-based interventions for patients with knee OA.

Trial registration: NCT02312713.

Keywords: Internet; Knee; Osteoarthritis; Physical activity; Physical therapy.

Published by Elsevier Ltd.

PubMed Disclaimer

Conflict of interest statement

Competing interests

Visual Health Information, Inc (VHI) owns the website used in the current manuscript. Heiderscheit and Seversen have received consulting fees from VHI. A patent related to the website described in this manuscript is currently under review.

Figures

**Fig. 2**
Estimated mean WOMAC Total Scores and 95% CIs by Group and Time Point.

**Fig. 3**
Comparison of change in WOMAC total scores between IBET and PT group (non-inferiority hypotheses): Results of intent-to-treat analyses.

See this image and copyright information in PMC

References

1. Meneses SR, Goode AP, Nelson AE, Lin J, Jordan JM, Allen KD, et al. Clinical algorithms to aid osteoarthritis guideline dissemination. Osteoarthr Cartil. 2016 Sep;24(9):1487–99. - PubMed
1. Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM. A systematic review of recommendations and guidelines for the management of osteoarthritis: the Chronic Osteoarthritis Management Initiative of the U.S. Bone and Joint Initiative. Semin Arthritis Rheum. 2014;434:701–12. - PubMed
1. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015;49:1554–7. - PubMed
1. Fontaine KR, Heo M. Changes in the prevalence of U.S. adults with arthritis who meet physical activity recommendations, 2001–2003. J Clin Rheumatol. 2005;11:13–6. - PubMed
1. Shih VC, Song J, Chang RW, Dunlop DD. Racial differences in activities of daily living limitation onset in older adults with arthritis: a national cohort study. Arch Phys Med Rehabil. 2005;86:1521–6. - PubMed

Publication types

Actions
Actions
Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Associated data

Actions
- Search in PubMed
- Search in ClinicalTrials.gov

Grants and funding

CER-1306-02043/PCORI/Patient-Centered Outcomes Research Institute/United States

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Physical therapy vs internet-based exercise training for patients with knee osteoarthritis: results of a randomized controlled trial

Affiliations

Physical therapy vs internet-based exercise training for patients with knee osteoarthritis: results of a randomized controlled trial

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical