. 2018 Jul 19;19(1):238.

doi: 10.1186/s12891-018-2139-y.

Level of participation in physical therapy or an internet-based exercise training program: associations with outcomes for patients with knee osteoarthritis

Megan Pignato¹, Liubov Arbeeva^{2

3}, Todd A Schwartz^{2

4

5}, Leigh F Callahan^{2

3}, Jennifer Cooke⁶, Yvonne M Golightly^{2

7

8}, Adam P Goode^{9

10}, Bryan C Heiderscheit¹¹, Carla Hill⁶, Kim M Huffman^{12

13}, Herbert H Severson¹⁴, Kelli D Allen^{15

16

17}

Affiliations

¹ University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd, Grand Forks, ND, USA.
² Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB#, Chapel Hill, NC, 7280, USA.
³ Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall CB#, Chapel Hill, NC, 7005, USA.
⁴ Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵ School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Division of Physical Therapy, Department of Allied Health Services, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁹ Duke Clinical Research Institute, Durham, NC, USA.
¹⁰ Division of Physical Therapy, Department of Orthopedic Surgery, Duke University Medical Center, Durham, USA.
¹¹ Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
¹² Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
¹³ Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, NC, USA.
¹⁴ Oregon Research Institute, Eugene, OR, USA.
¹⁵ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB#, Chapel Hill, NC, 7280, USA. kdallen@email.unc.edu.
¹⁶ Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall CB#, Chapel Hill, NC, 7005, USA. kdallen@email.unc.edu.
¹⁷ Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA. kdallen@email.unc.edu.

PMID: 30025540
PMCID: PMC6053740
DOI: 10.1186/s12891-018-2139-y

Level of participation in physical therapy or an internet-based exercise training program: associations with outcomes for patients with knee osteoarthritis

Megan Pignato et al. BMC Musculoskelet Disord. 2018.

. 2018 Jul 19;19(1):238.

doi: 10.1186/s12891-018-2139-y.

Authors

Affiliations

¹ University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd, Grand Forks, ND, USA.
² Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB#, Chapel Hill, NC, 7280, USA.
³ Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall CB#, Chapel Hill, NC, 7005, USA.
⁴ Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵ School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Division of Physical Therapy, Department of Allied Health Services, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁸ Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁹ Duke Clinical Research Institute, Durham, NC, USA.
¹⁰ Division of Physical Therapy, Department of Orthopedic Surgery, Duke University Medical Center, Durham, USA.
¹¹ Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
¹² Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
¹³ Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, NC, USA.
¹⁴ Oregon Research Institute, Eugene, OR, USA.
¹⁵ Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Bldg., CB#, Chapel Hill, NC, 7280, USA. kdallen@email.unc.edu.
¹⁶ Department of Medicine, University of North Carolina at Chapel Hill, 125 MacNider Hall CB#, Chapel Hill, NC, 7005, USA. kdallen@email.unc.edu.
¹⁷ Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA. kdallen@email.unc.edu.

PMID: 30025540
PMCID: PMC6053740
DOI: 10.1186/s12891-018-2139-y

Abstract

Background: To examine whether number of physical therapy (PT) visits or amount of use of an internet-based exercise training (IBET) program is associated with differential improvement in outcomes for participants with knee osteoarthritis (OA).

Methods: A secondary analysis was performed using data from participants in 2 arms of a randomized control trial for individuals with symptomatic knee OA: PT (N = 135) or IBET (N = 124). We examined associations of number of PT visits attended (up to 8) or number of days the IBET website was accessed during the initial 4-month study period with changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, pain and function subscales, as well as a 2-min Step Test, at 4-month and 12-month follow-up.

Results: Participants with more PT visits experienced greater improvement in WOMAC total score (estimate per additional visit = - 1.18, CI 95% = - 1.91, 0.46, p < 0.001) and function subscore (estimate = - 0.80, CI 95% = - 1.33, - 0.28, p < 0.001) across follow-up periods. For WOMAC pain subscale, the association with number of PT visits varied significantly between 4- and 12-month follow-up, with a stronger relationship at 4-months. There was a non-significant trend for more PT visits to be associated with greater improvement in 2-min Step Test. More frequent use of the IBET website was not associated with greater improvement for any outcome, at either time point.

Conclusion: Increased number of PT visits was associated with improved outcomes, and some of this benefit persisted 8 months after PT ended. This provides guidance for PT clinical practice and policies.

Trial registration: NCT02312713 , posted 9/25/2015.

Keywords: Exercise; Osteoarthritis; Physical therapy.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Institutional Review Boards of the University of North Carolna at Chapel Hill and Duke University Medical Center. All study participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

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

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Model-Predicted Mean Changes in Outcome by Number of PT Visits Attended

**Fig. 2**
Associations between Use of Physical Therapy (PT) or Internet-Based Exercise Training (IBET) and change in Western Ontario and McMasters Universities Osteoarthritis Index Pain and Total Scores at 4- and 12-month Follow-up

See this image and copyright information in PMC

References

1. Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59(9):1207–1213. doi: 10.1002/art.24021. - DOI - PMC - PubMed
1. Dominick KL, Ahern FM, Gold CH, Heller DA. Health-related quality of life and health service utilization among older adults with osteoarthritis. Arthritis Care Res. 2004;51:326–331. doi: 10.1002/art.20390. - DOI - PubMed
1. Hootman JM, Helmick CG, Brady TJ. A public health approach to addressing arthritis in older adults: the most common cause of disability. Am J Public Health. 2012;102(3):426–433. doi: 10.2105/AJPH.2011.300423. - DOI - PMC - 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(6):701–712. doi: 10.1016/j.semarthrit.2013.11.012. - DOI - 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(24):1554–1557. doi: 10.1136/bjsports-2015-095424. - DOI - PubMed

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Level of participation in physical therapy or an internet-based exercise training program: associations with outcomes for patients with knee osteoarthritis

Affiliations

Level of participation in physical therapy or an internet-based exercise training program: associations with outcomes for patients with knee osteoarthritis

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Figures

References

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