Blended Physical Activity Intervention With Reduced Face-To-Face Contact And Usual Physical Therapy Show Similar Effectiveness In Patients With Knee And Hip Osteoarthritis: A Randomized Controlled Trial

Background Exercise therapy is an effective treatment in patients with knee and hip osteoarthritis. However, face-to-face therapy is an expensive regimen. Blended exercise therapy, in which face-to-face contact is combined with a web-based program, might be a cost-effective alternative. Moreover, a blended intervention supports home-exercises and self-management through technology which is available at any time and place. We developed the blended intervention e-Exercise, a 12-week program in which up to five usual physical therapy sessions are integrated with a web-based program.Objectives The objective of this study was to evaluate the short-term effectiveness of e-Exercise compared to usual physical therapy for patients with knee and/or knee osteoarthritis.Methods A multicentre cluster randomized controlled trial was conducted. A number of 247 physical therapists were randomly allocated to e-Exercise (intervention group) or usual physical therapy (control group). The web-based part of e-Exercise is based on graded activity principles. Individual assignments for a central activity, such as walking or cycling, are gradually increased and supported with strength/stability exercises and information modules. Program progress can be evaluated during the face-to-face sessions. Content of these sessions were in both groups based on the Dutch physiotherapy guideline Osteoarthritis Hip-Knee which recommend education, self-management promotion, exercise therapy and if necessary manual therapy. Primary patient-outcomes, measured at baseline and after 12 weeks, were physical functioning and physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy and the number of physical therapy sessions. Data were analysed using a mixed linear model.Results Totally, 208 patients were included. There were no significant differences in baseline demographics between the intervention (N=108) and control group (N=100). 176 (85%) participants completed the follow-up questionnaire. After 12 weeks, none of the primary outcome measures were significant different between groups. Within group analyses, however, showed for both groups a significant improvement in physical functioning (IG: +4.1 points/100, pu003c0.01; CG: +5.3 points/100, pu003c0.01). Participants in the intervention group reported an increase of 23.7 minutes (p=0.03) physical activity per day, the control group an increase of 13.1 minutes (p=0.21). However, no significant differences were found for physical activity measured with ActiGraph accelerometers. With respect to the other outcomes, tiredness reduced significant (pu003c0.02) more in the intervention group (-1.3 points/10) compared to the control group (-0.5 points/10). Within both groups there were significant improvements for pain, tiredness, quality of life and self-efficacy. The intervention group received 5 face-to face sessions (range 2–16), the control group 12 (range 2–29).Conclusions In this study we found that e-Exercise is an effective treatment option in patients with knee and hip osteoarthritis. Subgroup-analysis, long-term effectiveness and cost-effectiveness of e-Exercise compared to usual physical therapy are forthcoming.Disclosure of Interest None declared