JMIR Publications

ABSTRACT

Background:

The global burden of hip and knee osteoarthritis (OA) has been ranked as the 11th highest contributor to global disability. Exercise has been shown to be effective to decrease pain and increase physical function. The model for physical activity-related health competence (PAHCO) describes possibilities to empower patients to perform physical exercises in the best possible health-promoting manner while taking into account their own physical condition. Face-to-face supervision is the gold standard for exercise guidance.

Objective:

The aim of this study is to evaluate whether instruction and guidance via a digital application based on an evidence-based exercise regime is not inferior to supervision by a physiotherapist with regard to movement quality, control competence for physical training, and exercise-specific self-efficacy.

Methods:

Patients with clinically diagnosed hip OA were recruited via print advertisements. The intervention consisted of two identical training sessions with one exercise for mobility, two for strength, and one for balance. One session was guided by a physiotherapist (P), the other by a fully automated tablet computer-based application (A). Both interventions took place at the University hospital. Outcomes were assessor rated movement quality (MQ) and self-reported questionnaires on exercise-specific self-efficacy (ESE), and control competence for physical training (CCPT). Participants were randomly assigned to one of two treatment sequences. One sequence started with the application in the first session followed by the physiotherapist in the second session after a minimum wash-out phase of 27 days (AP), the other sequence vice versa (PA). Non-inferiority was defined as a between treatment effect gIG was < 0.2 in favour of P including the upper confidence interval. Participants, assessors and statistician were neither blinded to the treatment nor to treatment sequence.

Results:

54 participants started the first training session (32 female, 22 male; mean age 62.4, SD 8.2 years). Both treatment sequence groups were similar in size (PA: n=26; AP: n=28). 7 subjects did not attend the second training session (PA: n=3; AP: n=4). The app was inferior to the physiotherapist in all outcomes considered, except MQ of the mobility exercise (gIG = -0.13, 95% CI = [-0.41, 0.16]). In contrast to the two strengthening exercises in different positions (supine gIG=0.76, 95% CI = [0.39, 1.13]; table gIG = 1.19, 95% CI = [0.84, 1.55]), MQ of the balance exercise was close to non-inferiority (gIG = 0.15, 95% CI = [-0.17, 0.48]). ESE showed a strong effect in favour of the physiotherapist (gIG = 0.84, 95% CI = [0.46, 1.22]). In terms of CCPT, the app was only slightly inferior to the physiotherapist (gIG=0.18, 95% CI = [-0.14, 0.50]).

Conclusions:

Despite its inferiority in almost all measures of interest, ESE and CCPT did improve in patients who used the digital app. MQ was acceptable for exercises that are easy to conduct and instruct. The digital app opens up possibilities as a supplementary tool to support the patient in independent home training for less complex exercises. However, it cannot replace a physiotherapist. Clinical Trial: German Clinical Trial Register number: DRKS00015759