Accepted for/Published in: JMIR Formative Research
Date Submitted: Aug 4, 2021
Date Accepted: Nov 22, 2021
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Expert-Moderated Peer-to-Peer Online Support Group for People With Knee Osteoarthritis: A Mixed Methods Randomized Controlled Pilot and Feasibility Study
ABSTRACT
Background:
Osteoarthritis (OA) is a major problem globally. Effective first-line management centers on education and self-management strategies. Online support groups may be a low-cost method of facilitating self-management.
Objective:
This randomized controlled pilot study evaluated the feasibility of the study design and implementation of an evidence-informed, expert-moderated, peer-to-peer online support group (My Knee Community) for people with knee OA. The impacts on psychological determinants of self-management, selected self-management behaviors and health outcomes were secondary investigations.
Methods:
This mixed methods study evaluated 1) study feasibility (participant recruitment, retention and costs), 2) experimental intervention feasibility (acceptability and fidelity to proposed design including perceived benefit, satisfaction and member engagement), 3) psychological determinants (eg, self-efficacy, social support), 4) behavioral measures, 5) health outcomes and 6) harms. Sixty-three participants (41 experimental, 22 control) with self-reported knee OA were recruited. Experimental group participants were provided membership to the My Knee Community that already had existing non-study members, plus recommended a web-based patient education resource (My Joint Pain). The control group received the My Joint Pain website recommendation only. Participants were not blinded to their group allocation or the study interventions. Participant-reported data were collected remotely using web-based questionnaires. Ten experimental group participants also participated in semi-structured interviews. The transcribed interview data and all forum posts by study participants were thematically analyzed.
Results:
Sixty-three participants (41 experimental, 22 control) with self-reported knee OA were recruited from 186 volunteers. Study feasibility is supported by acceptable levels of retention, however there were low levels of engagement with the support group by participants: 6 (15%) did not log in at all; median number of times visited was 4 per participant; only 12 (29%) of participants posted, and there were relatively low levels of activity overall on the forum. This impacted the results for satisfaction (mean overall 5.9/10, SD 2.7) and perceived benefit (17 (55%) ‘yes’). There were no differences between groups for quantitative outcomes. Themes discussed in the interviews were Connections and support, Information and advice, and Barriers/facilitators. Qualitative data suggest there is potential for people to derive benefit from connecting with others with knee OA through receiving support and assisting with unmet informational needs.
Conclusions:
While a large-scale study is feasible, the intervention implementation was considered unsatisfactory due to low levels of activity and engagement by members. We recommend that expectations about the support group need to be made clear from the outset. Also, the platform design needs to be more engaging and rewarding, and membership should only be offered to people willing to share their personal stories and/or who are interested in learning from the experiences of others. Clinical Trial: Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12619001230145; http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377958
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