JMIR Publications

ABSTRACT

Background:

Knee osteoarthritis (KOA) is the most common joint disorder in the U.S. and a leading cause of disability. Depression and obesity are highly comorbid with KOA and accelerate knee degeneration and disability through biopsychosocial mechanisms. Mind-body physical activity programs can engage biological, mechanical, and psychological mechanisms to improve outcomes in KOA, but such programs are not currently available.

Objective:

Here, we report on a mixed-methods study to adapt a mind-body activity program for the unique needs of patients with KOA, depression, and obesity (GetActive-OA) delivered via live video.

Methods:

Participants were adults (age ≥ 45) from rural Kentucky with obesity (BMI ≥ 30 kg/m2), idiopathic KOA with mild to moderate radiographic changes, and elevated depressive symptoms (PHQ-9 ≥ 10) recruited from two orthopedic centers. In Phase 1, we developed GetActive-OA and the study protocol using qualitative focus group feedback from the study population (N = 9; 2 focus groups, 90 minutes) and multidisciplinary expertise from clinical psychologists and orthopedic researchers. In Phase 2, we explored the initial feasibility, credibility, and acceptability of GetActive-OA, live video delivery, and study procedures via an open pilot with exit interviews (N = 5, 1 group). This research was guided by the NIH Model Stage 1A.

Results:

Phase 1 qualitative analyses revealed nuanced information about: 1) challenges with coping and increasing activity, 2) high interest in a mind-body activity program, 3) program participation facilitators (flexibility with technology) and barriers (amotivation, forgetfulness), and 4) perceived challenges with data collection procedures (blood and urine samples, homework). Phase 2 quantitative analyses showed that GetActive-OA met most a priori feasibility markers (e.g., feasibility of recruitment, acceptability, expectancy, credibility, adherence, and program satisfaction). Adherence to ActiGraph wear and collection of blood samples was low. Participation in GetActive-OA was associated with signals of improvements in pain, KOA symptoms, depression, anxiety, pain catastrophizing, self-efficacy, and general coping. Qualitative exit interviews confirmed quantitative findings and provided valuable information to optimize the program and protocol.

Conclusions:

Patients with KOA, depression, and obesity from rural Kentucky are interested in a virtual mind-body activity program this comorbidity GetActive-OA shows promise, but the program and protocol require further NIH stage 1 refinement before formal efficacy testing (NIH model stage II).