JMIR Publications

ABSTRACT

Background:

Osteoarthritis (OA) is a leading contributor to global disability, with the hip and knee being the most common joints affected. While evidence supports the effectiveness of Tai Chi for improving symptoms for people with hip and knee OA, access to in-person Tai Chi classes may be difficult for many due to logistical constraints and cost. Design of an unsupervised online Tai Chi intervention for people with OA has the potential to overcome these barriers. Use of the Approach to Human-Centered, Evidence-Driven Adaptive Design (AHEAD) framework provides a practical guide for co-designing such an intervention.

Objective:

To develop an unsupervised online Tai Chi program for people with hip/knee OA.

Methods:

An iterative process using the AHEAD framework. A panel of Tai Chi instructors and consumers with OA was assembled. A literature review was conducted to identify characteristics of effective supervised OA Tai Chi interventions. Findings informed content of a survey (survey 1), that was completed by the panel and additional Australian Tai Chi instructors, to identify Tai Chi movements for potential inclusion into the program. Selection of Tai Chi movements was based on 3 criteria: appropriate (for people with knee/hip OA aged over 45 years old); safe (to be performed at home unsupervised); and practical (to be delivered online using pre-recorded videos). Movements meeting these criteria were then ranked in a second survey (using conjoint analysis methodology) from the most appropriate/safe to least appropriate/safe. Survey findings were discussed in a focus group and the Tai Chi movements to be used in the program were identified. A draft of the online Tai Chi program was developed, and a final survey (Survey 3) was conducted with the panel to rate the proposed Tai Chi program’s appropriateness and safety. The final program was developed, and usability testing (Think-Aloud protocol) conducted with people with knee OA.

Results:

The panel consisted of 10 Tai Chi instructors and 3 consumers with OA. The literature review identified Yang style 24 as a common and effective Tai Chi style used in hip/knee OA studies. Survey 1 (n=35) and 2 (n=27) produced a ranked list of 24 Tai Chi movements for potential inclusion in the program. This list was refined, informed by focus group discussion, resulting in 10 Tai Chi movements being selected for inclusion (known as the Yang style 10 form). The third survey (n=13) found 92% of the panel believed that the proposed draft Tai Chi program was appropriate and safe resulting in its adoption for the online program. The final program was produced and housed within a customized website "My Joint Tai Chi" which was refined based on user feedback (n=5). “My Joint Tai Chi” is currently being evaluated in a randomised controlled trial.

Conclusions:

This study demonstrates use of the AHEAD framework to develop an unsupervised online Tai Chi intervention (“My Joint Tai Chi”) for people with hip/knee OA.