An App for Exercise Adherence in Knee OA

Project #3: Development of a Novel e-Health App for Knee OA Exercise Adherence (PI: Julie Keysor)

Knee osteoarthritis (OA) is a chronic, painful, and often progressive condition that 1 in 2 adults will develop in their lifetime. There is no cure for OA and for many people walking short distances and climbing stairs becomes difficult if not impossible. Numerous clinical trials show exercise is effective at decreasing pain and improving function but adherence to exercise regimens is poor. Effective interventions are needed to help people sustain exercise behaviors. M-health and E-health technology is rapidly expanding and could be used to promote adherence to evidence-based exercises. M-health or E-health approaches for sustained exercise adherence among people with knee OA are not available.

In December 2015, the Center for Enhancing Activity and Participation among Persons with Arthitis completed data collection on a large, randomized control trial, titled the “Boston Overcoming Osteoarthritis Strength Training Study (BOOST)”, examining the efficacy of a telelink communication system (TLC) to promote 2-year adherence to an evidence-based progressive resistance strength training program for people with knee OA. TLC is a technology that links computers with telephones to deliver behavioral motivational voice programming. Preliminary results show no effect of the TLC compared to the control group that received a computer generated monthly exercise reminder call; however, the BOOST study staff received “alerts” through the TLC system noting a participant stopped exercising, developed an illness, or had an increase in pain and may benefit from consultation with a BOOST exercise expert. Furthermore, preliminary findings from an ancillary qualitative study to BOOST suggest people who adhered to the program experienced and interpreted clear benefits to themselves (e.g., less pain) and were able to set goals and create an environment that supported their new exercise behavior (e.g., “I designated a spot in my room”); whereas, people who did not adhere to the program were more ambivalent about the benefits of exercise and noted the need for more social interaction and connection to peers and instructors. Participants were enthusiastic about strategies to foster adherence after the program had ended but the optimal mechanisms and technological approach were not clear.

Goal setting, building self-efficacy, enhancing motivation for changing and problem-solving are features of other apps that have been previously developed by ARC investigators (e.g., Borrelli & Quintiliani) and could be adapted for use and further developed and tailored for people with knee OA to sustain exercise after treatment. The area that is less explored is how patients with knee OA can be readily linked to experts and to others with knee OA through a mobile health application. To address this gap we propose to conduct several iterative focus groups to gain an understanding of the features that would be important to include in a mobile app to sustain exercise in a home setting among knee OA patients then to develop a low-fidelity mobile app on which to conduct user testing. Once this platform is approved by our stakeholders, we plan to pursue funding to test its efficacy in the home environment.