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“Using the strengthening exercises with mHealth may have the potential to reduce pain, improve mobility, functional activity, and activities of daily living among knee osteoarthritis patients who are overweight or obese," investigators stated.
Overweight or obese patients with knee osteoarthritis (OA) who utilized a lower limb rehabilitation protocol (LLRP) in conjunction with mobile health (mHealth) applications saw a reduction in knee pain and improvements in mobility, activities of daily living (ADL), and functional activity, according to a study published in Advances in Rheumatology.1
“Knee OA among patients who are overweight or obese has been shown to cause progressive changes in the muscles and articular cartilage of the joint that may not be sufficiently targeted with current rehabilitation approaches,” investigators explained. “Using the strengthening exercises of LLRP combined with mHealth may have the potential to reduce pain, improve mobility, functional activity, and ADL among knee OA patients who are overweight or obese.”
The single-blind, randomized control trial (RCT) was conducted at Teaching Bay of Rehmatul-Lil-Alameen Post Graduate Institute of Cardiology. Eligible patients were overweight or obese, aged between 45 and 50 years, had symptoms of knee OA for more than 3 months, were diagnosed with either mild or moderate OA, and were familiar with WhatsApp applications. Participants all lived in Lahore, Pakistan.
Patients were randomized into 3 groups: rehabilitation group with mHealth (RGw-mHealth, n = 38), rehabilitation group without mHealth (RGwo-mHealth, n = 38), and a control group (CG, n = 38). Patients in both RGw-mHealth and RGwo-mHealth cohorts received LLRP and instructions of daily care (ICD), which included general mobility guidelines and healthy eating tips. The RGw-mHealth group also received mHealth intervention in the form of regular reminders sent via text (2 text per day, 3 days a week). The CG only received IDC intervention. Over the course of 3 months, participants recorded completion of interventions.
LLRP, a progressive exercise program, focused on strengthening exercises for the lower limbs performed in sitting or lying positions. It included 10 minutes of warm up, followed by 45 to 60 minutes of strengthening exercises and 10 minutes of cool down.
The primary outcome was knee pain assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes, such as mobility, functional activity, and ADL, were assessed using the Timed Up and Go (TUG) test.
Of 114 participants, 84% (n = 96) were able to complete the trial. All groups had significant reduction in knee pain (RGw-mHealth: 2.54; RGwo-mHealth: 1.47; CG: 0.37). At the 3-month follow-up, RGw-mHealth and RGwo-mHealth cohorts demonstrated greater functional activity (− 2.65 [95% CI − 2.82, − 2.48] and − 1.00 [95% CI − 1.17, − 0.83], respectively) when compared with CG (− 0.06 (95% CI − 0.22, 0.10). The RGw-mHealth cohort had a significantly higher mean change in pairwise comparison when compared with both RGwo-mHealth (1.65 [1.35, 1.94]; p < 0.001) and CG (− 2.59 [− 2.89, − 2.30]; p < 0.001) groups. The RGw-mHealth and RGwo-Health cohorts also reported better mobility and ADL.
Patients in the RGw-mHealth group had a significantly higher change in WOMAC pain scores when compared with patients in the RGwo-mHealth (p = 0.022) and CG (p < 0.001) groups. Further, RGwo-mHealth participants had significantly higher WOMAC pain scores when compared with the CG cohort (p = 0.013).
TUG scores improved most in the RGw-mHealth cohort (2.64 s) when compared with RGwo-mHealth (1.34 s) and CG (0.29 s). Again, the RGwo-mHealth was significantly higher than the CG (p < 0.001) regarding a pairwise comparison of TUG scores.
A greater adherence to intervention was seen in patients in the RGw-mHealth group when compared with the RG-wo-mHealth and CG cohorts (difference, 0.79 [0.10, 1.47]; p = 0.017); difference, 3.00 [2.31, 3.68]; p < 0.001, respectively).
As patients were only studied for 3 months, the long-term effects could not be determined. Investigators urge future research involving multiple centers, long-term follow-up, and confirming the findings in relation to psychosocial, physical activity, and comorbidity factors.
“The results of the current study suggest that less knee pain, faster mobility, better functional activity, and ADL score among knee OA patients who were overweight and obese, are augmented better by the implementation of the rehabilitation protocol by using mHealth for rehabilitation or general treatment without mHealth,” investigators concluded. “In this study, the importance of mHealth was revealed in rehabilitation programs for overweight and obese knee OA patients.”
Rafiq MT, Abdul Hamid MS, Hafiz E. The effect of rehabilitation protocol using mobile health in overweight and obese patients with knee osteoarthritis: a clinical trial. Adv Rheumatol. 2021;61(1):63. Published 2021 Oct 24. doi:10.1186/s42358-021-00221-4