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SAT0432 Blended Physical Activity Intervention with Reduced Face-To-Face Contact and Usual Physical Therapy Show Similar Effectiveness in Patients with Knee and Hip Osteoarthritis: A Randomized Controlled Trial
  1. C.J. Kloek1,
  2. D. Bossen2,
  3. D.H. de Bakker3,
  4. J. Dekker4,
  5. C. Veenhof5
  1. 1TRANZO, Tilburg University, Tilburg
  2. 2ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam
  3. 3Netherlands Institute for Health Services Research, Utrecht
  4. 4Department of Rehabilitation Medicine & Department of Psychiatry, EMGO Institute, VU University Medical Center Amsterdam, Amsterdam
  5. 5Department of Rehabilitation, Nursing Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands

Abstract

Background Exercise therapy is an effective treatment in patients with knee and hip osteoarthritis. However, face-to-face therapy is an expensive regimen. Blended exercise therapy, in which face-to-face contact is combined with a web-based program, might be a cost-effective alternative. Moreover, a blended intervention supports home-exercises and self-management through technology which is available at any time and place. We developed the blended intervention e-Exercise, a 12-week program in which up to five usual physical therapy sessions are integrated with a web-based program.

Objectives The objective of this study was to evaluate the short-term effectiveness of e-Exercise compared to usual physical therapy for patients with knee and/or knee osteoarthritis.

Methods A multicentre cluster randomized controlled trial was conducted. A number of 247 physical therapists were randomly allocated to e-Exercise (intervention group) or usual physical therapy (control group). The web-based part of e-Exercise is based on graded activity principles. Individual assignments for a central activity, such as walking or cycling, are gradually increased and supported with strength/stability exercises and information modules. Program progress can be evaluated during the face-to-face sessions. Content of these sessions were in both groups based on the Dutch physiotherapy guideline Osteoarthritis Hip-Knee which recommend education, self-management promotion, exercise therapy and if necessary manual therapy. Primary patient-outcomes, measured at baseline and after 12 weeks, were physical functioning and physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy and the number of physical therapy sessions. Data were analysed using a mixed linear model.

Results Totally, 208 patients were included. There were no significant differences in baseline demographics between the intervention (N=108) and control group (N=100). 176 (85%) participants completed the follow-up questionnaire. After 12 weeks, none of the primary outcome measures were significant different between groups. Within group analyses, however, showed for both groups a significant improvement in physical functioning (IG: +4.1 points/100, p<0.01; CG: +5.3 points/100, p<0.01). Participants in the intervention group reported an increase of 23.7 minutes (p=0.03) physical activity per day, the control group an increase of 13.1 minutes (p=0.21). However, no significant differences were found for physical activity measured with ActiGraph accelerometers. With respect to the other outcomes, tiredness reduced significant (p<0.02) more in the intervention group (-1.3 points/10) compared to the control group (-0.5 points/10). Within both groups there were significant improvements for pain, tiredness, quality of life and self-efficacy. The intervention group received 5 face-to face sessions (range 2–16), the control group 12 (range 2–29).

Conclusions In this study we found that e-Exercise is an effective treatment option in patients with knee and hip osteoarthritis. Subgroup-analysis, long-term effectiveness and cost-effectiveness of e-Exercise compared to usual physical therapy are forthcoming.

Disclosure of Interest None declared

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