Effectiveness of a Web-Guided Self-Managed Telerehabilitation Program Enhanced with Outdoor Physical Activity on Physical Function, Physical Activity Levels and Pain in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Maria Moutzouri; George A Koumantakis; Michael Hurley; Aggeliki Georgia Kladouchou; George Gioftsos

doi:10.3390/jcm13040934

Effectiveness of a Web-Guided Self-Managed Telerehabilitation Program Enhanced with Outdoor Physical Activity on Physical Function, Physical Activity Levels and Pain in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

J Clin Med. 2024 Feb 6;13(4):934. doi: 10.3390/jcm13040934.

Authors

Maria Moutzouri¹, George A Koumantakis¹, Michael Hurley^{2

3

4}, Aggeliki Georgia Kladouchou¹, George Gioftsos¹

Affiliations

¹ Department of Physiotherapy, University of West Attica, 12243 Athens, Greece.
² Centre for Allied Health, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
³ Department of Rehabilitation Sciences, Kingston University, Holmwood House, Grove Crescent, Kingston upon Thames KT1 2EE, UK.
⁴ Orthopaedic Research UK, Furlong House, 10a Chandos Street, London W1G 9DQ, UK.

Abstract

Background: Telerehabilitation to guide self-management has been shown to be a feasible care strategy for knee osteoarthritis (KOA). The aim of this study was to explore the effectiveness of a blended web-based rehabilitation program enhanced with outdoor physical activity (BWR-OPA) and consultation versus an OPA (usual care) program in KOA patients. Methods: Forty-four KOA participants were prescribed to follow the programs five times/week for 6 weeks. The primary outcome was self-reported physical function, measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS). The secondary outcomes were pain, PA, function (timed up-and-go (TUG) test, 30 s chair rise test (30 s CRT)), psychological functioning and QoL. Results: There was a significant difference between the groups' KOOSs for pain and symptom subscales at the 6- and 12-week post-intervention assessments compared to baseline (p < 0.005) favoring the BWR-OPA group. There was a superior improvement in PA in the BWR-OPA training group (p < 0.05). Statistical and clinical improvements were found (p < 0.001) with effect sizes over 2.0 for objective measures of function. Similar improvements were recorded over time (p < 0.005) at 12 weeks for QoL, KOOS subscales for ADL, QoL and sports/recreation and psychological functioning for both groups. Conclusions: A blended web-based self-managed care program with outdoor PA was superior in many respects to usual care in KOA participants.

Keywords: advice; home-based; knee osteoarthritis; physical activity; self-managed exercise; web-based.

Grants and funding

This research study is co-financed by Greece and the European Union (European Social Fund-ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning» in the context of the project “Reinforcement of Postdoctoral Researchers—2nd Cycle” (MIS-5033021), implemented by the State Scholarships Foundation (ΙΚΥ).