Session Information
Date: Tuesday, November 7, 2017
Title: ARHP Rehabilitation Science
Session Type: ARHP Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: The majority of adults with osteoarthritis (OA) are inactive, highlighting the need for continued efforts to promote regular engagement in exercise. Few studies have directly compared different strategies, ranging in intensity of resources required, for improving exercise and related outcomes among patients with OA. The objective of this study was to compare the effectiveness of physical therapy (PT) (with an emphasis on a home exercise program) and internet-based exercise training (IBET) among individuals with knee OA.
Methods: This was a randomized controlled trial of 350 participants with symptomatic knee OA, allocated to PT, IBET and a wait list (WL) control group in a 2:2:1 ratio, respectively. The PT group received up to 8 individual visits within 4 months. The IBET program provided tailored exercises, video demonstrations, and guidance on progression. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and four physical performance tests were included as secondary outcomes: unilateral stand test, 30-second chair stand, 2-minute march, and Timed Up-and-Go. Outcomes were assessed at baseline, 4 months and 12 months. General linear mixed effects modeling compared changes in outcomes among study groups, using an intent-to-treat paradigm.
Results: At 4-months, both the PT and IBET groups improved in WOMAC score, but mean differences compared to WL were not statistically significant (PT: -3.36, 95% Confidence Interval (CI) = -6.84, 0.12, p=0.06; IBET: -2.70, 95%CI = -6.24, 0.85, p=0.14). Similarly, at 12-months mean differences compared to WL were not statistically significant for either group (PT: -1.59, 95% Confidence Interval (CI) = -5.26, 2.08, p=0.39; IBET: -2.63, 95%CI = -6.37, 1.11, p=0.17). Results for WOMAC subscales and physical performance tests are shown in Table 1.
Conclusion: Modest improvements in outcomes following both PT and IBET were observed in comparison to a WL control group. Initial gains were better for the PT group, but the IBET group maintained improvements in WOMAC better over time. A combination of these two interventions, with IBET used as a tool to facilitate home exercise following PT, may result in more robust effects and maintenance over time.
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Table 1. Within- and Between-Group Mean Changes in Outcomes and 95% Confidence Intervals: |
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Outcome |
Baseline to 4-Month Difference (95% CI) |
Difference in Baseline to 4-Month vs. WL (95% CI), p-value |
Baseline to 12-Month Difference (95% CI) |
Difference in Baseline to 12-Month vs. WL (95% CI), p-value |
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WOMAC Total (N=348)* |
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WL PT IBET |
-3.37 (-6.33,-0.41) -6.73 (-8.86,-4.6) -6.06 (-8.29,-3.84) |
— -3.36 (-6.84,0.12), 0.06 -2.70 (-6.24,0.85), 0.14 |
-2.83 (-5.93,0.27) -4.42 (-6.66,-2.17) -5.46 (-7.82,-3.09) |
— -1.59 (-5.26,2.08), 0.39 -2.63 (-6.37,1.11), 0.17 |
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WOMAC Function (N=348) |
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WL PT IBET |
-2.30 (-4.46,-0.14) -4.77 (-6.32,-3.23) -3.74 (-5.36,-2.12) |
— -2.48 (-5.02,0.07), 0.06 -1.44 (-4.03,1.15), 0.27 |
-1.51 (-3.76,0.74) -3.3 (-4.91,-1.68) -3.4 (-5.11,-1.7) |
— -1.79 (-4.45,0.87), 0.19 -1.90 (-4.61,0.82), 0.17 |
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WOMAC Pain (N=350) |
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WL PT IBET |
-0.66 (-1.41,0.09) -1.11 (-1.65,-0.58) -1.59 (-2.15,-1.02) |
— -0.45 (-1.33,0.42), 0.31 -0.93 (-1.82,-0.03),0.04 |
-0.64 (-1.38,0.09) -0.70 (-1.23,-0.16) -1.15 (-1.71,-0.59) |
— -0.05 (-0.92,0.81), 0.90 -0.51 (-1.39,0.38), 0.26 |
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Unilateral Stand Time (N=350) |
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WL PT IBET |
0.04 (-0.75,0.82) -0.59 (-1.15,-0.03) 0.02 (-0.57,0.61) |
— -0.63 (-1.56,0.30), 0.19 -0.02 (-0.97,0.93), 0.97 |
-0.09 (-0.88,0.69) -0.05 (-0.6,0.50) -0.05 (-0.64,0.53) |
— 0.04 (-0.89,0.98), 0.93 0.04 (-0.91,1.00), 0.93 |
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30 Second Chair Stand (N=350) |
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WL PT IBET |
0.18 (-0.87,1.23) -0.13 (-0.87,0.61) 0.50 (-0.29,1.28) |
— -0.31 (-1.55,0.94), 0.63 0.32 (-0.95,1.59), 0.62 |
0.66 (-0.27,1.58) 0.16 (-0.49,0.82) 0.90 (0.20,1.60) |
— -0.49 (-1.58,0.60), 0.37 0.24 (-0.87,1.35), 0.67 |
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2 Minute March Test (N=350) |
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WL PT IBET |
-8.43 (-14.61,-2.24) -0.68 (-5.07,3.71) -3.54 (-8.20,1.11) |
— 7.75 (0.43,15.07), 0.04 4.88 (-2.56,12.33), 0.20 |
0.00 (-6.49,6.48) 1.11 (-3.45,5.67) 1.12 (-3.76,6.00) |
— 1.12 (-6.59,8.82), 0.78 1.13 (-6.74,8.99), 0.78 |
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Timed Up-and-Go (N=346) |
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WL PT IBET |
-0.23 (-1.24,0.78) -0.62 (-1.34,0.09) -0.87 (-1.63,-0.11) |
— -0.39 (-1.58,0.80), 0.52 -0.64 (-1.85,0.58), 0.30 |
-0.26 (-1.4,0.87) -0.77 (-1.57,0.04) -1.49 (-2.35,-0.63) |
— -0.5 (-1.86,0.85), 0.46 -1.22 (-2.61,0.16), 0.08 |
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*Indicates number included in the statistical model for that outcome. |
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To cite this abstract in AMA style:
Allen K, Arbeeva L, Callahan LF, Golightly YM, Goode AP, Heiderscheit B, Hill C, Huffman K, Seversen H, Schwartz TA. Physical Therapy Vs. Internet-Based Exercise Training for Patients with Knee Osteoarthritis: Results of a Randomized Controlled Trial [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/physical-therapy-vs-internet-based-exercise-training-for-patients-with-knee-osteoarthritis-results-of-a-randomized-controlled-trial/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/physical-therapy-vs-internet-based-exercise-training-for-patients-with-knee-osteoarthritis-results-of-a-randomized-controlled-trial/