Background/Purpose:

Knee Osteoarthritis (OA) is one of the most common chronic musculoskeletal conditions and is a leading cause of disability.  Strengthening exercise is well known to improve pain and physical function, but benefits decline as adherence to exercise ceases.  Participation drops precipitously when trainer initiated instruction and social support for exercise are withdrawn.  We have developed a dynamic automated telephone calling system, Boston Osteoarthritis Strengthening telephone linked-communication (BOOST TLC), to empower and motivate people with knee OA to adhere to strengthening exercise after participating in a class.

TLC is an automated, interactive conversation system that speaks with a recorded human voice.  During the conversation the system asks questions, comments on the users’ responses and educates and counsels them.  TLC stores the users’ answers in a database used to direct current and future TLC conversations.  The system is run by a scheduling protocol with the ability to receive and make calls.  The purpose of this abstract is to describe 1) the content of the BOOST TLC system we developed, and 2) the methods of an ongoing randomized controlled clinical trial to examine long-term exercise adherence.  

Methods:

We designed the BOOST TLC to 1) assess adherence to strengthening exercise in the previous 2 weeks 2) provide feedback on current adherence vs. the goals previously set in the last call 3) negotiate and set new adherence goals 4) provide education and counseling to improve adherence. 

The BOOST TLC education and counseling content is derived from social cognitive theory, in which self-efficacy is a central concept, and decision-making theory, an individual’s evaluation of the pros and cons of exercise.  The system addresses reasons for low self-efficacy and ways to increase it, and provides education on the benefits of strengthening exercise and overcoming common barriers to exercise.   In addition the BOOST TLC system utilizes the users’ self-reported exercise adherence information to detect and provide special counseling to those that lapse (>3 weeks of no exercise), providing information on behavioral and cognitive strategies to help users recover from a lapse and prevent future lapses.

Subjects (N=100) with painful knee OA will be recruited from the community, participate in a 6-week strengthening class twice a week, randomized to BOOST TLC or control, and followed for 2 years.  The BOOST TLC will receive biweekly calls for 6 months and monthly calls for the remaining 18 months.  Data includes self-report questionnaires on pain and physical function, timed physical function tasks and isokinetic muscle strength.

Results:

To date, 62 subjects are enrolled. Table 1 describes the study population. 

Conclusion:

TLC is a low-cost approach for continued exercise instruction and counseling that has the potential to improve exercise adherence in people with knee OA.