Effectiveness of a Web-Based Physical Activity Intervention in Patients With Knee and/or Hip Osteoarthritis: Randomized Controlled Trial
Effectiveness of a Web-Based Physical Activity Intervention in Patients With Knee and/or Hip Osteoarthritis: Randomized Controlled Trial
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DOI：
10.2196/jmir.2662
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发表时间：
2013-11-01
影响因子：
7.4
通讯作者：
De Bakker, Dinny H.
中科院分区：
文献类型：
--
作者：
Bossen, Daniel;Veenhof, Cindy;De Bakker, Dinny H.
背景资料：膝关节和/或髋关节骨关节炎（OA）患者的体力活动少于一般人群，而体力活动（PA）的益处已得到充分证明。基于行为分级活动治疗，我们开发了一种基于网络的干预措施，以改善膝关节和/或髋关节OA患者的PA水平，名为“Join 2 move”。Join 2 move干预是一个自定进度的9周PA计划，在该计划中，患者最喜欢的娱乐活动以时间相关的方式逐渐增加。目的：本研究的目的是调查膝关节和/或髋关节OA患者的全自动基于Web的PA干预是否会导致与等待列表对照组相比PA水平、身体功能和自我感知效果的改善。研究设计为非盲态的双臂随机对照试验。通过报纸和卫生相关网站上的文章招募志愿者。参与者的资格标准是：（1）年龄50-75岁，（2）自我报告的膝关节和/或髋关节OA，（3）自我报告的不活动（30分钟的中度PA，每周5次或更少），（4）在过去6个月内没有与除全科医生以外的医疗保健提供者面对面咨询OA，（5）每周访问互联网的能力，（6）无禁忌症，无需监督即可锻炼。通过在线问卷收集基线、3个月和12个月随访数据。主要结果为PA、身体功能和自我感知效果。在一个参与者亚组中，使用加速度计客观测量PA。次要结果是疼痛，疲劳，焦虑，抑郁，症状，生活质量，自我效能，疼痛应对，和locus of control.Results：在581名感兴趣的受访者中，199名符合条件的参与者被随机分配到干预组（n=100）或等待名单对照组（n=99）。3个月和12个月时的问卷回复率分别为84.4%（168/199）和75.4%（150/199）。在这项研究中，94.0%（94/100）的参与者实际上开始了该计划，46.0%（46/100）达到了9个模块中完成6个模块的依从性阈值。在3个月时，与对照组相比，干预组的参与者报告身体功能状态显著改善（差异=6.5分，95%CI 1.8-11.2）和积极的自我感知效果（OR 10.7，95%CI 4.3-26.4）。自我报告的PA无影响。12个月后，与对照组相比，干预组显示出更高水平的主观PA（差异=21.2分，95% CI 3.6-38.9）和客观PA（差异=24分钟，95% CI 0.5-46.8）。12个月后，身体机能（差异=5分，95%CI-1.0至11.0）和自我感知效果（OR 1.2，95%CI 0.6-2.4）没有发现任何影响。对于几个次要终点，干预组表现出有利于干预group.Conclusions的改善：Join 2 move导致在几个主要和次要结果的预期方向的变化。考虑到这些益处及其自助形式，Join 2 move可以成为改善膝关节和/或髋关节OA久坐患者PA的一个组成部分。
Background: Patients with knee and/or hip osteoarthritis (OA) are less physically active than the general population, while the benefits of physical activity (PA) have been well documented. Based on the behavioral graded activity treatment, we developed a Web-based intervention to improve PA levels in patients with knee and/or hip OA, entitled "Join2move". The Join2move intervention is a self-paced 9-week PA program in which the patient's favorite recreational activity is gradually increased in a time-contingent way.Objective: The aim of the study was to investigate whether a fully automated Web-based PA intervention in patients with knee and/or hip OA would result in improved levels of PA, physical function, and self-perceived effect compared with a waiting list control group.Methods: The study design was a two-armed randomized controlled trial which was not blinded. Volunteers were recruited via articles in newspapers and health-related websites. Eligibility criteria for participants were: (1) aged 50-75 years, (2) self-reported knee and/or hip OA, (3) self-reported inactivity (30 minutes of moderate PA, 5 times or less per week), (4) no face-to-face consultation with a health care provider other than general practitioners, for OA in the last 6 months, (5) ability to access the Internet weekly, and (6) no contra-indications to exercise without supervision. Baseline, 3-month, and 12-month follow-up data were collected through online questionnaires. Primary outcomes were PA, physical function, and self-perceived effect. In a subgroup of participants, PA was measured objectively using accelerometers. Secondary outcomes were pain, fatigue, anxiety, depression, symptoms, quality of life, self-efficacy, pain coping, and locus of control.Results: Of the 581 interested respondents, 199 eligible participants were randomly assigned to the intervention (n=100) or waiting list control group (n=99). Response rates of questionnaires were 84.4% (168/199) after 3 months and 75.4% (150/199) after 12 months. In this study, 94.0% (94/100) of participants actually started the program, and 46.0% (46/100) reached the adherence threshold of 6 out of 9 modules completed. At 3 months, participants in the intervention group reported a significantly improved physical function status (difference=6.5 points, 95% CI 1.8-11.2) and a positive self-perceived effect (OR 10.7, 95% CI 4.3-26.4) compared with the control group. No effect was found for self-reported PA. After 12 months, the intervention group showed higher levels of subjective (difference=21.2 points, 95% CI 3.6-38.9) and objective PA (difference=24 minutes, 95% CI 0.5-46.8) compared with the control group. After 12 months, no effect was found for physical function (difference=5 points, 95% CI -1.0 to 11.0) and self-perceived effect (OR 1.2, 95% CI 0.6-2.4). For several secondary endpoints, the intervention group demonstrated improvements in favor of the intervention group.Conclusions: Join2move resulted in changes in the desired direction for several primary and secondary outcomes. Given the benefits and its self-help format, Join2move could be a component in the effort to enhance PA in sedentary patients with knee and/or hip OA.