Physical therapy vs. internet-based exercise training (PATH-IN) for patients with knee osteoarthritis: study protocol of a randomized controlled trial

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  • Williams, Quinn I
    • Affiliation: School of Medicine, Thurston Arthritis Research Center
  • Gunn, Alexander H
    • Affiliation: School of Medicine, Thurston Arthritis Research Center
  • Beaulieu, John E
    • Other Affiliation: Visual Health Information, Inc., Tacoma, WA, USA
  • Benas, Bernadette C
    • Affiliation: School of Medicine, Thurston Arthritis Research Center
  • Buley, Bruce
    • Other Affiliation: Comprehensive Physical Therapy Center
  • Callahan, Leigh
    • Affiliation: School of Medicine, Thurston Arthritis Research Center
  • Cantrell, John
    • Affiliation: School of Medicine, Thurston Arthritis Research Center, Injury Prevention Research Center
  • Genova, Andrew P
    • Other Affiliation: Comprehensive Physical Therapy Center
  • Golightly, Yvonne
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology, Injury Prevention Research Center
  • Goode, Adam P
    • Other Affiliation: Department of Orthopedic Surgery, Division of Physical Therapy, Duke University Medical Center, Durham, NC, USA
  • Gridley, Christopher I
    • Other Affiliation: Advanced Physical Therapy of Smithfield, Smithfield, NC, USA
  • Gross, Michael T.
    • Affiliation: School of Medicine, Department of Allied Health Sciences, Division of Physical Therapy
  • Heiderscheit, Bryan C
    • Other Affiliation: Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
  • Hill, Carla H
    • Affiliation: School of Medicine, Department of Allied Health Sciences, Division of Physical Therapy
  • Huffman, Kim M
    • Other Affiliation: Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA; Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, NC, USA
  • Kline, Aaron
    • Other Affiliation: Advanced Physical Therapy of Smithfield, Smithfield, NC, USA
  • Schwartz, Todd
    • Affiliation: School of Medicine, Thurston Arthritis Research Center, Gillings School of Global Public Health, Department of Biostatistics
  • Allen, Kelli D
    • Affiliation: School of Medicine, Thurston Arthritis Research Center
    • Other Affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA
Abstract
  • Abstract Background Physical activity improves pain and function among individuals with knee osteoarthritis (OA), but most people with this condition are inactive. Physical therapists play a key role in helping people with knee OA to increase appropriate physical activity. However, health care access issues, financial constraints, and other factors impede some patients from receiving physical therapy (PT) for knee OA. A need exists to develop and evaluate other methods to provide physical activity instruction and support to people with knee OA. This study is examining the effectiveness of an internet-based exercise training (IBET) program designed for knee OA, designed by physical therapists and other clinicians. Methods/Design This is a randomized controlled trial of 350 participants with symptomatic knee OA, allocated to three groups: IBET, standard PT, and a wait list (WL) control group (in a 2:2:1 ratio, respectively). The study was funded by the Patient Centered Outcomes Research Institute, which conducted a peer review of the proposal. The IBET program provides patients with a tailored exercise program (based on functional level, symptoms, and current activity), video demonstrations of exercises, and guidance for appropriate exercise progression. The PT group receives up to 8 individual visits with a physical therapist, mirroring standard practice for knee OA and with an emphasis on a home exercise program. Outcomes are assessed at baseline, 4 months (primary time point) and 12 months (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include objective physical function, satisfaction with physical function, physical activity, depressive symptoms and global assessment of change. Linear mixed models will be used to compare both the IBET and standard PT groups to the WL control group, examine whether IBET is non-inferior to PT (a treatment that has an established evidence base for knee OA), and explore whether participant characteristics are associated with differential effects of IBET and/or standard PT. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Board of the University of North Carolina at Chapel Hill. Discussion The IBET program could be disseminated widely at relatively low cost and could be an important resource for helping patients with knee OA to adopt and maintain appropriate physical activity. This trial will provide an important evaluation of the effectiveness of this IBET program for knee OA. Trial registration NCT02312713
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  • Article
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  • In Copyright
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  • Williams et al.
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  • English
Bibliographic citation
  • BMC Musculoskeletal Disorders. 2015 Sep 28;16(1):264
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  • BioMed Central

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