Development of the intelligent knee osteoarthritis lifestyle app: a person-based approach.

BACKGROUND: Knee osteoarthritis is one of the most prevalent long term health conditions globally. Exercise and physical activity are now widely recognised to significantly reduce joint pain, improve physical function and quality of life in patients with knee osteoarthritis. However, prescribed exercise without regular contact with a healthcare professional often results in lower adherence and poorer health outcomes. Digital mobile health (mHealth) technologies offer great potential to support people with long-term conditions such as knee osteoarthritis more efficiently and effectively and with relatively lower cost than existing interventions. However, there are currently very few mHealth interventions for the self-management of knee osteoarthritis. The aim of the present study was to describe the development process of a mHealth app to extend the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through self-management, personalised physical activity, education, and social support. METHODS: The development of the intelligent knee osteoarthritis lifestyle application intervention involved an iterative and interconnected process comprising intervention 'planning' and 'optimisation' informed by the person-based approach framework for the development of digital health interventions. The planning phase involved a literature review and collection of qualitative data obtained from focus groups with individuals with knee osteoarthritis (n = 26) and interviews with relevant physiotherapists (n = 5) to generate 'guiding principles' for the intervention. The optimisation phase involved usability testing (n = 7) and qualitative 'think aloud' sessions (n = 6) with potential beneficiaries to refine the development of the intervention. RESULTS: Key themes that emerged from the qualitative data included the need for educational material, modifying activities to suit individual abilities and preferences as well as the inclusion of key features such as rehabilitation exercises. Following a user-trial further changes were made to improve the usability of the application. CONCLUSIONS: Using a systematic person-based, development approach, we have developed the intelligent knee osteoarthritis lifestyle application to help people maintain physical activity behaviour. The app extends the support for physical activity and musculoskeletal health beyond short-term, structured rehabilitation through personalised physical activity guidance, education, and social support.

Influence of the intelligent knee osteoarthritis lifestyle app (iKOALA) on knee joint pain.

BACKGROUND: The intelligent knee osteoarthritis lifestyle app (iKOALA) has been co-developed with target users to extend the support for physical activity (PA) and musculoskeletal health, beyond short-term structured rehabilitation, using personalised PA guidance, education, and social support. The purpose of this study was to assess the preliminary effectiveness and usability of the iKOALA digital intervention on indices of musculoskeletal (MSK) health, symptoms, and physical activity levels in a broad range of individuals with knee osteoarthritis (KOA) over 12 weeks to inform the design of a larger randomised controlled trial. METHODS: Thirty-eight (33 female) participants living in the UK with a mean (SD) age of 58 (± 9) years diagnosed radiographically or clinically with KOA completed a 12-week user trial of the iKOALA. Participants completed an in-app physical activity questionnaire which intelligently recommended suitable strengthening and aerobic based activities to individuals. Throughout the trial, participants wore a physical activity monitor and were given access to functions within the app (physical activity (PA) reminders, information and education, symptom and PA tracking as well as social support forums) to support them in maintaining their PA plan. Participants completed a MSK questionnaire for chronic symptoms and quality of life (MSK-HQ) as well as an acute iKOALA symptoms questionnaire (confidence, fatigue, mood, pain during the day/night, sleep and ability to walk) in the week prior to starting and following completion of the trial. RESULTS: Physical activity levels were consistent over the 12 weeks with total daily steps of 9102 (± 3514) in week 1, 9576 (± 4214) in week 6 and 9596 (± 3694) in week 12. Group mean changes in all iKOALA MSK symptom scores and the total MSK-HQ (pre 33.1 (7.6) vs. post 40.2 (7.6)) score improved significantly (p < .001, 95% CI [-8.89, -5.16]) over the 12-week period. CONCLUSIONS: Physical activity levels were maintained at a high level throughout the 12 weeks. Significant improvements in mean MSK symptom scores and the total MSK-HQ score were also observed. Efforts to ensure more generalised reach amongst sex and socioeconomic status of the digital intervention in a randomised controlled clinical trial are warranted.

Implementation of Physical Employment Standards for Physically Demanding Occupations.

OBJECTIVE: The aim of this paper was to describe an approach to implementing and integrating physical employment standards into an organizational procedure, to ensure the safe and effective supervision of physical fitness of workers in a physically demanding occupation, using a real-world example. METHODS: Using previously published cardiorespiratory, muscular strength, and endurance physical demands data from UK firefighters, a process to manage all levels of physical capability was developed with industry stakeholders. RESULTS: Performance standards and associated cut-scores relating to acceptable, uncertain, and unacceptable job performance, using a traffic-light style process, were agreed by stakeholders to ensure the safe and effective management of incumbent's physical fitness. CONCLUSIONS: This paper describes the processes involved in implementing a physical capability management procedure, for the administration of routine in-service physical employment standards and tests in the UK Fire & Rescue Service.

Validity and Reliability of Firefighting Simulation Test Performance.

OBJECTIVE: To assess the validity and reliability of a firefighting simulation test (FFST). METHODS: Sixty-nine operational firefighters completed a best-effort FFST on one occasion and 22 participants completed a further FFST. All participants completed a maximal treadmill test to determine cardiorespiratory fitness (VO2max). RESULTS: Time to complete the FFST demonstrated a strong inverse relationship with VO2max (r = -0.73), although the prediction error was high. Reliability of the FFST was high (r = 0.84, P = 0.01), demonstrating a coefficient of variation of 4.5%. CONCLUSIONS: The FFST demonstrated reasonable validity as a surrogate assessment of cardiorespiratory fitness for firefighting. The FFST also demonstrated good reliability. Given the apparent magnitude of the prediction error, the FFST would be best used as a training tool, rather than as a primary means of assessing cardiorespiratory fitness for firefighting.

Physical and Physiological Performance Determinants of a Firefighting Simulation Test.

OBJECTIVE: To examine determinants of firefighting simulation test performance. METHODS: Sixty-eight (63 male; 5 female) firefighters completed a firefighting simulation (eg, equipment carry, casualty evacuation) previously validated to test occupational fitness among UK firefighters. Multiple linear regression methods were used to determine physiological and physical attributes that best predicted completion time. RESULTS: Mean (±SD) time taken to complete the simulation was 610 (±79) seconds. The prediction model combining absolute cardiorespiratory capacity (L min) and fat mass explained the greatest variance in performance and elicited the least random error (R = 0.765, R = 0.585, standard error of the estimate [SEE]: ±52 seconds). Higher fitness and lower fat mass were associated with faster performance. CONCLUSIONS: Firefighter simulation test performance is associated with absolute cardiorespiratory fitness and fat mass. Fitter and leaner individuals perform the task more quickly. Work-based interventions should enhance these attributes to promote safe and effective operational performance.

Physical Employment Standards for UK Firefighters: Minimum Muscular Strength and Endurance Requirements.

OBJECTIVE: The aim of this study was to assess sensitivity and specificity of surrogate physical ability tests as predictors of criterion firefighting task performance and to identify corresponding minimum muscular strength and endurance standards. METHODS: Fifty-one (26 male; 25 female) participants completed three criterion tasks (ladder lift, ladder lower, ladder extension) and three corresponding surrogate tests [one-repetition maximum (1RM) seated shoulder press; 1RM seated rope pull-down; repeated 28 kg seated rope pull-down]. Surrogate test standards were calculated that best identified individuals who passed (sensitivity; true positives) and failed (specificity; true negatives) criterion tasks. RESULTS: Best sensitivity/specificity achieved were 1.00/1.00 for a 35 kg seated shoulder press, 0.79/0.92 for a 60 kg rope pull-down, and 0.83/0.93 for 23 repetitions of the 28 kg rope pull-down. CONCLUSIONS: These standards represent performance on surrogate tests commensurate with minimum acceptable performance of essential strength-based occupational tasks in UK firefighters.

A Task Analysis Methodology for the Development of Minimum Physical Employment Standards.

OBJECTIVE: The aim of this study was to develop a systematic task analysis process for determination of minimum acceptable job performance in arduous safety-related occupations. METHODS: A task analysis using modifications on established methods was completed in UK firefighters. Subject-matter experts (all male) identified critical, physically arduous tasks generic to all UK firefighters and developed individual, role-specific task simulations. Video footage and blinded voting were used to determine minimum acceptable task performance. RESULTS: Eight tasks were identified in combination with role-specific variations, task simulations suitable for use in a physical demands analysis, and corresponding minimum acceptable performance. CONCLUSIONS: The bespoke steps highlighted here allow structured identification of task-specific minimum performance standards and simulations from which physical employment standards could be based. However, including a more divergent expert panel with respect to age, sex, and race would strengthen the applicability of this framework in future practice.