Comparing Video-Based, Telehealth-Delivered Exercise and Weight Loss Programs With Online Education on Outcomes of Knee Osteoarthritis : A Randomized Trial.
Ann Intern Med
; 175(2): 198-209, 2022 Feb.
Article
en En
| MEDLINE
| ID: mdl-34843383
ABSTRACT
BACKGROUND:
Scalable knee osteoarthritis programs are needed to deliver recommended education, exercise, and weight loss interventions.OBJECTIVE:
To evaluate two 6-month, telehealth-delivered exercise programs, 1 with and 1 without dietary intervention.DESIGN:
3-group, parallel randomized (552) trial. (Australian New Zealand Clinical Trials Registry ACTRN12618000930280).SETTING:
Australian private health insurance members.PARTICIPANTS:
415 persons with symptomatic knee osteoarthritis and a body mass index between 28 and 40 kg/m2 who were aged 45 to 80 years. INTERVENTION All groups received access to electronic osteoarthritis information (control). The exercise program comprised 6 physiotherapist consultations via videoconference for exercise, self-management advice, and behavioral counseling, plus exercise equipment and resources. The diet and exercise program included an additional 6 dietitian consultations for a ketogenic very-low-calorie diet (2 formulated meal replacements and a low-carbohydrate meal daily) followed by a transition to healthy eating, as well as nutrition and behavioral resources. MEASUREMENTS Primary outcomes were changes in knee pain (numerical rating scale [NRS] of 0 to 10, higher indicating worse) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]; scale, 0 to 68, higher indicating worse) at 6 months (primary time point) and 12 months. Secondary outcomes were weight, physical activity, quality of life, mental health, global change, satisfaction, willingness to have surgery, orthopedic appointments, and knee surgery.RESULTS:
A total of 379 participants (91%) provided 6-month primary outcomes, and 372 (90%) provided 12-month primary outcomes. At 6 months, both programs were superior to control for pain (between-group mean difference in change on NRS diet and exercise, -1.5 [95% CI, -2.1 to -0.8]; exercise, -0.8 [CI, -1.5 to -0.2]) and function (between-group mean difference in change on WOMAC diet and exercise, -9.8 [CI, -12.5 to -7.0]; exercise, -7.0 [CI, -9.7 to -4.2]). The diet and exercise program was superior to exercise (pain, -0.6 [CI, -1.1 to -0.2]; function, -2.8 [CI, -4.7 to -0.8]). Findings were similar at 12 months.LIMITATION:
Participants and clinicians were unblinded.CONCLUSION:
Telehealth-delivered exercise and diet programs improved pain and function in people with knee osteoarthritis and overweight or obesity. A dietary intervention conferred modest additional pain and function benefits over exercise. PRIMARY FUNDING SOURCE Medibank, the Medibank Better Health Foundation Research Fund, and a National Health and Medical Research Council Centre of Research Excellence.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Ejercicio Físico
/
Educación del Paciente como Asunto
/
Telemedicina
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Osteoartritis de la Rodilla
/
Educación a Distancia
/
Programas de Reducción de Peso
Tipo de estudio:
Clinical_trials
Límite:
Aged
/
Humans
/
Middle aged
País/Región como asunto:
Oceania
Idioma:
En
Revista:
Ann Intern Med
Año:
2022
Tipo del documento:
Article