Level of participation in physical therapy or an internet-based exercise training program: associations with outcomes for patients with knee osteoarthritis

Megan Pignato,Todd A. Schwartz,Kim M. Huffman,Bryan C. Heiderscheit,Carla Hill,Adam P. Goode,Kelli D. Allen,Jennifer Cooke,Herbert H. Severson,Yvonne M. Golightly,Leigh F. Callahan,Liubov Arbeeva

doi:10.1186/s12891-018-2139-y

Abstract

BackgroundTo examine whether number of physical therapy (PT) visits or amount of use of an internet-based exercise training (IBET) program is associated with differential improvement in outcomes for participants with knee osteoarthritis (OA).MethodsA secondary analysis was performed using data from participants in 2 arms of a randomized control trial for individuals with symptomatic knee OA: PT (N = 135) or IBET (N = 124). We examined associations of number of PT visits attended (up to 8) or number of days the IBET website was accessed during the initial 4-month study period with changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, pain and function subscales, as well as a 2-min Step Test, at 4-month and 12-month follow-up.ResultsParticipants with more PT visits experienced greater improvement in WOMAC total score (estimate per additional visit = − 1.18, CI 95% = − 1.91, 0.46, p < 0.001) and function subscore (estimate = − 0.80, CI 95% = − 1.33, − 0.28, p < 0.001) across follow-up periods. For WOMAC pain subscale, the association with number of PT visits varied significantly between 4- and 12-month follow-up, with a stronger relationship at 4-months. There was a non-significant trend for more PT visits to be associated with greater improvement in 2-min Step Test. More frequent use of the IBET website was not associated with greater improvement for any outcome, at either time point.ConclusionIncreased number of PT visits was associated with improved outcomes, and some of this benefit persisted 8 months after PT ended. This provides guidance for PT clinical practice and policies.Trial registrationNCT02312713, posted 9/25/2015.

Highlights

To examine whether number of physical therapy (PT) visits or amount of use of an internet-based exercise training (IBET) program is associated with differential improvement in outcomes for participants with knee osteoarthritis (OA)
These studies indicate that degree of participation in structured, supervised exercise programs may influence the magnitude of impact, there is still a need for better understanding of whether and how this association may vary by format of exercise-based intervention, including those that are supervised (e.g. PT) and those that are self-directed
This study reports on secondary analyses from a 12-month randomized trial comparing PT to an internet-based exercise training program (IBET) for participants with symptomatic knee OA [15, 16]

Summary

Introduction

To examine whether number of physical therapy (PT) visits or amount of use of an internet-based exercise training (IBET) program is associated with differential improvement in outcomes for participants with knee osteoarthritis (OA). Another study found that greater attendance during a 20-week aquatics exercise program for individuals with OA was associated with greater improvement in self-reported quality of well-being and depressive symptoms [8]. These studies indicate that degree of participation in structured, supervised exercise programs may influence the magnitude of impact, there is still a need for better understanding of whether and how this association may vary by format of exercise-based intervention, including those that are supervised (e.g. PT) and those that are self-directed

Methods

Results

Discussion

Conclusion