Telehealth programs improve outcomes in patients with knee osteoarthritis, obesity

Patients with knee osteoarthritis who were overweight or obese and took part in telehealth exercise and diet programs reported less pain and improved function compared with similar patients who did not have telehealth sessions, data showed.

Osteoarthritis affects more than 32 million adults in the U.S., according to Kim Bennell, PhD, the chair of the physiotherapy department at the University of Melbourne in Australia, and colleagues. In 2013, osteoarthritis cost U.S. hospitals approximately $16.5 billion, making it the second-most expensive condition that year.

Overweight and obesity can exacerbate osteoarthritis, the researchers added. Although behavioral and lifestyle interventions are recommended as first-line management, these strategies are often underused.

“Given the escalating osteoarthritis burden, particularly related to overweight and obesity, an urgent need exists for effective, accessible and scalable programs for lifestyle management in this population,” Bennell and colleagues wrote in Annals of Internal Medicine.

The researchers conducted a parallel, randomized trial to evaluate the potential benefits of telehealth-delivered programs. The researchers recruited 415 participants with knee osteoarthritis from Australia who were aged 45 to 80 years and had a BMI that ranged between 28 kg/m² and 40 kg/m². About half of the participants were women.

“We did not assess radiographic osteoarthritis severity because radiographs are not recommended for routine osteoarthritis diagnosis and imaging findings do not predict nonsurgical treatment response,” the researchers wrote.

The participants were randomly assigned to one of three interventions. In the first, the exercise only program, participants attended six consultations with a physiotherapist via telehealth. During these consultations, participants received exercise and self-management advice, behavioral counseling and access to exercise equipment and resources.

In the second intervention, the diet and exercise program, participants received the same program, plus six dietitian consultations via telehealth. The dietitian provided support to help participants lose 10% of their body weight through a ketogenic very low-calorie diet, which consisted of “two formulated meal replacements and a low-carbohydrate meal daily followed by a transition to healthy eating, as well as nutrition and behavioral resources,” the researchers wrote.

The third intervention served as a control, in which participants only received access to a website that contained details regarding osteoarthritis, treatment options, exercise and physical activity, weight loss, managing pain, sleep, “success stories” of patients who had done well following the website’s approaches and other resources that provided additional information in these areas.

According to Bennell and colleagues, more than 90% of participants had 12 months of data available for analysis. At 6 months, both the exercise only program and the diet and exercise program were superior to the control program for pain (between-group mean difference in change on numeric rating scale among the diet and exercise cohort = –1.5 points; [95% CI, –2.1 to –0.8]; exercise only cohort = –0.8 points; [95% CI, –1.5 to –0.2]) and function (between-group mean difference in change on Western Ontario and McMaster Universities Osteoarthritis score among the diet and exercise cohort = –9.8; [95% CI, –12.5 to –7]; exercise only cohort = –7; [95% CI, –9.7 to –4.2]). The diet and exercise cohort experienced superior benefits compared with the exercise only cohort (pain score = –0.6 points; [95% CI, –1.1 to –0.2]; function score = –2.8 points; 95% CI, –4.7 to –0.8]). The results at 12 months were similar.

“The telehealth programs represent potentially scalable and accessible ways for people with knee osteoarthritis to receive core recommended interventions,” the researchers wrote.

References

Bennell KL, et al. Ann Intern Med. 2021;doi:10.7326/M21-2388.

Population under 18 declined in the last decade. https://www.census.gov/library/stories/2021/08/united-states-adult-population-grew-faster-than-nations-total-population-from-2010-to-2020.html. Published Aug. 12, 2021. Accessed Nov. 24, 2021.