New research describes an exciting novel tool utilizing telephone linked technology that shows potential as a low cost approach to improving exercise adherence in patients with knee osteoarthritis.
The research was presented at the American College of Rheumatology Annual Meeting in San Diego. The telephone- linked technology acts as an automated physical trainer and behavior therapist to improve adherence to a strengthening protocol for knee osteoarthritis.
Osteoarthritis, or OA as it is commonly called, is the most common joint disease affecting middle-age and older people. It is characterized by progressive damage to the joint cartilage-the cushioning material at the end of long bones-and causes changes in the structures around the joint. These changes can include fluid accumulation, bony overgrowth, and loosening and weakness of muscles and tendons, all of which may limit movement and cause pain and swelling.
Knee osteoarthritis is a common form of osteoarthritis and is caused by cartilage breakdown in the knee joint. Factors that increase the risk of knee osteoarthritis include being overweight, age, injury or stress to the joints, and family history.
Researchers at Boston University investigated what resources might help patients with osteoarthritis of the knee continue muscle-strengthening resistance training programs that help them manage their pain. Past studies have shown that when patients stop receiving instruction from a physical trainer or social support, perhaps due to cost or lack of coverage for long-term support, many stop participating in these exercise programs. The researchers are testing a low-cost, telephone-based system that provides interactive assessment of the patient's current exercise regimen and motivational support for continued activity. The system, Boston Osteoarthritis Strengthening Telephone-Linked Communication (BOOST TLC), is automated and stores users' responses to questions in a database for future use. Using the self- reported exercise adherence data for each participant, the system provides encouragement or advice tailored to the person's needs.
"Research has consistently supported the benefits of exercise, especially strength training, for knee osteoarthritis," says Kristin Baker, PhD; assistant research professor; Center for Enhancing Activity and Participation among Persons with Arthritis (EMNACT); Boston University; and lead investigator in the study. "Knee osteoarthritis is frequently progressive and not always responsive to surgery or pharmacological interventions. In addition, many individuals with knee osteoarthritis prefer to avoid pharmaceutical intervention and delay or not have surgery. However, the key barrier to the effectiveness of exercise is the low adherence to exercise protocols, especially in the long term. We were interested in utilizing a tool that has been shown to be effective in other settings to change behavior, telephone linked communication, to see if it could improve adherence to our strengthening protocol in people with knee osteoarthritis."
In an ongoing study, 62 participants with painful knee OA have been recruited to participate in a twice- weekly muscle-strengthening class for six weeks. Following the class period participants are randomized to one of two groups for 2 years of follow up. The first group, the BOOST TLC receives automated phone calls from the previously described system bimonthly for six months and monthly for the remaining 18 months. The control group receives an automated message once per month, reminding them to strength train and record their progress in their logs. Outcomes include self-reported questionnaires on the participants' pain and physical function levels, timed physical function tasks and isokinetic muscle strength.
The researchers feel strongly that telephone support is a low-cost option for delivering continued exercise instruction that will improve adherence rates in this population.
"The study is ongoing and we are presenting the development of the TLC system with some pilot data, baseline data from our long-term randomized controlled trial, and usage of the TLC by the subjects in the randomized controlled trial up to this point in the study," Dr. Baker explains. "Success can be notated in that the subjects are engaging with the TLC system. We will not have outcome data until data collection is complete in 2015."
The American College of Rheumatology is an international professional medical society that represents more than 9,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. For more information about the meeting, visit http://www.acrannualmeeting.org/ or join the conversation on Twitter by using the official hashtag: #ACR13
Editor's Notes: Dr. Baker will present this research during the ACR Annual Meeting at the San Deigo Convention Center at 5:00 PM on Monday, October 28 in Room 32 A. Dr. Baker will be available for media questions and briefing at 1:30 PM Monday, October 28 in the on-site press conference room, 27 AB.
Abstract Number: 1818
Automated Telephone-Linked Communication: A Novel Approach To Enhance Long-Term Adherence To Resistance Training Exercise Among People With Knee Osteoarthritis
Kristin Baker1, Aileen Ledingham1, Michael P. Lavalley2, Julie J. Keysor1 and David T. Felson3, 1Boston University Sargent College, Boston, MA, 2Boston University, Boston, MA, 3University of Manchester, Manchester, United Kingdom
Knee Osteoarthritis (OA) is one of the most common chronic musculoskeletal conditions and is a leading cause of disability. Strengthening exercise is well known to improve pain and physical function, but benefits decline as adherence to exercise ceases. Participation drops precipitously when trainer initiated instruction and social support for exercise are withdrawn. We have developed a dynamic automated telephone calling system, Boston Osteoarthritis Strengthening telephone linked- communication (BOOST TLC), to empower and motivate people with knee OA to adhere to strengthening exercise after participating in a class.
TLC is an automated, interactive conversation system that speaks with a recorded human voice. During the conversation the system asks questions, comments on the users' responses and educates and counsels them. TLC stores the users' answers in a database used to direct current and future TLC conversations. The system is run by a scheduling protocol with the ability to receive and make calls. The purpose of this abstract is to describe 1) the content of the BOOST TLC system we developed, and 2) the methods of an ongoing randomized controlled clinical trial to examine long-term exercise adherence.
We designed the BOOST TLC to 1) assess adherence to strengthening exercise in the previous 2 weeks 2) provide feedback on current adherence vs. the goals previously set in the last call 3) negotiate and set new adherence goals 4) provide education and counseling to improve adherence.
The BOOST TLC education and counseling content is derived from social cognitive theory, in which self- efficacy is a central concept, and decision-making theory, an individual's evaluation of the pros and cons of exercise. The system addresses reasons for low self-efficacy and ways to increase it, and provides education on the benefits of strengthening exercise and overcoming common barriers to exercise. In addition the BOOST TLC system utilizes the users' self-reported exercise adherence information to detect and provide special counseling to those that lapse (>3 weeks of no exercise), providing information on behavioral and cognitive strategies to help users recover from a lapse and prevent future lapses.
Subjects (N=100) with painful knee OA will be recruited from the community, participate in a 6-week strengthening class twice a week, randomized to BOOST TLC or control, and followed for 2 years. The BOOST TLC will receive biweekly calls for 6 months and monthly calls for the remaining 18 months. Data includes self-report questionnaires on pain and physical function, timed physical function tasks and isokinetic muscle strength.
To date, 62 subjects are enrolled. Table 1 describes the study population.
TLC is a low-cost approach for continued exercise instruction and counseling that has the potential to improve exercise adherence in people with knee OA.