Data indicated that patients with knee osteoarthritis who were overweight or obese and participated in telemedicine exercise and diet programs reported decreased pain and increased function compared to comparable patients who did not participate in telehealth sessions.
According to Kim Bennell, PhD, head of the physiotherapy department at the University of Melbourne in Australia, and colleagues, osteoarthritis affects more than 32 million persons in the United States. Osteoarthritis cost hospitals in the United States around $16.5 billion in 2013, making it the second-most costly ailment that year.
Obesity and being overweight may aggravate osteoarthritis, according to the study. Although behavioural and lifestyle therapies are suggested as first-line treatments, they are often underutilised.
Bennell and colleagues wrote in Annals of Internal Medicine that given the growing osteoarthritis burden, especially among those who are overweight or obese, there is an urgent need for effective, accessible, and scalable lifestyle control interventions in this group.
The researchers carried out a parallel, randomised experiment to assess the potential advantages of telehealth-delivered programs. The researchers enlisted 415 Australians with knee osteoarthritis ranging in age from 45 to 80 years, with a BMI ranging from 28 kg/m2 to 40 kg/m2. Women made up almost half of the participants.
The researchers did not measure radiographic osteoarthritis severity since radiographs are not indicated for routine osteoarthritis diagnosis, and imaging results do not predict nonsurgical treatment response.
The participants were randomised to one of three interventions at random. Participants in the first program, the exercise alone program, had six telehealth consultations with a physiotherapist. During these consultations participants received exercise and self-management guidance, behavioural therapy, and access to exercise equipment and resources during these consultations.
Participants in the second intervention, the diet, and activity program, received the same schedule and six telehealth dietician consultations. 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 behavioural 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 six months, both the exercise only program and the diet and exercise program was 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]). In addition 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 researchers wrote that the telehealth programs represent potentially scalable and accessible ways for people with knee osteoarthritis to receive core recommended interventions.
