Rehabilitation Applications Based on Behavioral Therapy for People With Knee Osteoarthritis: Systematic Review

Overview

Journal JMIR Mhealth Uhealth

Specialties Biomedical Engineering
Medical Informatics

Date 2024 May 2

PMID 38696250

Authors

Dian Zhu

Jianan Zhao

Mingxuan Wang

Bochen Cao

Wenhui Zhang

Yunlong Li

Chenqi Zhang

Ting Han

Affiliations

Soon will be listed here.

Abstract

Background: The development of digital applications based on behavioral therapies to support patients with knee osteoarthritis (KOA) has attracted increasing attention in the field of rehabilitation. This paper presents a systematic review of research on digital applications based on behavioral therapies for people with KOA.

Objective: This review aims to describe the characteristics of relevant digital applications, with a special focus on the current state of behavioral therapies, digital interaction technologies, and user participation in design. The secondary aim is to summarize intervention outcomes and user evaluations of digital applications.

Methods: A systematic literature search was conducted using the keywords "Knee Osteoarthritis," "Behavior Therapy," and "Digitization" in the following databases (from January 2013 to July 2023): Web of Science, Embase, Science Direct, Ovid, and PubMed. The Mixed Methods Assessment Tool (MMAT) was used to assess the quality of evidence. Two researchers independently screened and extracted the data.

Results: A total of 36 studies met the inclusion criteria and were further analyzed. Behavioral change techniques (BCTs) and cognitive behavioral therapy (CBT) were frequently combined when developing digital applications. The most prevalent areas were goals and planning (n=31) and repetition and substitution (n=27), which were frequently used to develop physical activity (PA) goals and adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email (n=12), which has tremendous potential. This area of application design offers notable advantages, primarily manifesting in pain mitigation (n=24), reduction of physical dysfunction (n=21), and augmentation of PA levels (n=12). Additionally, when formulating design strategies, it is imperative to consider the perspectives of stakeholders, especially in response to the identified shortcomings in application design elucidated within the study.

Conclusions: The results demonstrate that "goals and planning" and "repetition and substitution" are frequently used to develop PA goals and PA behavior adherence. The most prevalent combination strategy was app/website plus SMS text message/telephone/email, which has tremendous potential. Moreover, incorporating several stakeholders in the design and development stages might enhance user experience, considering the distinct variations in their requirements. To improve the efficacy and availability of digital applications, we have several proposals. First, comprehensive care for patients should be ensured by integrating multiple behavioral therapies that encompass various aspects of the rehabilitation process, such as rehabilitation exercises and status monitoring. Second, therapists could benefit from more precise recommendations by incorporating additional intelligent algorithms to analyze patient data. Third, the implementation scope should be expanded from the home environment to a broader social community rehabilitation setting.

Citing Articles

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References

Ostlind E, Ekvall Hansson E, Eek F, Stigmar K . Experiences of activity monitoring and perceptions of digital support among working individuals with hip and knee osteoarthritis - a focus group study. BMC Public Health. 2022; 22(1):1641. PMC: 9426251. DOI: 10.1186/s12889-022-14065-0. View

Scheer J, Costa F, Janela D, Molinos M, Areias A, Moulder R . Sleep Disturbance in Musculoskeletal Conditions: Impact of a Digital Care Program. J Pain Res. 2023; 16:33-46. PMC: 9830709. DOI: 10.2147/JPR.S394421. View

Li L, Sayre E, Xie H, Clayton C, Feehan L . A Community-Based Physical Activity Counselling Program for People With Knee Osteoarthritis: Feasibility and Preliminary Efficacy of the Track-OA Study. JMIR Mhealth Uhealth. 2017; 5(6):e86. PMC: 5504340. DOI: 10.2196/mhealth.7863. View

Stuhlreyer J, Roder C, Krug F, Zollner C, Flor H, Klinger R . A digital application and augmented physician rounds reduce postoperative pain and opioid consumption after primary total knee replacement (TKR): a randomized clinical trial. BMC Med. 2022; 20(1):469. PMC: 9721029. DOI: 10.1186/s12916-022-02638-0. View

Kostic A, Leifer V, Gong Y, Robinson M, Collins J, Neogi T . Cost-Effectiveness of Surgical Weight-Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity. Arthritis Care Res (Hoboken). 2022; 75(3):491-500. PMC: 9827536. DOI: 10.1002/acr.24967. View

Ravalli S, Roggio F, Lauretta G, Di Rosa M, DAmico A, DAgata V . Exploiting real-world data to monitor physical activity in patients with osteoarthritis: the opportunity of digital epidemiology. Heliyon. 2022; 8(2):e08991. PMC: 8889133. DOI: 10.1016/j.heliyon.2022.e08991. View

Nelligan R, Hinman R, Teo P, Bennell K . Exploring Attitudes and Experiences of People With Knee Osteoarthritis Toward a Self-Directed eHealth Intervention to Support Exercise: Qualitative Study. JMIR Rehabil Assist Technol. 2020; 7(2):e18860. PMC: 7728537. DOI: 10.2196/18860. View

Bennell K, Nelligan R, Schwartz S, Kasza J, Kimp A, Crofts S . Behavior Change Text Messages for Home Exercise Adherence in Knee Osteoarthritis: Randomized Trial. J Med Internet Res. 2020; 22(9):e21749. PMC: 7551110. DOI: 10.2196/21749. View

Evers A, Kraaimaat F, van Riel P, de Jong A . Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: a randomized controlled trial. Pain. 2002; 100(1-2):141-53. DOI: 10.1016/s0304-3959(02)00274-9. View

10.

Mecklenburg G, Smittenaar P, Erhart-Hledik J, Perez D, Hunter S . Effects of a 12-Week Digital Care Program for Chronic Knee Pain on Pain, Mobility, and Surgery Risk: Randomized Controlled Trial. J Med Internet Res. 2018; 20(4):e156. PMC: 5943627. DOI: 10.2196/jmir.9667. View

11.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135. View

12.

Nelligan R, Hinman R, Atkins L, Bennell K . A Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel. JMIR Mhealth Uhealth. 2019; 7(10):e14619. PMC: 7012505. DOI: 10.2196/14619. View

13.

Jormand H, Mohammadi N, Jeihooni A, Afzali Harsini P . Self-care behaviors in older adults suffering from knee osteoarthritis: Application of theory of planned behavior. Front Public Health. 2022; 10:958614. PMC: 9672679. DOI: 10.3389/fpubh.2022.958614. View

14.

Broderick J, Keefe F, Schneider S, Junghaenel D, Bruckenthal P, Schwartz J . Cognitive behavioral therapy for chronic pain is effective, but for whom?. Pain. 2016; 157(9):2115-2123. DOI: 10.1097/j.pain.0000000000000626. View

15.

Rini C, Katz A, Nwadugbo A, Porter L, Somers T, Keefe F . Changes in Identification of Possible Pain Coping Strategies by People with Osteoarthritis who Complete Web-based Pain Coping Skills Training. Int J Behav Med. 2020; 28(4):488-498. PMC: 8582007. DOI: 10.1007/s12529-020-09938-w. View

16.

Shah N, Costello K, Mehta A, Kumar D . Applications of Digital Health Technologies in Knee Osteoarthritis: Narrative Review. JMIR Rehabil Assist Technol. 2022; 9(2):e33489. PMC: 9218886. DOI: 10.2196/33489. View

17.

Dobson F, Bennell K, French S, Nicolson P, Klaasman R, Holden M . Barriers and Facilitators to Exercise Participation in People with Hip and/or Knee Osteoarthritis: Synthesis of the Literature Using Behavior Change Theory. Am J Phys Med Rehabil. 2016; 95(5):372-89. DOI: 10.1097/PHM.0000000000000448. View

18.

Allegrante J, Kovar P, MacKenzie C, Peterson M, Gutin B . A walking education program for patients with osteoarthritis of the knee: theory and intervention strategies. Health Educ Q. 1993; 20(1):63-81. DOI: 10.1177/109019819302000107. View

19.

Zhang Z, Tian L, He K, Xu L, Wang X, Huang L . Digital Rehabilitation Programs Improve Therapeutic Exercise Adherence for Patients With Musculoskeletal Conditions: A Systematic Review With Meta-Analysis. J Orthop Sports Phys Ther. 2022; 52(11):726-739. DOI: 10.2519/jospt.2022.11384. View

20.

Cohen E, Lee Y . A Mechanism-Based Approach to the Management of Osteoarthritis Pain. Curr Osteoporos Rep. 2015; 13(6):399-406. PMC: 4623875. DOI: 10.1007/s11914-015-0291-y. View