Telehealth Stepped Exercise Program for Rural Veterans With Knee Osteoarthritis

Durham VA Medical Center

Status: Active, not recruiting

Conditions: Knee Osteoarthritis

Treatments: Behavioral: Stepped Exercise for Knee Osteoarthritis

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT04775589

15997

Details and patient eligibility

About

The goal of this study is to evaluate a telehealth Stepped Exercise Program for Knee OsteoArthritis (STEP-KOA) among rural veterans. Methods: This is a single arm, pre-post pilot trial of the 6-month STEP-KOA program among rural Veterans with a physician diagnosis of knee OA who self-report knee pain ≥3 on a 0-10 scale and self-reported difficulty with either walking or stair climbing. We aim to enroll 20 Veterans in this project but may enroll up to 30 in order to obtain sufficient information to evaluate the program, particularly among Veterans who live in very rural areas. Assessments will be conducted via a combination of telephone and video at baseline and 2-, 4-, and 6-month follow-up. Assessments will include questionnaires related to pain, function and physical activity, as well as several physical performance tests. STEP-KOA begins with a low cost, primarily self-directed exercise program (supported by an internet-based tool; Step 1). Patients are then assessed for degree of improvement in symptoms, and then can step up sequentially to telephone or video-based physical activity coaching (Step 2) and physical therapy (Step 3) if they do not make clinically relevant improvements in prior steps. For this project, patients will be assessed approximately every 2 months to determine step progression. Participants will advance to the next step if they do not meet response criteria for pain and function established by the Outcome Measures in Rheumatology group and the Osteoarthritis Research Society International (OMERACT-OARSI). The Step 2 intervention involves bi-weekly telephone or video calls. Step 3 involves 3 telehealth PT visits, based on standard care for knee OA.

Enrollment: 19 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Rural dwelling Veterans (VA healthcare users)
• Clinician diagnosis of knee osteoarthritis
• Self-reported knee pain =>3 on a scale of 0-10 and self-reported difficulty either walking or stair climbing.

Exclusion criteria

• Advanced Dementia
• Psychosis
• Active substance abuse disorder
• Meniscus or ACL tear in the past 6 months
• Total joint replacement or other major lower extremity surgery in the past 6 months
• Severe hearing or visual impairment (e.g. unable to participate in STEP-KOA intervention components)
• Serious / terminal illness
• Unstable angina
• History of ventricular tachycardia
• Unstable chronic obstructive pulmonary disease (two hospitalizations within the previous 12 months and/or on oxygen)
• Uncontrolled hypertension (diastolic blood pressure >110 mm/Hg or systolic > 200mm/Hg)
• Stroke with moderate to severe aphasia
• Recent history of falls
• Resident of a long-term care facility
• Hospitalization for a cardiovascular condition in the past 3 months
• Other health conditions that would make home exercise unsafe or participation in the program not feasible

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

---

19 participants in 1 patient group

Stepped Exercise for Knee Osteoarthritis

Experimental group

Description:

Patients start with a home-based exercise program, supported by an internet-based tool (Step 1). Patients are then assessed for degree of improvement in symptoms, and then can step up sequentially to telephone or video-based physical activity coaching (Step 2) and physical therapy (Step 3) if they do not make clinically relevant improvements in prior steps.

Treatment:

Behavioral: Stepped Exercise for Knee Osteoarthritis