Abstract
Background: Knee osteoarthritis (KOA) is the most common joint disorder in the United States and a leading cause of disability. Depression and obesity are highly comorbid with KOA and accelerate knee degeneration and disability through biopsychosocial mechanisms. Mind-body physical activity programs can engage biological, mechanical, and psychological mechanisms to improve outcomes in KOA, but such programs are not currently available. Objective: This mixed methods study aims to adapt a mind-body activity program for the unique needs of patients with KOA, depression, and obesity (GetActive-OA) delivered via live video. Methods: Participants were adults (aged. 45 years) from rural Kentucky with obesity (BMI.30 kg/m2), idiopathic KOA with mild to moderate radiographic changes, and elevated depressive symptoms (9-item Patient Health Questionnaire. 10) recruited from 2 orthopedic centers. In phase 1, we developed GetActive-OA and the study protocol using qualitative focus group feedback from the study population (N=9; 2 focus groups, 90 minutes) and multidisciplinary expertise from clinical psychologists and orthopedic researchers. In phase 2, we explored the initial feasibility, credibility, and acceptability of GetActive-OA, live video delivery, and study procedures via an open pilot with exit interviews (N=5; 1 group). This research was guided by National Institutes of Health (NIH) model stage IA. Results: Phase 1 qualitative analyses revealed nuanced information about challenges with coping and increasing activity, high interest in a mind-body activity program, program participation facilitators (flexibility with technology) and barriers (amotivation and forgetfulness), and perceived challenges with data collection procedures (blood and urine samples and homework). Phase 2 quantitative analyses showed that GetActive-OA met most a priori feasibility markers: acceptability (80%), expectancy (100%), credibility (100%), clinician adherence (90%), homework adherence (80%), questionnaire data collection (100%), program satisfaction (100%), and safety (100%). Adherence to ActiGraph wear (80% baseline, 20% posttest) and collection of blood samples (60%) were low. Participation in GetActive-OA was associated with signals of improvements in general coping (Cohen d=2.41), pain catastrophizing (Cohen d=1.24), depression (Cohen d=0.88), anxiety (Cohen d=0.78), self-efficacy (Cohen d=0.73), pain (Cohen d=0.39), and KOA symptoms (Cohen d=0.36). Qualitative exit interviews confirmed quantitative findings and provided valuable information to optimize the program and protocol. Conclusions: Patients with KOA, depression, and obesity from rural Kentucky were interested in a live video mind-body activity program. GetActive-OA shows promise; however, the program and protocol require further NIH stage I refinement before formal efficacy testing (NIH model stage II).
| Original language | English |
|---|---|
| Article number | e34654 |
| Journal | JMIR Formative Research |
| Volume | 6 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2022 |
Bibliographical note
Publisher Copyright:© 2022 JMIR Formative Research. All rights reserved.
Funding
This study was funded by a clinical trial grant awarded to CAJ and AMV by the National Center for Complementary and Integrative Health (R34 AT010370-01A1). JG’s contribution was made possible through National Center for Complementary and Integrative Health grant 1K23AT010653-01A1. This project was supported by the National Institutes of Health National Center for Advancing Translational Sciences through grant UL1TR001998. The sponsors were not involved in the review or approval of this manuscript for publication. The authors would like to thank Sarah Hopkins for coleading the GetActive-OA intervention and Jennifer Wang and Megan Edwards for their tireless efforts in enrollment and data collection. The authors would also like to thank Jason Kim and the Arthritis Foundation for supporting this project by circulating information about the study through their peer-to-peer patient network.
| Funders | Funder number |
|---|---|
| National Institutes of Health National Center for Advancing Translational Sciences | UL1TR001998 |
| Arthritis Foundation | |
| National Center for Complementary and Integrative Health | R34 AT010370-01A1, 1K23AT010653-01A1 |
| National Center for Complementary and Integrative Health |
Keywords
- depression
- knee osteoarthritis
- mind-body
- mixed-methods
- mobile phone
- obesity
- physical activity
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Health Informatics
