The efficacy of electronic health-supported home exercise interventions for patients with osteoarthritis of the knee: Systematic review
Background: Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management h...
| Main Authors: | , , , , |
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| Format: | Journal Article |
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Journal of Medical Internet Research
2018
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| Online Access: | http://hdl.handle.net/20.500.11937/68469 |
| _version_ | 1848761809959387136 |
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| author | Schäfer, A. Zalpour, C. Von Piekartz, H. Hall, Toby Paelke, V. |
| author_facet | Schäfer, A. Zalpour, C. Von Piekartz, H. Hall, Toby Paelke, V. |
| author_sort | Schäfer, A. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background: Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far. Objective: The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee. Methods: MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=-0.31, 95% CI -0.58 to -0.04, low quality; QoL SMD=0.24, 95% CI 0.05-0.43, moderate quality) and long-term effects (pain -0.30, 95% CI -0.07 to -0.53, moderate quality; physical function 0.41, 95% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95% CI 0.06-0.47, high quality). Conclusions: eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence. |
| first_indexed | 2025-11-14T10:37:35Z |
| format | Journal Article |
| id | curtin-20.500.11937-68469 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T10:37:35Z |
| publishDate | 2018 |
| publisher | Journal of Medical Internet Research |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-684692021-01-08T07:54:28Z The efficacy of electronic health-supported home exercise interventions for patients with osteoarthritis of the knee: Systematic review Schäfer, A. Zalpour, C. Von Piekartz, H. Hall, Toby Paelke, V. Background: Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far. Objective: The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee. Methods: MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=-0.31, 95% CI -0.58 to -0.04, low quality; QoL SMD=0.24, 95% CI 0.05-0.43, moderate quality) and long-term effects (pain -0.30, 95% CI -0.07 to -0.53, moderate quality; physical function 0.41, 95% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95% CI 0.06-0.47, high quality). Conclusions: eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence. 2018 Journal Article http://hdl.handle.net/20.500.11937/68469 10.2196/jmir.9465 http://creativecommons.org/licenses/by/4.0/ Journal of Medical Internet Research fulltext |
| spellingShingle | Schäfer, A. Zalpour, C. Von Piekartz, H. Hall, Toby Paelke, V. The efficacy of electronic health-supported home exercise interventions for patients with osteoarthritis of the knee: Systematic review |
| title | The efficacy of electronic health-supported home exercise interventions for patients with osteoarthritis of the knee: Systematic review |
| title_full | The efficacy of electronic health-supported home exercise interventions for patients with osteoarthritis of the knee: Systematic review |
| title_fullStr | The efficacy of electronic health-supported home exercise interventions for patients with osteoarthritis of the knee: Systematic review |
| title_full_unstemmed | The efficacy of electronic health-supported home exercise interventions for patients with osteoarthritis of the knee: Systematic review |
| title_short | The efficacy of electronic health-supported home exercise interventions for patients with osteoarthritis of the knee: Systematic review |
| title_sort | efficacy of electronic health-supported home exercise interventions for patients with osteoarthritis of the knee: systematic review |
| url | http://hdl.handle.net/20.500.11937/68469 |