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Published in: BMC Musculoskeletal Disorders 1/2024

Open Access 01-12-2024 | Knee Osteoarthritis | Research

Influence of the intelligent knee osteoarthritis lifestyle app (iKOALA) on knee joint pain

Authors: Richard D.M. Stevenson, Enhad A. Chowdhury, Jesudas Lobo, Max J. Western, James L.J. Bilzon

Published in: BMC Musculoskeletal Disorders | Issue 1/2024

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Abstract

Background

The intelligent knee osteoarthritis lifestyle app (iKOALA) has been co-developed with target users to extend the support for physical activity (PA) and musculoskeletal health, beyond short-term structured rehabilitation, using personalised PA guidance, education, and social support. The purpose of this study was to assess the preliminary effectiveness and usability of the iKOALA digital intervention on indices of musculoskeletal (MSK) health, symptoms, and physical activity levels in a broad range of individuals with knee osteoarthritis (KOA) over 12 weeks to inform the design of a larger randomised controlled trial.

Methods

Thirty-eight (33 female) participants living in the UK with a mean (SD) age of 58 (± 9) years diagnosed radiographically or clinically with KOA completed a 12-week user trial of the iKOALA. Participants completed an in-app physical activity questionnaire which intelligently recommended suitable strengthening and aerobic based activities to individuals. Throughout the trial, participants wore a physical activity monitor and were given access to functions within the app (physical activity (PA) reminders, information and education, symptom and PA tracking as well as social support forums) to support them in maintaining their PA plan. Participants completed a MSK questionnaire for chronic symptoms and quality of life (MSK-HQ) as well as an acute iKOALA symptoms questionnaire (confidence, fatigue, mood, pain during the day/night, sleep and ability to walk) in the week prior to starting and following completion of the trial.

Results

Physical activity levels were consistent over the 12 weeks with total daily steps of 9102 (± 3514) in week 1, 9576 (± 4214) in week 6 and 9596 (± 3694) in week 12. Group mean changes in all iKOALA MSK symptom scores and the total MSK-HQ (pre 33.1 (7.6) vs. post 40.2 (7.6)) score improved significantly (p < .001, 95% CI [-8.89, -5.16]) over the 12-week period.

Conclusions

Physical activity levels were maintained at a high level throughout the 12 weeks. Significant improvements in mean MSK symptom scores and the total MSK-HQ score were also observed. Efforts to ensure more generalised reach amongst sex and socioeconomic status of the digital intervention in a randomised controlled clinical trial are warranted.
Literature
1.
go back to reference Nolte E, Knai C, McKee M. Managing chronic conditions: experience in eight countries. WHO Regional Office Europe; 2008. Nolte E, Knai C, McKee M. Managing chronic conditions: experience in eight countries. WHO Regional Office Europe; 2008.
2.
go back to reference Goodwin N, Curry N, Naylor C, Ross S, Duldig W. Managing people with long-term conditions. London: The Kings Fund. 2010:50 – 1. Goodwin N, Curry N, Naylor C, Ross S, Duldig W. Managing people with long-term conditions. London: The Kings Fund. 2010:50 – 1.
3.
go back to reference Gibson PG, Powell H, Wilson A, Abramson MJ, Haywood P, Bauman A, et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database of Systematic Reviews; 2002. Gibson PG, Powell H, Wilson A, Abramson MJ, Haywood P, Bauman A, et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database of Systematic Reviews; 2002.
4.
go back to reference Corben S, Rosen R. Self-management for long-term conditions. London: King’s Fund; 2005. Corben S, Rosen R. Self-management for long-term conditions. London: King’s Fund; 2005.
5.
go back to reference Jones MC, Macgillivray S, Kroll T, Zohoor AR, Connaghan J. A thematic analysis of the conceptualisation of self-care, self-management and self-management support in the long-term conditions management literature. J Nurs Healthc Chronic Illn. 2011;3(3):174–85.CrossRef Jones MC, Macgillivray S, Kroll T, Zohoor AR, Connaghan J. A thematic analysis of the conceptualisation of self-care, self-management and self-management support in the long-term conditions management literature. J Nurs Healthc Chronic Illn. 2011;3(3):174–85.CrossRef
6.
go back to reference Agnihothri S, Cui L, Delasay M, Rajan B. The value of mHealth for managing chronic conditions. Health Care Manag Sci. 2020;23(2):185–202.CrossRefPubMed Agnihothri S, Cui L, Delasay M, Rajan B. The value of mHealth for managing chronic conditions. Health Care Manag Sci. 2020;23(2):185–202.CrossRefPubMed
7.
go back to reference Dennison L, Morrison L, Conway G, Yardley L. Opportunities and challenges for Smartphone Applications in supporting Health Behavior change: qualitative study. J Med Internet Res. 2013;15(4):e86.CrossRefPubMedPubMedCentral Dennison L, Morrison L, Conway G, Yardley L. Opportunities and challenges for Smartphone Applications in supporting Health Behavior change: qualitative study. J Med Internet Res. 2013;15(4):e86.CrossRefPubMedPubMedCentral
8.
go back to reference Simons L, Valentine AZ, Falconer CJ, Groom M, Daley D, Craven MP, et al. Developing mHealth Remote Monitoring Technology for attention deficit hyperactivity disorder: a qualitative study eliciting user priorities and needs. JMIR mHealth and uHealth. 2016;4(1):e31.CrossRefPubMedPubMedCentral Simons L, Valentine AZ, Falconer CJ, Groom M, Daley D, Craven MP, et al. Developing mHealth Remote Monitoring Technology for attention deficit hyperactivity disorder: a qualitative study eliciting user priorities and needs. JMIR mHealth and uHealth. 2016;4(1):e31.CrossRefPubMedPubMedCentral
9.
go back to reference Simpson SA, Matthews L, Pugmire J, Mcconnachie A, Mcintosh E, Coulman E et al. An app-, web- and social support-based weight loss intervention for adults with obesity: the ‘HelpMeDoIt!’ Feasibility randomised controlled trial. Pilot and Feasibility Studies. 2020;6(1). Simpson SA, Matthews L, Pugmire J, Mcconnachie A, Mcintosh E, Coulman E et al. An app-, web- and social support-based weight loss intervention for adults with obesity: the ‘HelpMeDoIt!’ Feasibility randomised controlled trial. Pilot and Feasibility Studies. 2020;6(1).
10.
go back to reference Alhussein G, Hadjileontiadis L. Digital Health Technologies for Long-Term Self-management of osteoporosis: systematic review and Meta-analysis. JMIR mHealth and uHealth. 2022;10(4):e32557.CrossRefPubMedPubMedCentral Alhussein G, Hadjileontiadis L. Digital Health Technologies for Long-Term Self-management of osteoporosis: systematic review and Meta-analysis. JMIR mHealth and uHealth. 2022;10(4):e32557.CrossRefPubMedPubMedCentral
11.
go back to reference Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR. Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. J Med Internet Res. 2012;14(3):e70.CrossRefPubMedPubMedCentral Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR. Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. J Med Internet Res. 2012;14(3):e70.CrossRefPubMedPubMedCentral
12.
go back to reference Markossian TW, Boyda J, Taylor J, Etingen B, Modave F, Price R, et al. A Mobile app to support self-management of chronic kidney disease: Development Study. JMIR Hum Factors. 2021;8(4):e29197.CrossRefPubMedPubMedCentral Markossian TW, Boyda J, Taylor J, Etingen B, Modave F, Price R, et al. A Mobile app to support self-management of chronic kidney disease: Development Study. JMIR Hum Factors. 2021;8(4):e29197.CrossRefPubMedPubMedCentral
13.
go back to reference Ramos RM, Cheng PGF, Jonas SM. Validation of an mHealth app for Depression Screening and Monitoring (psychologist in a Pocket): correlational study and concurrence analysis. JMIR mHealth and uHealth. 2019;7(9):e12051.CrossRefPubMedPubMedCentral Ramos RM, Cheng PGF, Jonas SM. Validation of an mHealth app for Depression Screening and Monitoring (psychologist in a Pocket): correlational study and concurrence analysis. JMIR mHealth and uHealth. 2019;7(9):e12051.CrossRefPubMedPubMedCentral
14.
go back to reference Whitehead L, Seaton P. The effectiveness of Self-Management Mobile phone and tablet apps in long-term Condition Management: a systematic review. J Med Internet Res. 2016;18(5):e97.CrossRefPubMedPubMedCentral Whitehead L, Seaton P. The effectiveness of Self-Management Mobile phone and tablet apps in long-term Condition Management: a systematic review. J Med Internet Res. 2016;18(5):e97.CrossRefPubMedPubMedCentral
15.
go back to reference Choi W, Zheng H, Franklin P, Tulu B. mHealth technologies for osteoarthritis self-management and treatment: a systematic review. Health Inf J. 2019;25(3):984–1003.CrossRef Choi W, Zheng H, Franklin P, Tulu B. mHealth technologies for osteoarthritis self-management and treatment: a systematic review. Health Inf J. 2019;25(3):984–1003.CrossRef
16.
go back to reference Skrepnik N, Spitzer A, Altman R, Hoekstra J, Stewart J, Toselli R. Assessing the impact of a Novel Smartphone Application compared with Standard Follow-Up on mobility of patients with knee osteoarthritis following treatment with Hylan G-F 20: a Randomized Controlled Trial. JMIR mHealth and uHealth. 2017;5(5):e64.CrossRefPubMedPubMedCentral Skrepnik N, Spitzer A, Altman R, Hoekstra J, Stewart J, Toselli R. Assessing the impact of a Novel Smartphone Application compared with Standard Follow-Up on mobility of patients with knee osteoarthritis following treatment with Hylan G-F 20: a Randomized Controlled Trial. JMIR mHealth and uHealth. 2017;5(5):e64.CrossRefPubMedPubMedCentral
17.
go back to reference Alasfour M, Almarwani M. The effect of innovative smartphone application on adherence to a home-based exercise programs for female older adults with knee osteoarthritis in Saudi Arabia: a randomized controlled trial. Disabil Rehabil. 2022;44(11):2420–7.CrossRefPubMed Alasfour M, Almarwani M. The effect of innovative smartphone application on adherence to a home-based exercise programs for female older adults with knee osteoarthritis in Saudi Arabia: a randomized controlled trial. Disabil Rehabil. 2022;44(11):2420–7.CrossRefPubMed
18.
go back to reference Patten RK, Tacey A, Pile R, Parker A, De Gori M, Tran P et al. Digital self-management interventions for osteoarthritis: a systematic scoping review of intervention characteristics, adherence and attrition. Archives of Public Health. 2022;80(1). Patten RK, Tacey A, Pile R, Parker A, De Gori M, Tran P et al. Digital self-management interventions for osteoarthritis: a systematic scoping review of intervention characteristics, adherence and attrition. Archives of Public Health. 2022;80(1).
19.
go back to reference Safari R, Jackson J, Sheffield D. Digital Self-Management interventions for people with osteoarthritis: systematic review with Meta-analysis. J Med Internet Res. 2020;22(7):e15365.CrossRefPubMedPubMedCentral Safari R, Jackson J, Sheffield D. Digital Self-Management interventions for people with osteoarthritis: systematic review with Meta-analysis. J Med Internet Res. 2020;22(7):e15365.CrossRefPubMedPubMedCentral
20.
go back to reference Kanavaki AM, Rushton A, Efstathiou N, Alrushud A, Klocke R, Abhishek A, et al. Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence. BMJ Open. 2017;7(12):e017042.CrossRefPubMedPubMedCentral Kanavaki AM, Rushton A, Efstathiou N, Alrushud A, Klocke R, Abhishek A, et al. Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence. BMJ Open. 2017;7(12):e017042.CrossRefPubMedPubMedCentral
21.
go back to reference Bennell KL, Dobson F, Hinman RS. Exercise in osteoarthritis: moving from prescription to adherence. Best Pract Res Clin Rheumatol. 2014;28(1):93–117.CrossRefPubMed Bennell KL, Dobson F, Hinman RS. Exercise in osteoarthritis: moving from prescription to adherence. Best Pract Res Clin Rheumatol. 2014;28(1):93–117.CrossRefPubMed
22.
go back to reference Saw MM, Kruger-Jakins T, Edries N, Parker R. Significant improvements in pain after a six-week physiotherapist-led exercise and education intervention, in patients with osteoarthritis awaiting arthroplasty, in South Africa: a randomised controlled trial. BMC Musculoskelet Disord. 2016;17(1). Saw MM, Kruger-Jakins T, Edries N, Parker R. Significant improvements in pain after a six-week physiotherapist-led exercise and education intervention, in patients with osteoarthritis awaiting arthroplasty, in South Africa: a randomised controlled trial. BMC Musculoskelet Disord. 2016;17(1).
23.
go back to reference Stevenson RDM, Chowdhury EA, Lobo J, Western MJ, Bilzon JL. J. Development of the intelligent knee osteoarthritis lifestyle app: a person based approach. BMC Musculoskelet Disord. 2023;Under Review. Stevenson RDM, Chowdhury EA, Lobo J, Western MJ, Bilzon JL. J. Development of the intelligent knee osteoarthritis lifestyle app: a person based approach. BMC Musculoskelet Disord. 2023;Under Review.
24.
go back to reference Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60.CrossRefPubMed Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60.CrossRefPubMed
25.
go back to reference Yardley L, Ainsworth B, Arden-Close E, Muller I. The person-based approach to enhancing the acceptability and feasibility of interventions. Pilot and Feasibility Studies. 2015;1(1). Yardley L, Ainsworth B, Arden-Close E, Muller I. The person-based approach to enhancing the acceptability and feasibility of interventions. Pilot and Feasibility Studies. 2015;1(1).
26.
go back to reference Tashakkori A, Teddlie C. Handbook on mixed methods in the behavioral and social sciences. Thousand Oaks, CA: Sage; 2003. Tashakkori A, Teddlie C. Handbook on mixed methods in the behavioral and social sciences. Thousand Oaks, CA: Sage; 2003.
27.
go back to reference Hill JC, Kang S, Benedetto E, Myers H, Blackburn S, Smith S, et al. Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ Open. 2016;6(8):e012331.CrossRefPubMedPubMedCentral Hill JC, Kang S, Benedetto E, Myers H, Blackburn S, Smith S, et al. Development and initial cohort validation of the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ Open. 2016;6(8):e012331.CrossRefPubMedPubMedCentral
28.
go back to reference Versus Arthritis. Osteoarthritis of the knee. Copeman House, St Mary’s Court, St Mary’s Gate, Chesterfield, Derbyshire S41 7TD.; 2020. Versus Arthritis. Osteoarthritis of the knee. Copeman House, St Mary’s Court, St Mary’s Gate, Chesterfield, Derbyshire S41 7TD.; 2020.
29.
go back to reference Scott IC, McCray G, Lancaster G, Foster NE, Hill JC, editors. Validation of the Musculoskeletal Health Questionnaire (MSK-HQ) in primary care patients with musculoskeletal pain. Seminars in arthritis and Rheumatism. Elsevier; 2020. Scott IC, McCray G, Lancaster G, Foster NE, Hill JC, editors. Validation of the Musculoskeletal Health Questionnaire (MSK-HQ) in primary care patients with musculoskeletal pain. Seminars in arthritis and Rheumatism. Elsevier; 2020.
30.
go back to reference Price AJ, Ogollah R, Kang S, Hay E, Barker KL, Benedetto E, et al. Determining responsiveness and meaningful changes for the Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ Open. 2019;9(10):e025357.CrossRefPubMedPubMedCentral Price AJ, Ogollah R, Kang S, Hay E, Barker KL, Benedetto E, et al. Determining responsiveness and meaningful changes for the Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways. BMJ Open. 2019;9(10):e025357.CrossRefPubMedPubMedCentral
31.
go back to reference Likert R. A technique for the measurement of attitudes. Archives of Psychology. 1932;22 140:55. Likert R. A technique for the measurement of attitudes. Archives of Psychology. 1932;22 140:55.
32.
go back to reference Brooke J. A quick and dirty usability scale. In: Jordan PW, Thomas B, Weerdmeester BA, McLelland IL, editors. Usability in evaluation in industry. London: Taylor Francis.; 1996. 189 – 94. Brooke J. A quick and dirty usability scale. In: Jordan PW, Thomas B, Weerdmeester BA, McLelland IL, editors. Usability in evaluation in industry. London: Taylor Francis.; 1996. 189 – 94.
33.
go back to reference Cohen J. Statistical Power Analysis for the behavioral sciences. London: Academic Press; 1988. Cohen J. Statistical Power Analysis for the behavioral sciences. London: Academic Press; 1988.
34.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101.CrossRef
35.
go back to reference Bennell K, Hinman RS, Wrigley TV, Creaby MW, Hodges P. Exercise and osteoarthritis: cause and effects. Compr Physiol. 2011;1(4):1943–2008.CrossRefPubMed Bennell K, Hinman RS, Wrigley TV, Creaby MW, Hodges P. Exercise and osteoarthritis: cause and effects. Compr Physiol. 2011;1(4):1943–2008.CrossRefPubMed
36.
37.
go back to reference Lazar A, Koehler C, Tanenbaum J, Nguyen DH, editors. Why we use and abandon smart devices. Proceedings of the 2015 ACM International Joint Conference on Pervasive and Ubiquitous Computing - UbiComp ‘15; 2015 2015-01-01: ACM Press. Lazar A, Koehler C, Tanenbaum J, Nguyen DH, editors. Why we use and abandon smart devices. Proceedings of the 2015 ACM International Joint Conference on Pervasive and Ubiquitous Computing - UbiComp ‘15; 2015 2015-01-01: ACM Press.
38.
go back to reference Klasnja P, Pratt W. Managing health with mobile technology. Interactions. 2014;21(1):66–9.CrossRef Klasnja P, Pratt W. Managing health with mobile technology. Interactions. 2014;21(1):66–9.CrossRef
39.
go back to reference Western MJ, Armstrong MEG, Islam I, Morgan K, Jones UF, Kelson MJ. The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis. Int J Behav Nutr Phys Activity. 2021;18(1). Western MJ, Armstrong MEG, Islam I, Morgan K, Jones UF, Kelson MJ. The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis. Int J Behav Nutr Phys Activity. 2021;18(1).
Metadata
Title
Influence of the intelligent knee osteoarthritis lifestyle app (iKOALA) on knee joint pain
Authors
Richard D.M. Stevenson
Enhad A. Chowdhury
Jesudas Lobo
Max J. Western
James L.J. Bilzon
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2024
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-024-07198-3

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