Telehealth-Supported Exercise or Physical Activity Programs for Knee Osteoarthritis: Systematic Review and Meta-Analysis (Preprint)

Abstract

The integration of telehealth-supported programs in chronic disease management has become increasingly common. However, its effectiveness for individuals with knee osteoarthritis (KOA) remains unclear.

This study aimed to assess the effectiveness of telehealth-supported exercise or physical activity programs for individuals with KOA.

A comprehensive literature search encompassing Embase, MEDLINE, CENTRAL, Web of Science, PubMed, Scopus, PEDro, GreyNet, and medRxiv from inception to September 2023 was conducted to identify randomized controlled trials comparing telehealth-supported exercise or physical activity programs to a control condition for KOA. Data were extracted and qualitatively synthesized across eligible studies, and a meta-analysis was performed to evaluate the effects. The study was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020.

In total, 23 studies met eligibility criteria, with 20 included in the meta-analysis. Results showed that telehealth-supported exercise or physical activity programs reduced pain (<i>g</i>=–0.39; 95% CI –0.67 to –0.11; <i>P</i>&lt;.001), improved physical activity (<i>g</i>=0.13; 95% CI 0.03-0.23; <i>P</i>=.01), and enhanced physical function (<i>g</i>=–0.51; 95% CI –0.98 to –0.05; <i>P</i>=.03). Moreover, significant improvements in quality of life (<i>g</i>=0.25; 95% CI 0.14-0.36; <i>P</i>&lt;.001), self-efficacy for pain (<i>g</i>=0.72; 95% CI 0.53-0.91; <i>P</i>&lt;.001), and global improvement (odds ratio 2.69, 95% CI 1.41-5.15; <i>P</i>&lt;.001) were observed. However, self-efficacy for physical function (<i>g</i>=0.14; 95% CI –0.26 to 0.53; <i>P</i>=.50) showed insignificant improvements. Subgroup analyses based on the World Health Organization classification of digital health (pain: <i>χ</i>²₂=6.5; <i>P</i>=.04 and physical function: <i>χ</i>²₂=6.4; <i>P</i>=.04), the type of teletechnology in the intervention group (pain: <i>χ</i>²₄=4.8; <i>P</i>=.31 and function: <i>χ</i>²₄=13.0; <i>P</i>=.01), and active or inactive controls (pain: <i>χ</i>²₁=5.3; <i>P</i>=.02 and physical function: <i>χ</i>²₁=3.4; <i>P</i>=.07) showed significant subgroup differences.

Telehealth-supported exercise or physical activity programs might reduce knee pain and improve physical activity, physical function, quality of life, self-efficacy, and global improvement in individuals with KOA. Future research should consider longer implementation durations and assess the feasibility of incorporating wearables and standardized components into large-scale interventions to evaluate the effects.

PROSPERO CRD42022359658; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=359658