Applications of Digital Health Technologies in Knee Osteoarthritis: A Narrative Review (Preprint)

Abstract

With increasing adoption of high-speed internet and mobile technologies by older adults, digital health (comprising websites, mobile applications, text messaging, tele-health, etc.) is a promising modality to enhance research and clinical care for people with osteoarthritis (OA), including those with knee replacement (KR).

This narrative review summarizes key digital health technologies and the use of digital health for delivery of patient education, supervised and unsupervised exercise and/or physical activity interventions, psychological interventions, cost-effectiveness of digital health, and clinician and patient perspective toward digital health in the field of knee OA and KR. Remaining challenges and future opportunities for digital health technologies to improve care in knee OA and KR are also discussed.

Search terms such as “mobile health”, “smartphone”, mobile application”, “mobile technology”, “ehealth”, “text message”, “internet”, “knee osteoarthritis” etc. were used in PubMed and EMBASE databases in February 2021. The search was limited to original articles published in English language within the prior ten years. In all, 91 relevant studies were included in this review.

Digital health technologies such as websites, mobile phone apps, telephone calls, text-messaging, social media, video-conferencing software, and custom multi-technology systems have been used to deliver healthcare in knee OA and KR populations. Digital patient education interventions improved disease related knowledge at shorter follow-up periods, especially when used as an adjunct to traditional methods of patient education. The benefits of digital health for exercise and physical activity interventions in people with knee OA appear mixed. Digital interventions that use more than one technology and/or strategies to engage the participants may be more promising than those that rely on a single modality. Digital interventions for chronic knee pain that include psychological treatments are effective. Digital health appears appropriate for enhancing in-person physical therapy care for people with knee OA but may not serve as replacement for in-person interventions. However, the cost-effectiveness of hybrid (i.e., digital and in-person) interventions needs further investigation for people with knee OA. Finally, both people with knee OA and clinicians had positive views on digital health, but raised privacy and security related concerns, and logistic and training related concerns, respectively.

For people with knee OA, blended interventions that integrate digital and in-person care are promising but need further investigations. For people pre- or post-KR, digital health appears to be similar to or better than in-person rehabilitation and cost-effective. Wider implementation of these promising technologies should be considered. Patient and clinician preferences should be incorporated early in the intervention design process for digital health.