BACKGROUND
Knee osteoarthritis (KOA) is the most common joint disorder in the U.S. 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
Here, we report on a mixed-methods study 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 (age ≥ 45) from rural Kentucky with obesity (BMI ≥ 30 kg/m2), idiopathic KOA with mild to moderate radiographic changes, and elevated depressive symptoms (PHQ-9 ≥ 10) recruited from two 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 the NIH Model Stage 1A.
RESULTS
Phase 1 qualitative analyses revealed nuanced information about: 1) challenges with coping and increasing activity, 2) high interest in a mind-body activity program, 3) program participation facilitators (flexibility with technology) and barriers (amotivation, forgetfulness), and 4) perceived challenges with data collection procedures (blood and urine samples, homework). Phase 2 quantitative analyses showed that GetActive-OA met most a priori feasibility markers (e.g., feasibility of recruitment, acceptability, expectancy, credibility, adherence, and program satisfaction). Adherence to ActiGraph wear and collection of blood samples was low. Participation in GetActive-OA was associated with signals of improvements in pain, KOA symptoms, depression, anxiety, pain catastrophizing, self-efficacy, and general coping. 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 are interested in a virtual mind-body activity program this comorbidity GetActive-OA shows promise, but the program and protocol require further NIH stage 1 refinement before formal efficacy testing (NIH model stage II).
INTERNATIONAL REGISTERED REPORT
RR2-10.1016/j.conctc.2021.100720