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Using a web-based tool to facilitate tailored exercise for people with osteoarthritis
S240
Abstracts / Osteoarthritis and Cartilage 24 (2016) S63eS534
Conclusions: The average OA QI score at baseline was 61% and the audit and feedback of patients’ symptoms and care to date with automatic recommendations did not change the QI scores or pain and function level of patients. The baseline scores of care were higher than other studies which may explain the lack of improvement on the questionnaire. PDSA cycles resulted in changes that helped to clarify patient responses and the subsequent supports used to implement tailored action plans. This formed the basis for a large scale implementation for all patients with knee OA in the family practice. 414 USING A WEB-BASED TOOL TO FACILITATE TAILORED EXERCISE FOR PEOPLE WITH OSTEOARTHRITIS A. Zbehlik y, z, E.A. Scherer x, k, E.J. Li ¶, J. Graber #, S.J. Bartels x, yy. y Dartmouth Hitchcock Med. Ctr., Lebanon, NH, USA; z The Dartmouth Inst., Geisel Sch. of Med. at Dartmouth, Hanover, NH, USA; x Geisel Sch. of Med. at Dartmouth, Hanover, NH, USA; k Dept. of Community and Family Med. and Dept. of BioMed. Data Sci., Hanover, NH, USA; ¶ The Feinberg Sch. of Med.-Northwestern Univ., Chicago, IL, USA; # Carter Community Building Association, Lebanon, NH, USA; yy Dartmouth Ctr.s for Hlth. and Aging, Lebanon, NH, USA Purpose: Osteoarthritis (OA) of the knee is a major cause of mobility disability world-wide and is associated with high health care and societal costs. Exercise and weight loss can minimize the symptoms and complications of the disease. Unfortunately, people with knee OA commonly experience a “treatment paradox” where pain and fear of joint damage prevent them from exercising and hinder their ability to improve their metabolic and cardiovascular health. How to engage individuals in exercise remains elusive in the context of the medical system. The purpose of this study was to assess the feasibility, acceptability, and potential effectiveness of identifying people with knee OA interested in individualized exercise programs through a web-based OA application; assess their exercise barriers, facilitators, motivators, and preferences; and engage them in an exercise program tailored to meet their needs by a fitness instructor. Methods: Participants aged 50e85 years with knee OA who did not meet physical activity guidelines completed the Preference Diagnosis (PDx), a web-based software program developed by The Dartmouth Center for Health Care Delivery Science that assesses preferences for knee OA treatment. The first 10 participants who responded “yes” to an embedded exercise question assessed their exercise barriers, facilitators, motivators, and preferences. Participants then worked with a fitness instructor to develop exercise routines and modify them as needed, but exercised on their own. Demographics and anthropomorphic measures included age, sex, height, weight, and waist circumference. Outcomes were measured at baseline, 1, and 3 months. The primary outcome measure was the proportion of participants who completed the PDx and endorsed the exercise question within 3 months. Secondary outcomes included: change in mean number of self-reported minutes spent in mild, moderate or vigorous exercise over the previous week; Rapid Assessment of Physical Activity (RAPA); proportion of participants who adopted an exercise routine at 1 and 3 months; change in health goal attainment confidence; and pain, measured by a 10cm visual analog scale. Interviews of the participants at 3 months were analyzed for themes to assess acceptability. This study was not powered to detect significant difference in outcome measures, but was aimed at addressing feasibility, acceptability, and potential effectiveness of the intervention. Results: Ten participants completed PDx within 3 months, and 10/10 (100%) were interested in exercise. Nine (9/10, 90%) participants completed the baseline, 1, month and 3 month follow ups. The most preferred exercise was walking, the greatest motivator was improved mood, and the greatest barriers were lack of energy and cost. Total exercise increased by 1,744 minutes/week between baseline and 3 months. At baseline, 3 participants reported an exercise routine which increased to 7 at 3 months. Mean pain decreased from 5.40 to 3.04 for a difference of 2.34 points. Mean confidence improved from 6.89 to 8.06 (difference 1.17, scale 0e10). Paired t-tests comparing baseline to 3 month values show significant change for pain (mean change (SD) 2.34 (2.39) p¼0.0188). There was no significant change over time in exercise minutes, RAPA, or confidence. Preliminary qualitative analysis shows most participants found the intervention was more valuable than a clinic visit for their overall health.
Conclusions: It is feasible and acceptable to identify people with osteoarthritis interested in individualized exercise programs through a web-based osteoarthritis application. Engaging them in an exercise program tailored to meet their needs by a fitness instructor may increase physical activity, decrease pain, and improve health confidence. This method may help bridge the gap between provider recommendations for physical activity and adoption of exercise routines.
Imaging & Joint Morphometry 415 VARIATIONS IN HIP MORPHOLOGY ARE ASSOCIATED WITH FUNCTIONAL STATUS: PRELIMINARY RESULTS FROM THE JOHNSTON COUNTY OSTEOARTHRITIS PROJECT A.E. Nelson y, J.L. Stiller y, X.A. Shi z, J.B. Renner y, T.A. Schwartz y, M.K. Javaid x, N.K. Arden x, J.M. Jordan y. y Univ. of North Carolina, Chapel Hill, NC, USA; z SAS Inst., Inc, Cary, NC, USA; x Univ. of Oxford, Oxford, United Kingdom Purpose: Alterations in hip morphology, such as femoroacetabular impingement, have been associated with incident hip OA and total hip replacement (THR), but associations of these morphologic variations with functional status are less clear, and have not been studied in a community-based sample including participants with and without OA. Methods: This preliminary analysis was performed as part of our ongoing work to determine the prevalence of morphologic features at the hip at the baseline visit (1990e97) for the Johnston County OA project, a large population-based cohort. At the time of this analysis, 3564 hips had been read, 446 were excluded based on excessive tilt/ rotation, and 3118 hips (from 1559 individuals) were included. Given known differences by sex in both hip morphology and functional outcomes, all results were stratified by sex. Three functional outcomes were assessed: 1) Self-reported functional status using the Stanford Health Assessment Questionnaire (HAQ) Disability Index, with scores from 0e3 (categorized as 0, more than 0 but less than 1, and 1 or more); 2) Seconds to rise from a chair 5 times (categorized as a 3-level variable, less than the median time, greater than or equal to the median time, or unable); 3) Average seconds to complete an 8 foot walk (dichotomized at the median time). Standardized software (HipMorf) was used to assess hip morphology in both hips, with the right hip as the primary variable of interest. P-values for the differences among means for each morphologic measure by category of functional outcome were determined by analysis of variance. Separate logistic and proportional odds regression models, as appropriate, adjusting for age and baseline KLG were used to produce adjusted odds ratios for associations between each morphologic measure and each functional outcome. Results: Of the included individuals, 31.7% were men, 35.0% were African American, with a mean age of 64.2 ± 10.2 years and BMI 28.9 ± 6.1 kg/(m squared). Baseline KLG was 0 or 1 in 75% of hips. Reliability for all measures was acceptable (intra- [ICC 0.7e1.00] and inter-reader ICC 0.5e1.00). We focused on 9 continuous measures of hip morphology, and results for HAQ and walk time for the right hip in women are presented in the Table. Higher scores on the HAQ, indicative of greater disability, were associated with greater AP alpha angles and Gosvig ratios. Prolonged times to complete the 8-foot walk task were associated with greater AP alpha angles, Gosvig ratio, and triangular index height as well as smaller mJSW. In models adjusted for age and baseline KLG, the associations were only slightly attenuated (Table). Longer times for completing the chair stand task, or inability to do so, were associated with smaller femoral shaft angles and proximal femoral angles, as well as greater triangular index height (data not shown). For the left hip among women, unadjusted results were overall similar although an additional statistically significant association was seen between HAQ and mJSW, and the association between alpha angle and walk time was not significant. Among men, the only statistically significant associations seen were for HAQ with higher Gosvig ratio (p¼0.03) and lateral CEA (p¼0.04). Conclusions: Indicators of femoral morphology, including femoral angles and measures of cam deformity (AP alpha angle, Gosvig ratio, and triangular index height) were associated with functional outcomes in women. These preliminary findings are supportive of an association between hip morphology such as that seen in FAI and physical function in the general population. Further study in a larger number of hips will assess differences by race and other key covariates.
Abstracts / Osteoarthritis and Cartilage 24 (2016) S63eS534
Conclusions: The average OA QI score at baseline was 61% and the audit and feedback of patients’ symptoms and care to date with automatic recommendations did not change the QI scores or pain and function level of patients. The baseline scores of care were higher than other studies which may explain the lack of improvement on the questionnaire. PDSA cycles resulted in changes that helped to clarify patient responses and the subsequent supports used to implement tailored action plans. This formed the basis for a large scale implementation for all patients with knee OA in the family practice. 414 USING A WEB-BASED TOOL TO FACILITATE TAILORED EXERCISE FOR PEOPLE WITH OSTEOARTHRITIS A. Zbehlik y, z, E.A. Scherer x, k, E.J. Li ¶, J. Graber #, S.J. Bartels x, yy. y Dartmouth Hitchcock Med. Ctr., Lebanon, NH, USA; z The Dartmouth Inst., Geisel Sch. of Med. at Dartmouth, Hanover, NH, USA; x Geisel Sch. of Med. at Dartmouth, Hanover, NH, USA; k Dept. of Community and Family Med. and Dept. of BioMed. Data Sci., Hanover, NH, USA; ¶ The Feinberg Sch. of Med.-Northwestern Univ., Chicago, IL, USA; # Carter Community Building Association, Lebanon, NH, USA; yy Dartmouth Ctr.s for Hlth. and Aging, Lebanon, NH, USA Purpose: Osteoarthritis (OA) of the knee is a major cause of mobility disability world-wide and is associated with high health care and societal costs. Exercise and weight loss can minimize the symptoms and complications of the disease. Unfortunately, people with knee OA commonly experience a “treatment paradox” where pain and fear of joint damage prevent them from exercising and hinder their ability to improve their metabolic and cardiovascular health. How to engage individuals in exercise remains elusive in the context of the medical system. The purpose of this study was to assess the feasibility, acceptability, and potential effectiveness of identifying people with knee OA interested in individualized exercise programs through a web-based OA application; assess their exercise barriers, facilitators, motivators, and preferences; and engage them in an exercise program tailored to meet their needs by a fitness instructor. Methods: Participants aged 50e85 years with knee OA who did not meet physical activity guidelines completed the Preference Diagnosis (PDx), a web-based software program developed by The Dartmouth Center for Health Care Delivery Science that assesses preferences for knee OA treatment. The first 10 participants who responded “yes” to an embedded exercise question assessed their exercise barriers, facilitators, motivators, and preferences. Participants then worked with a fitness instructor to develop exercise routines and modify them as needed, but exercised on their own. Demographics and anthropomorphic measures included age, sex, height, weight, and waist circumference. Outcomes were measured at baseline, 1, and 3 months. The primary outcome measure was the proportion of participants who completed the PDx and endorsed the exercise question within 3 months. Secondary outcomes included: change in mean number of self-reported minutes spent in mild, moderate or vigorous exercise over the previous week; Rapid Assessment of Physical Activity (RAPA); proportion of participants who adopted an exercise routine at 1 and 3 months; change in health goal attainment confidence; and pain, measured by a 10cm visual analog scale. Interviews of the participants at 3 months were analyzed for themes to assess acceptability. This study was not powered to detect significant difference in outcome measures, but was aimed at addressing feasibility, acceptability, and potential effectiveness of the intervention. Results: Ten participants completed PDx within 3 months, and 10/10 (100%) were interested in exercise. Nine (9/10, 90%) participants completed the baseline, 1, month and 3 month follow ups. The most preferred exercise was walking, the greatest motivator was improved mood, and the greatest barriers were lack of energy and cost. Total exercise increased by 1,744 minutes/week between baseline and 3 months. At baseline, 3 participants reported an exercise routine which increased to 7 at 3 months. Mean pain decreased from 5.40 to 3.04 for a difference of 2.34 points. Mean confidence improved from 6.89 to 8.06 (difference 1.17, scale 0e10). Paired t-tests comparing baseline to 3 month values show significant change for pain (mean change (SD) 2.34 (2.39) p¼0.0188). There was no significant change over time in exercise minutes, RAPA, or confidence. Preliminary qualitative analysis shows most participants found the intervention was more valuable than a clinic visit for their overall health.
Conclusions: It is feasible and acceptable to identify people with osteoarthritis interested in individualized exercise programs through a web-based osteoarthritis application. Engaging them in an exercise program tailored to meet their needs by a fitness instructor may increase physical activity, decrease pain, and improve health confidence. This method may help bridge the gap between provider recommendations for physical activity and adoption of exercise routines.
Imaging & Joint Morphometry 415 VARIATIONS IN HIP MORPHOLOGY ARE ASSOCIATED WITH FUNCTIONAL STATUS: PRELIMINARY RESULTS FROM THE JOHNSTON COUNTY OSTEOARTHRITIS PROJECT A.E. Nelson y, J.L. Stiller y, X.A. Shi z, J.B. Renner y, T.A. Schwartz y, M.K. Javaid x, N.K. Arden x, J.M. Jordan y. y Univ. of North Carolina, Chapel Hill, NC, USA; z SAS Inst., Inc, Cary, NC, USA; x Univ. of Oxford, Oxford, United Kingdom Purpose: Alterations in hip morphology, such as femoroacetabular impingement, have been associated with incident hip OA and total hip replacement (THR), but associations of these morphologic variations with functional status are less clear, and have not been studied in a community-based sample including participants with and without OA. Methods: This preliminary analysis was performed as part of our ongoing work to determine the prevalence of morphologic features at the hip at the baseline visit (1990e97) for the Johnston County OA project, a large population-based cohort. At the time of this analysis, 3564 hips had been read, 446 were excluded based on excessive tilt/ rotation, and 3118 hips (from 1559 individuals) were included. Given known differences by sex in both hip morphology and functional outcomes, all results were stratified by sex. Three functional outcomes were assessed: 1) Self-reported functional status using the Stanford Health Assessment Questionnaire (HAQ) Disability Index, with scores from 0e3 (categorized as 0, more than 0 but less than 1, and 1 or more); 2) Seconds to rise from a chair 5 times (categorized as a 3-level variable, less than the median time, greater than or equal to the median time, or unable); 3) Average seconds to complete an 8 foot walk (dichotomized at the median time). Standardized software (HipMorf) was used to assess hip morphology in both hips, with the right hip as the primary variable of interest. P-values for the differences among means for each morphologic measure by category of functional outcome were determined by analysis of variance. Separate logistic and proportional odds regression models, as appropriate, adjusting for age and baseline KLG were used to produce adjusted odds ratios for associations between each morphologic measure and each functional outcome. Results: Of the included individuals, 31.7% were men, 35.0% were African American, with a mean age of 64.2 ± 10.2 years and BMI 28.9 ± 6.1 kg/(m squared). Baseline KLG was 0 or 1 in 75% of hips. Reliability for all measures was acceptable (intra- [ICC 0.7e1.00] and inter-reader ICC 0.5e1.00). We focused on 9 continuous measures of hip morphology, and results for HAQ and walk time for the right hip in women are presented in the Table. Higher scores on the HAQ, indicative of greater disability, were associated with greater AP alpha angles and Gosvig ratios. Prolonged times to complete the 8-foot walk task were associated with greater AP alpha angles, Gosvig ratio, and triangular index height as well as smaller mJSW. In models adjusted for age and baseline KLG, the associations were only slightly attenuated (Table). Longer times for completing the chair stand task, or inability to do so, were associated with smaller femoral shaft angles and proximal femoral angles, as well as greater triangular index height (data not shown). For the left hip among women, unadjusted results were overall similar although an additional statistically significant association was seen between HAQ and mJSW, and the association between alpha angle and walk time was not significant. Among men, the only statistically significant associations seen were for HAQ with higher Gosvig ratio (p¼0.03) and lateral CEA (p¼0.04). Conclusions: Indicators of femoral morphology, including femoral angles and measures of cam deformity (AP alpha angle, Gosvig ratio, and triangular index height) were associated with functional outcomes in women. These preliminary findings are supportive of an association between hip morphology such as that seen in FAI and physical function in the general population. Further study in a larger number of hips will assess differences by race and other key covariates.