Nero Håkan, Dahlberg Jakob, Dahlberg Leif E
Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
Arthro Therapeutics AB, Malmö, Sweden.
J Med Internet Res. 2017 Dec 18;19(12):e422. doi: 10.2196/jmir.9255.
Osteoarthritis (OA) is one of the most common causes of disability, with a burden of disease estimated to increase over time. Joint Academy, a Web-based treatment for individuals with clinically verified knee or hip OA, was developed to increase access to and facilitate implementation of evidence-based nonsurgical OA treatment in accordance with international guidelines.
The primary aim of this study was to evaluate joint pain, physical function, and health-related quality of life (HRQoL) over time of users of the Joint Academy program.
We enrolled 350 patients who were recruited online and completed the initial health journal in the 6-week program. We asked patients to complete an eHealth journal and e-questionnaires, including pain level assessed by a numerical rating scale, as well as a physical function evaluation using the 30-second chair-stand test. In addition, we assessed HRQoL using the 3-level version of the EQ-5D. We also asked participants whether they experienced difficulty walking and were afraid of physical activity due to their OA and their desire for surgery. We collected descriptive data and compared pre- versus postintervention data. As a reference group, we included results retrieved from the Swedish well-structured face-to-face self-supportive OA management program Better Management of Patients With Osteoarthritis (BOA).
Of the study cohort (n=350 patients; 239 women, mean age 62 years, mean body mass index 27 kg/m2), 71.4% (n=250) completed the program and were included in the study. We used the questionnaires to secure a clinical diagnosis of OA and to establish baseline study values. After 6 weeks of treatment, the change in mean numerical rating scale was larger than the minimal clinical difference (5.4 vs 4.1; P<.001), while physical function increased (from 10.88 to 13.14; P<.001). The percentage of participants having walking difficulties decreased from 81.7% (196/240) to 62.1% (149/240; P<.001), those afraid of being physically active decreased from 22.1% (53/240) to 6.7% (16/240; P<.001), and 22.0% (55/250) reported that they had reduced the amount of OA-related medication. After 6 weeks, 24% (13/54) of those desiring surgery at the start of the program were no longer interested. In addition, the comparison between Joint Academy and the BOA program showed similar levels of pain at 3 months, but suggested greater reduction with the use of Joint Academy due to a higher level of pain at baseline.
The reported data suggest that participation in Joint Academy is associated with a clinically relevant decrease in pain and an increase in physical function and HRQoL, as well as a decreasing fear of physical activity. This innovative Web-based OA treatment is scalable, is population specific, and can reach a large number of individuals with impaired joints who have Internet access.
骨关节炎（OA）是导致残疾的最常见原因之一，预计其疾病负担会随着时间推移而增加。“关节学院”是一种针对临床确诊的膝关节或髋关节OA患者的基于网络的治疗方法，旨在根据国际指南增加循证非手术性OA治疗的可及性并促进其实施。
本研究的主要目的是评估“关节学院”项目使用者随时间推移的关节疼痛、身体功能及健康相关生活质量（HRQoL）。
我们招募了350名通过网络招募的患者，他们在为期6周的项目中完成了初始健康日志。我们要求患者完成一份电子健康日志和电子问卷，包括用数字评分量表评估的疼痛程度，以及使用30秒坐立试验进行的身体功能评估。此外，我们使用EQ-5D的3级版本评估HRQoL。我们还询问参与者是否因OA而行走困难、害怕体育活动以及他们对手术的渴望程度。我们收集描述性数据并比较干预前后的数据。作为参考组，我们纳入了从瑞典结构完善的面对面自我支持OA管理项目“骨关节炎患者更好管理”（BOA）中获取的结果。
在研究队列（n = 350例患者；239名女性，平均年龄62岁，平均体重指数27kg/m²）中，71.4%（n = 250）完成了该项目并纳入研究。我们使用问卷来确定OA的临床诊断并建立研究基线值。治疗6周后，平均数字评分量表的变化大于最小临床差异（5.4对4.1；P <.001），而身体功能有所改善（从10.88提高到13.14；P <.001）。有行走困难的参与者比例从81.7%（196/240）降至62.1%（149/240；P <.001），害怕体育活动的参与者比例从22.1%（53/240）降至6.7%（16/240；P <.001），22.0%（55/250）报告他们减少了OA相关药物的用量。6周后，项目开始时渴望手术的患者中有24%（13/54）不再感兴趣。此外，“关节学院”与BOA项目的比较显示，3个月时疼痛水平相似，但由于基线时疼痛水平较高，提示使用“关节学院”时疼痛减轻幅度更大。
报告的数据表明，参与“关节学院”与疼痛在临床上的显著减轻、身体功能和HRQoL的改善以及对体育活动恐惧的减少相关。这种创新的基于网络的OA治疗方法具有可扩展性，针对特定人群，并且可以惠及大量有关节问题且能上网的个体。
