A remotely - applied behaviorally- designed intervention incorporating gamification, social incentives, and health coaching to improve durability of physical therapy for knee osteoarthritis (ReAKTIV)

Knee osteoarthritis (KOA) is a high-priority problem among the aging population, and in particular, among veterans. Notably, few interventions have been shown to be effective in the long-term management of symptoms of the disease. Physical therapy (PT) interventions have been shown to be a safe and effective strategy to improve symptoms of KOA through strengthening of peri-articular tissues and improving biomechanics. Current guidelines also support the promotion of greater overall physical activity in order to address persistent symptoms of OA (e.g., pain, physical function). Recent studies have articulated both the quality and quantity of physical activity necessary to reduce the symptomatic burden of hip and knee osteoarthritis. Current organizational guidelines for the non-operative management of KOA also include strong recommendations for supervised exercise delivered through standard PT and the promotion of greater physical activity in management plans. While PT is often an effective and safe therapy, longer-term adherence to home exercise programs and increases in physical activity is low, and benefits of exercise programs are therefore often short-lived. We have experience using remotely-applied programs to promote healthy behaviors. The proposed study aims to promote greater adherence to home exercise programs and promote greater overall physical activity with the long-term goal of achieving maintenance of symptomatic gains for patients that complete standard PT interventions. We designed both a remote behavioral intervention and health coaching program to address multiple themes that are known to drive maintenance of behavior change over the long- term. Specifically, we propose to fill important knowledge gaps in this area with a large, pragmatic clinical trial. In this study, we will randomize participants in a factorial design to receive the behaviorally-designed remote intervention, a virtual health coach, or both, after being released from a standard PT intervention with proven efficacy in order to promote adherence to a home exercise program and greater overall physical activity with the goal of maintaining the symptomatic gains observed during PT over 18 months. To accomplish these aims, we will utilize innovative mobile applications for smart phones and wearable activity trackers through the Way- to-HealthTM platform and assess, in real time, the impact of the intervention on patient-reported function and pain as well as physical activity levels and adherence to specific knee-related exercises at home. The technology will allow for the recording of outcomes in real time, as they occur, thereby avoiding information bias due to poor recall as well as participation bias. The study will follow 240 patients, enrolled over 5 VA sites, for 18 months during the interventional phase and then monitor them for another 6 months after the interventions have been removed. The investigative team includes investigators with experience conducting similar trials using this infrastructure as well team members to inform trial design and support the health coach. The study involves a centralized organizational structure in close collaboration with investigators across the country, enhancing the generalizability and feasibility of recruitment. The proposed aims represent a direct response to a special emphasis area in VA Rehabilitation Research and are informed by a report from the Evidence Synthesis Program. The successful completion of these aims would support the development and dissemination of a tool applied remotely and at low cost to add to effective PT interventions that are already being utilized. Project Number: 1I01RX004770-01A2 | Fiscal Year: 2025 | NIH Institute/Center: Veterans Affairs (VA) | Principal Investigator: JOSHUA BAKER | Institution: PHILADELPHIA VA MEDICAL CENTER, PHILADELPHIA, PA | Activity Code: I01 | Study Section: Musculoskeletal Health & Function[RRD2] View on NIH RePORTER: https://reporter.nih.gov/project-details/10992320