title: Effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis: randomized controlled trial.
abstract: BACKGROUND
  Patients with knee and/or hip osteoarthritis (OA) are less physically active than the general population, while the benefits of physical activity (PA) have been well documented. Based on the behavioral graded activity treatment, we developed a Web-based intervention to improve PA levels in patients with knee and/or hip OA, entitled "Join2move". The Join2move intervention is a self-paced 9-week PA program in which the patient's favorite recreational activity is gradually increased in a time-contingent way.
  
  
  OBJECTIVE
  The aim of the study was to investigate whether a fully automated Web-based PA intervention in patients with knee and/or hip OA would result in improved levels of PA, physical function, and self-perceived effect compared with a waiting list control group.
  
  
  METHODS
  The study design was a two-armed randomized controlled trial which was not blinded. Volunteers were recruited via articles in newspapers and health-related websites. Eligibility criteria for participants were: (1) aged 50-75 years, (2) self-reported knee and/or hip OA, (3) self-reported inactivity (30 minutes of moderate PA, 5 times or less per week), (4) no face-to-face consultation with a health care provider other than general practitioners, for OA in the last 6 months, (5) ability to access the Internet weekly, and (6) no contra-indications to exercise without supervision. Baseline, 3-month, and 12-month follow-up data were collected through online questionnaires. Primary outcomes were PA, physical function, and self-perceived effect. In a subgroup of participants, PA was measured objectively using accelerometers. Secondary outcomes were pain, fatigue, anxiety, depression, symptoms, quality of life, self-efficacy, pain coping, and locus of control.
  
  
  RESULTS
  Of the 581 interested respondents, 199 eligible participants were randomly assigned to the intervention (n=100) or waiting list control group (n=99). Response rates of questionnaires were 84.4% (168/199) after 3 months and 75.4% (150/199) after 12 months. In this study, 94.0% (94/100) of participants actually started the program, and 46.0% (46/100) reached the adherence threshold of 6 out of 9 modules completed. At 3 months, participants in the intervention group reported a significantly improved physical function status (difference=6.5 points, 95% CI 1.8-11.2) and a positive self-perceived effect (OR 10.7, 95% CI 4.3-26.4) compared with the control group. No effect was found for self-reported PA. After 12 months, the intervention group showed higher levels of subjective (difference=21.2 points, 95% CI 3.6-38.9) and objective PA (difference=24 minutes, 95% CI 0.5-46.8) compared with the control group. After 12 months, no effect was found for physical function (difference=5 points, 95% CI -1.0 to 11.0) and self-perceived effect (OR 1.2, 95% CI 0.6-2.4). For several secondary endpoints, the intervention group demonstrated improvements in favor of the intervention group.
  
  
  CONCLUSIONS
  Join2move resulted in changes in the desired direction for several primary and secondary outcomes. Given the benefits and its self-help format, Join2move could be a component in the effort to enhance PA in sedentary patients with knee and/or hip OA.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands. d.bossen@nivel.nl.
authors.forename: Daniël
authors.initials: D
authors.lastname: Bossen
authors.forename: Cindy
authors.initials: C
authors.lastname: Veenhof
authors.forename: Karin Ec
authors.initials: KE
authors.lastname: Van Beek
authors.forename: Peter Mm
authors.initials: PM
authors.lastname: Spreeuwenberg
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.forename: Dinny H
authors.initials: DH
authors.lastname: De Bakker
mesh_terms: D000368:Aged; D015444:Exercise; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015207:Osteoarthritis, Hip / Q000503:physiopathology / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011795:Surveys and Questionnaires; D014850:Waiting Lists
keywords: Web-based intervention; osteoarthritis; physical activity; randomized controlled trial