A Remotely - Applied Behaviorally- Designed Intervention Incorporating Gamification, Social Incentives, and Health Coaching to Improve Durability of Physical Therapy for Knee Osteoarthritis (ReAKTIV)
VA Office of Research and Development
Summary
The aims are to determine whether 1) an incentive based on behaviorally-enhanced gamification and social incentives and 2) health coaching can promote adherence to exercise and physical activity after physical therapy for osteoarthritis of the knee (KOA). The research design is a randomized clinical trial with factorial design This randomized clinical trial of 254 patients using a factorial design will leverage a clinical trial platform developed through the University of Pennsylvania that allows for the remotely capture important patient-reported outcomes and other interaction through a participant's smart phone. The investigators will randomize participants to receive social incentives with gamification to promote adherence to prescribed exercises as well as maintenance of greater levels of physical activity and compare to controls that receive a Fitbit but no additional incentive. Participants may also be randomized to receive a health coach. The investigators will utilize mobile applications for smart phones and wearable activity trackers through the Way-to-Health platform and assess, in real time, the impact of the interventions on patient-reported function and pain (as measured by the Knee Osteoarthritis Outcome Score) as well as physical activity. Participants will be followed for 2 years, with a total of 5 in-person visits. Knee osteoarthritis (KOA) is one of the most prevalent and disabling conditions among Veterans and accounts for high morbidity and high costs for the VA. Importantly, while physical therapy is valuable for patients with KOA, lack of adherence to home exercises and low overall physical activity limit the durability of response. The current proposal aims to address two important knowledge gaps in the management of KOA in order to improve pain and function.
Description
Knee osteoarthritis (KOA) is a high-priority problem among the aging population, and in particular, among Veterans. Few interventions have been shown effective in the long-term management of symptoms. Current guidelines for non-operative KOA management include strong recommendations for exercise delivered through standard physical therapy (PT) and the promotion of greater physical activity. Standard physical therapy (PT) interventions characterized by 6-8 week of supervised exercises (e.g., strengthening peri-articular tissues) and mobility training (e.g., improving biomechanics and movement p…
Eligibility
- Age range
- 40–90 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Clinical diagnosis or chronic knee osteoarthritis. * Age between 40-90 years * Initiating physical therapy for KOA (has initial appointment within the next month or had first PT visit within the last 7 days) * To be randomized: PT feels that they are able to safely and reliably participate in ongoing exercise. * To be randomized: must have completed at least 4 virtual or in-person appointments with PT * To be randomized: must sync their Fitbit at least monthly. Exclusion Criteria: * Lack of a smart phone allowing interaction with the WTH platform * Inability to walk 2…
Interventions
- BehavioralHealth coach
Health Coaching
- BehavioralRemote Incentive Program
Behavioral incentive program including gamification, social incentivization, and monitoring.
Locations (5)
- Birmingham VA Medical Center, Birmingham, ALBirmingham, Alabama
- Omaha VA Nebraska-Western Iowa Health Care System, Omaha, NEOmaha, Nebraska
- VA Portland Health Care System, Portland, ORPortland, Oregon
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PAPhiladelphia, Pennsylvania
- VA Puget Sound Health Care System Seattle Division, Seattle, WASeattle, Washington