Corelien Kloek

A Blended Intervention for Patients With Knee and Hip Osteoarthritis in the Physical Therapy Practice: Development and a Pilot Study

Background Blended care, a combination of online and face-to-face care, is seen as a promising treatment option. However, actual use of blended interventions in practice is disappointing. Objective The objective of this study was two folded. The first aim was to develop a blended exercise therapy intervention for patients with knee and hip osteoarthritis that matches the values of the users and that can be implemented in the daily routine of physical therapists. The second aim was to investigate the feasibility through interviews and a pilot study. Methods In this paper, we employed the first 3 steps of the CeHRes road map to develop a blended intervention for patients with knee and hip osteoarthritis. We used interviews, a focus group and discussions with stakeholders to explore the needs, values, and requirements with respect to our to-be-developed blended intervention, which we called e-Exercise. The first version of e-Exercise was tested in a pilot study. Feasibility outcomes, including recruitment rates within each practice, website usage (assignments completed and website visits), and user satisfaction, were measured. In addition, therapists and patients from the pilot study were interviewed to investigate users’ experiences. Results The study captured important information about stakeholders’ needs and perspectives. Based on our findings, we created a first version and attuned the application’s content, functionality, and structure. Patients and, to lesser extent, physical therapists were satisfied with the e-Exercise intervention. Eight patients were recruited by 8 physical therapists. Of the 8 patients, 6 completed more than 7 of 12 modules. Conclusions This study outlines the development and feasibility of a blended exercise therapy intervention for patients with knee and hip osteoarthritis. E-Exercise offers an alternative approach in the physical therapy treatment of knee and hip osteoarthritis. This study provides valuable information to conduct a further trial to evaluate the (cost) effectiveness of e-Exercise compared to usual physical therapy. Trial Registration Netherlands Trial Register Number: NTR4224; www.trialregister.nl/trialreg/admin/rctview.asp?TC=4224 (Archived by WebCite at http://www.webcitation.org/6fOK4lrTO).

Determinants of Adherence to the Online Component of a Blended Intervention for Patients with Hip and/or Knee Osteoarthritis: A Mixed Methods Study Embedded in the e-Exercise Trial

BACKGROUND Embedding Web-based interventions within physiotherapy has potential, but knowledge on patient adherence to these interventions is limited. INTRODUCTION This study explores which patient-, intervention-, and environment-related factors are determinants of adherence to the online component of e-Exercise, a 12-week blended intervention for patients with hip and/or knee osteoarthritis. METHODS A convergent mixed methods study was performed, embedded within an ongoing trial. Quantitative data of 109 participants that received e-Exercise were used for negative binomial regression analysis. Adherence was defined as the number of online evaluated weeks. Next, semistructured interviews on factors related to adherence to the online component were analyzed. RESULTS Nineteen participants with missing outcome data because their program was not started were excluded. Of the 90 analyzed participants, 81.1% were evaluated for at least 8 weeks. Adherence was highest for participants with middle education, 1-5-year osteoarthritis duration, and participants who were physiotherapist recruited. The 10 analyzed interviews revealed that sufficient Internet skills, self-discipline, execution of the exercise plan, the interventions usability, flexibility, persuasive design, added value, and acceptable required time, and research participation were linked to favorable adherence. DISCUSSION It is unknown if patients who adhered to the online component also adhered to their exercise plans. The relationship between adherence to the online component and clinical outcomes will be addressed in a future study. CONCLUSIONS The majority of the participants adhered to the online component of e-Exercise, illustrating its applicability. The integration within the physiotherapy setting and interventions persuasive design appear to have an important role in optimizing patient adherence.

Dutch General Practitioners’ weight management policy for overweight and obese patients

BackgroundGeneral practitioners (GPs) can play an important role in both the prevention and management of overweight and obesity. Current general practice guidelines in the Netherlands allow room for GPs to execute their own weight management policy.ObjectiveTo examine GPs’ current weight management policy and the factors associated with this policy.Methods800 Dutch GPs were asked to complete a questionnaire in December 2012. The questionnaire items were based on the Dutch Obesity Standard for GPs. The data were analyzed by means of descriptive statistics and multiple linear regression analyses in 2013.ResultsIn total, 307 GPs (39.0%) responded. Most respondents (82.9%) considered weight management as part of their responsibility for providing care. GPs aged <48 years discussed weight less frequent. Next, weight is less frequently discussed with patients without weight-related comorbidities or with moderately overweight patients compared to obese patients. On average, 47.7% of the GPs reported to refer obese patients to a weight management professional, preferably a dietitian (98.3%). GPs with a BMI ≥ 25 kg/m2 were less likely to refer obese patients. In addition, GPs who had frequent contact with a dietitian were more likely to refer obese patients.ConclusionsIn the context of General Practice and preventive medicine, GPs’ discussion of weight and the variety of obesity-determinants with their moderately overweight patients deserves more attention, especially from younger GPs. Strengthening interdisciplinary collaboration between GPs and dietitians could increase the referral percentage for dietary treatment.

Feasibility of a home-based exercise intervention with remote guidance for patients with stable grade II and III gliomas : A pilot randomized controlled trial

Objective: In this pilot study, we investigated the feasibility of a home-based, remotely guided exercise intervention for patients with gliomas. Design: Pilot randomized controlled trial (RCT) with randomization (2:1) to exercise or control group. Subjects: Patients with stable grade II and III gliomas. Intervention: The six-month intervention included three home-based exercise sessions per week at 60%–85% of maximum heart rate. Participants wore heart rate monitors connected to an online platform to record activities that were monitored weekly by the physiotherapist. Main measures: Accrual, attrition, adherence, safety, satisfaction, patient-reported physical activity, VO2 peak (by maximal cardiopulmonary exercise testing) and body mass index (BMI) at baseline and at six-month follow-up. Results: In all, 34 of 136 eligible patients (25%) were randomized to exercise training (N = 23) or the control group (N = 11), of whom 19 and 9, respectively, underwent follow-up. Mean adherence to prescribed sessions was 79%. Patients’ experiences were positive. There were no adverse events. Compared to the control group, the exercise group showed larger improvements in absolute VO2 peak (+158.9 mL/min; 95% CI: −44.8 to 362.5) and BMI (−0.3 kg/m²; 95% CI: −0.9 to 0.2). The median increase in physical activity was 1489 metabolic equivalent of task (MET) minutes higher in the exercise group. The most reported reasons for non-participation were lack of motivation or time. Conclusion: This innovative and intensive home-based exercise intervention was feasible in a small subset of patients with stable gliomas who were interested in exercising. The observed effects suggest that the programme may improve cardiorespiratory fitness. These results support the need for large-scale trials of exercise interventions in brain tumour patients.

Blended Interventions to Change Behavior in Patients With Chronic Somatic Disorders: Systematic Review

Background Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of blended behavior change interventions and how they should be composed is scattered. Objective This comprehensive systematic review aimed to provide an overview of characteristics and effectiveness of blended behavior change interventions for patients with chronic somatic disorders. Methods We searched for randomized controlled trials published from 2000 to April 2017 in PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Cochrane Collaboration tool. Study characteristics, intervention characteristics, and outcome data were extracted. Studies were sorted based on their comparison group. A best-evidence synthesis was conducted to summarize the effectiveness. Results A total of 25 out of the 29 included studies were of high quality. Most studies (n=21; 72%) compared a blended intervention with no intervention. The majority of interventions focused on changing pain behavior (n=17; 59%), and the other interventions focused on lifestyle change (n=12; 41%). In addition, 26 studies (90%) focused on one type of behavior, whereas 3 studies (10%) focused on multiple behaviors. A total of 23 studies (79%) mentioned a theory as basis for the intervention. The therapeutic guidance in most studies (n=18; 62%) was non face-to-face by using email, phone, or videoconferencing, and in the other studies (partly), it was face-to-face (n=11; 38%). In 26 studies (90%), the online care was provided via a website, and in 3 studies (10%) via an app. In 22 studies (76%), the therapeutic guidance and online care were integrated instead of two separate aspects. A total of 26 outcome measures were included in the evidence synthesis comparing blended interventions with no intervention: for the coping strategy catastrophizing, we found strong evidence for a significant effect. In addition, 1 outcome measure was included in the evidence synthesis comparing blended interventions with face-to-face interventions, but no evidence for a significant effect was found. A total of 6 outcome measures were included in the evidence synthesis comparing blended interventions with online interventions, but no evidence for a significant effect was found. Conclusions Blended behavior change interventions for patients with chronic somatic disorders show variety in the type of therapeutic guidance, the type of online care, and how these two delivery modes are integrated. The evidence of the effectiveness of blended interventions is inconsistent and nonsignificant for most outcome measures. Future research should focus on which type of blended intervention works for whom.

Huisartsenzorg bij overgewicht en obesitas

SamenvattingKloek CJJ, Tol J, Veenhof C, Van der Wulp I, Swinkels ICS. Huisartsenzorg bij overgewicht en obesitas. Huisarts Wet 2015;58(2):66-9.InleidingHuisartsen kunnen een belangrijke rol spelen bij de preventie en behandeling van overgewicht en obesitas. De NHG-Standaard Obesitas geeft de huisarts vrijheid in het uitvoeren van zijn of haar behandelbeleid bij deze doelgroep. Met dit onderzoek wilden we inzicht krijgen in het behandelbeleid van huisartsen bij patiënten met overgewicht en obesitas, en in de factoren, zoals persoonskenmerken of persoonlijke visie op dieetzorg, die gerelateerd zijn aan dit beleid.MethodenIn 2012 hebben we 800 huisartsen benaderd om een schriftelijke vragenlijst in te vullen. De vragen waren gebaseerd op de NHG-Standaard Obesitas. Door middel van beschrijvende statistiek en meervoudige lineaire regressieanalyses hebben we de factoren gerelateerd aan het bespreken van het gewicht en het verwijsbeleid voor voedings- en/of dieetadvies in kaart gebracht.ResultatenVan de 307 respondenten (netto respons 39,0%) vond 82,9% het bevorderen van een gezond gewicht een belangrijk onderdeel van de huisartsenzorg. Huisartsen jonger dan 48 jaar brachten het gewicht minder vaak ter sprake bij zwaarlijvige patiënten dan hun oudere collega’s. Daarnaast bespraken ze het gewicht minder vaak met patiënten met overgewicht of obesitas als er geen sprake was van een daaraan gerelateerde klacht. De huisartsen verwijzen bijna de helft van de patiënten met obesitas naar een professional, bij voorkeur een diëtist (98,3%). Huisartsen die frequent interdisciplinair contact met een diëtist hadden en huisartsen met een gezond gewicht stuurden hun patiënt met obesitas vaker door.BeschouwingIn het kader van de preventie van (ernstig) overgewicht vraagt het bespreken van gewicht en aan het gewicht gerelateerde onderwerpen bij patiënten met beginnend overgewicht vooral bij de jongere huisartsen om meer aandacht. Daarnaast blijken er tussen huisartsen verschillen te zijn in het verwijspercentage naar zorgverleners voor voedings- en/of dieetadvies.

SAT0432 Blended Physical Activity Intervention with Reduced Face-To-Face Contact and Usual Physical Therapy Show Similar Effectiveness in Patients with Knee and Hip Osteoarthritis: A Randomized Controlled Trial

Background Exercise therapy is an effective treatment in patients with knee and hip osteoarthritis. However, face-to-face therapy is an expensive regimen. Blended exercise therapy, in which face-to-face contact is combined with a web-based program, might be a cost-effective alternative. Moreover, a blended intervention supports home-exercises and self-management through technology which is available at any time and place. We developed the blended intervention e-Exercise, a 12-week program in which up to five usual physical therapy sessions are integrated with a web-based program. Objectives The objective of this study was to evaluate the short-term effectiveness of e-Exercise compared to usual physical therapy for patients with knee and/or knee osteoarthritis. Methods A multicentre cluster randomized controlled trial was conducted. A number of 247 physical therapists were randomly allocated to e-Exercise (intervention group) or usual physical therapy (control group). The web-based part of e-Exercise is based on graded activity principles. Individual assignments for a central activity, such as walking or cycling, are gradually increased and supported with strength/stability exercises and information modules. Program progress can be evaluated during the face-to-face sessions. Content of these sessions were in both groups based on the Dutch physiotherapy guideline Osteoarthritis Hip-Knee which recommend education, self-management promotion, exercise therapy and if necessary manual therapy. Primary patient-outcomes, measured at baseline and after 12 weeks, were physical functioning and physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy and the number of physical therapy sessions. Data were analysed using a mixed linear model. Results Totally, 208 patients were included. There were no significant differences in baseline demographics between the intervention (N=108) and control group (N=100). 176 (85%) participants completed the follow-up questionnaire. After 12 weeks, none of the primary outcome measures were significant different between groups. Within group analyses, however, showed for both groups a significant improvement in physical functioning (IG: +4.1 points/100, p<0.01; CG: +5.3 points/100, p<0.01). Participants in the intervention group reported an increase of 23.7 minutes (p=0.03) physical activity per day, the control group an increase of 13.1 minutes (p=0.21). However, no significant differences were found for physical activity measured with ActiGraph accelerometers. With respect to the other outcomes, tiredness reduced significant (p<0.02) more in the intervention group (-1.3 points/10) compared to the control group (-0.5 points/10). Within both groups there were significant improvements for pain, tiredness, quality of life and self-efficacy. The intervention group received 5 face-to face sessions (range 2–16), the control group 12 (range 2–29). Conclusions In this study we found that e-Exercise is an effective treatment option in patients with knee and hip osteoarthritis. Subgroup-analysis, long-term effectiveness and cost-effectiveness of e-Exercise compared to usual physical therapy are forthcoming. Disclosure of Interest None declared