Effectiveness of a Smartphone Application to Improve Home Exercise Adherence in Adults with Knee Osteoarthritis in Saudi Arabia: A Randomized Controlled Trial
DOI:
https://doi.org/10.62464/ijoprp.v4i5.109Keywords:
knee osteoarthritis, telerehabilitation, exercise therapy, smartphone, mobile applications, treatment adherence, complianceAbstract
Background: Knee osteoarthritis (OA) is a prevalent condition globally, with poor adherence to home exercise programs (HEPs) posing a major barrier to effective management. This study examined the impact of a smartphone-based HEP with motivational text messaging on adherence, pain, and physical function among adults with knee OA in Saudi Arabia. Methods: A randomized controlled trial was conducted with 42 participants diagnosed with knee OA, recruited from a clinic at King Fahad Medical City (KFMC). Participants were randomized into two groups: the intervention group (n = 21) received a HEP delivered via WhatsApp with motivational text messages, while the control group (n = 21) received a paper-based HEP. Outcomes included self-reported adherence, pain (measured by visual analogue scale), and physical function (assessed using the Arabic version of the WOMAC physical function subscale). Assessments were conducted at baseline and at 6 weeks by a physical therapist with six years of experience. Results: At 6 weeks, the intervention group demonstrated significantly greater adherence (p = 0.001), lower pain scores (p = 0.017), and improved physical function (p = 0.001) compared to the control group. Conclusion: Delivering a HEP via a smartphone application with motivational text messaging may significantly improve adherence, reduce pain, and enhance physical function in adults with knee OA.
Keywords Knee Osteoarthritis, Tele Rehabilitation, Exercise Therapy, Smartphone, Mobile Applications, Treatment Adherence and Compliance.
References
Alasfour, M., & Almarwani, M. (2020). The effect of innovative smartphone application on adherence to a home-based exercise programs for female older adults with knee osteoarthritis in Saudi Arabia: a randomized controlled trial. Disability and Rehabilitation, 1–8. DOI: https://doi.org/10.1080/09638288.2020.1836268
Bellamy, N., Buchanan, W. W., Goldsmith, C. H., Campbell, J., & Stitt, L. W. (1988). Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. The Journal of Rheumatology, 15(12), 1833–1840.
Bennell, K. L., Dobson, F., & Hinman, R. S. (2014). Exercise in osteoarthritis: Moving from prescription to adherence. Best Practice and Research: Clinical Rheumatology, 28(1), 93–117. https://doi.org/10.1016/j.berh.2014.01.009 DOI: https://doi.org/10.1016/j.berh.2014.01.009
Broglio, K. (2018). Randomization in clinical trials: permuted blocks and stratification. Jama, 319(21), 2223–2224. DOI: https://doi.org/10.1001/jama.2018.6360
Colbert, C. J., Song, J., Dunlop, D., Chmiel, J. S., Hayes, K. W., Cahue, S., … Sharma, L. (2012). Knee confidence as it relates to physical function outcome in persons with or at high risk of knee osteoarthritis in the osteoarthritis initiative. Arthritis & Rheumatism, 64(5), 1437–1446. DOI: https://doi.org/10.1002/art.33505
Digital 2021: Global Overview Report — DataReportal – Global Digital Insights. (n.d.). Retrieved May 9, 2022, from https://datareportal.com/reports/digital-2021-global-overview-report
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. DOI: https://doi.org/10.3758/BF03193146
Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, (1). DOI: https://doi.org/10.1002/14651858.CD004376.pub3
Guermazi, M., Poiraudeau, S., Yahia, M., Mezganni, M., Fermanian, J., Elleuch, M. H., & Revel, M. (2004). Translation, adaptation and validation of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) for an Arab population: the Sfax modified WOMAC. Osteoarthritis and Cartilage, 12(6), 459–468. DOI: https://doi.org/10.1016/j.joca.2004.02.006
Hawker, G. A., Mian, S., Kendzerska, T., & French, M. (2011). Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short form‐36 bodily pain scale (sf. Arthritis Care & Research, 63(S11), S240–S252. DOI: https://doi.org/10.1002/acr.20543
Hawley-Hague, H., Horne, M., Skelton, D. A., & Todd, C. (2016). Review of how we should define (and measure) adherence in studies examining older adults’ participation in exercise classes. BMJ Open, 6(6). DOI: https://doi.org/10.1136/bmjopen-2016-011560
Hinman, R. S., Campbell, P. K., Lawford, B. J., Briggs, A. M., Gale, J., Bills, C., … Bennell, K. L. (2020). Does telephone-delivered exercise advice and support by physiotherapists improve pain and/or function in people with knee osteoarthritis? Telecare randomised controlled trial. British Journal of Sports Medicine, 54(13), 790–797. https://doi.org/10.1136/bjsports-2019-101183 DOI: https://doi.org/10.1136/bjsports-2019-101183
Holden, M. A., Haywood, K. L., Potia, T. A., Gee, M., & McLean, S. (2014). Recommendations for exercise adherence measures in musculoskeletal settings: a systematic review and consensus meeting (protocol). Systematic Reviews, 3(1), 10. https://doi.org/10.1186/2046-4053-3-10 DOI: https://doi.org/10.1186/2046-4053-3-10
James, S. L., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., … Abdelalim, A. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1789–1858. DOI: https://doi.org/10.1016/S0140-6736(18)32279-7
Leumann, A., Leonard, T., Nüesch, C., Horisberger, M., Mündermann, A., & Herzog, W. (2019). The natural initiation and progression of osteoarthritis in the anterior cruciate ligament deficient feline knee. Osteoarthritis and Cartilage, 27(4), 687–693. https://doi.org/10.1016/j.joca.2019.01.003 DOI: https://doi.org/10.1016/j.joca.2019.01.003
Marks, R. (2012). Knee osteoarthritis and exercise adherence: a review. Current Aging Science, 5(1), 72–83. DOI: https://doi.org/10.2174/1874609811205010072
McAlindon, T. E., Bannuru, R., Sullivan, M. C., Arden, N. K., Berenbaum, F., Bierma-Zeinstra, S. M., … Kawaguchi, H. (2014). OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage, 22(3), 363–388. DOI: https://doi.org/10.1016/j.joca.2014.01.003
Nelligan, R. K., Hinman, R. S., Kasza, J., & Bennell, K. L. (2019). Effectiveness of internet-delivered education and home exercise supported by behaviour change SMS on pain and function for people with knee osteoarthritis: A randomised controlled trial protocol. BMC Musculoskeletal Disorders, 20(1), 1–11. https://doi.org/10.1186/s12891-019-2714-x DOI: https://doi.org/10.1186/s12891-019-2714-x
Sandra Frances Bassett. (2003). The assessment of patient adherence to physiotherapy rehabilitation. New Zealand Journal of Physiotherapy, 31(2), 60–66.
Schäfer, A. G. M., Zalpour, C., Von Piekartz, H., Hall, T. M., & Paelke, V. (2018). The efficacy of electronic health-supported home exercise interventions for patients with osteoarthritis of the knee: Systematic review. Journal of Medical Internet Research, 20(4), 1–17. https://doi.org/10.2196/jmir.9465 DOI: https://doi.org/10.2196/jmir.9465
Sebbag, E., Felten, R., Sagez, F., Sibilia, J., Devilliers, H., & Arnaud, L. (2019). The world-wide burden of musculoskeletal diseases: a systematic analysis of the World Health Organization Burden of Diseases Database. Annals of the Rheumatic Diseases, 78(6), 844–848. DOI: https://doi.org/10.1136/annrheumdis-2019-215142
Spoelstra, S. L., Given, C. W., Sikorskii, A., Coursaris, C. K., Majumder, A., DeKoekkoek, T., … Given, B. A. (2015). Feasibility of a text messaging intervention to promote self-management for patients prescribed oral anticancer agents. Oncol Nurs Forum, 42(6), 647–657. DOI: https://doi.org/10.1188/15.ONF.647-657
Tittlemier, B. J., Wittmeier, K. D., & Webber, S. C. (2021). Quality and content analysis of clinical practice guidelines which include nonpharmacological interventions for knee osteoarthritis. Journal of Evaluation in Clinical Practice, 27(1), 93–102. DOI: https://doi.org/10.1111/jep.13391
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 International Journal of Physical Therapy Research & Practice
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
