https://immattersacp.org/weekly/archives/2021/03/02/4.htm

Telehealth options show benefit in treating effects of osteoarthritis

Recent randomized trials in patients with osteoarthritis showed that an app-based program was associated with some reduction in reported pain and that cognitive behavioral therapy by phone improved insomnia symptoms.


Two studies assessed telehealth programs for pain caused by osteoarthritis.

The first study randomized participants ages 45 years or older with a diagnosis of knee osteoarthritis to an intervention group (n=48) receiving treatment through a smartphone app or a control group (n=57) receiving routine self-management care. The primary outcome was change from baseline to six weeks in self-reported pain during the previous seven days, reported on a scale from 0 to 10. Results were published Feb. 23 by JAMA Network Open.

Patients receiving the smartphone-based program showed a greater pain score reduction than the control group (between-group difference, −1.5 points; 95% CI, −2.2 to −0.8 points; P<0.001). The intervention group had better improvements in the 30-second sit-to-stand test (between-group difference in times the participant could rise from a sitting position on a chair to a full standing position in 30 seconds, 3.4; 95% CI, 2.2 to 4.5; P<0.001) and Timed Up-and-Go test (between-group difference, −1.8 s; 95% CI, −3.0 to −0.5 s; P=0.007), as well on other scores for pain (between-group difference, −1.1 point; 95% CI, −2.0 to −0.2 points; P=0.02), stiffness (between-group difference, −1.0 point; 95% CI, −1.5 to −0.5 points; P<0.001), and physical function (between-group difference, −3.4 points; 95% CI, −6.2 to −0.7 points; P=0.02).

No adverse events were reported, but the researchers noted that the COVID-19 lockdown prevented 27 participants from attending the follow-up visit, so the study failed to reach planned statistical power. Still, they said, results suggest that the smartphone-delivered treatment was superior to routine self-managed usual care and could be provided without harm. “Digital delivery was superior to routine self-management,” the authors wrote. “Our findings suggest that digital treatment has the potential to decrease the osteoarthritis burden on both the health care systems and patients.”

The second study tested a brief telephone cognitive behavioral therapy for insomnia (CBT-I) in patients ages 60 years and older with moderate to severe osteoarthritis pain.

The telehealth intervention comprised six 20- to 30-minute telephone sessions provided over eight weeks. Participants submitted daily diaries and received group-specific educational materials. The CBT-I instruction included sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and homework. The control group received information about sleep and osteoarthritis.

The primary outcome was score on the Insomnia Severity Index (ISI) two months after treatment and at 12 months of follow-up, while Secondary outcomes included pain score on the Brief Pain Inventory-Short Form, depression score on the 8-item Patient Health Questionnaire, and fatigue score on the Flinders Fatigue Scale. Results were published Feb. 22 by JAMA Internal Medicine.

In the 282 participants with follow-up data, scores at two months after treatment had decreased 8.1 points in the CBT-I group and 4.8 points in the education-only group, an adjusted mean between-group difference of −3.5 points (95% CI, −4.4 to −2.6 points; P<0.001). At 12 months, 56.3% of participants receiving CBT-I remained in remission (ISI ≤7) at 12 months compared with 25.8% of participants in the education-only control group.

Fatigue was also significantly reduced in the CBT-I group compared with the control group two months after treatment (mean between-group difference, −2.0 points; 95% CI, −3.1 to −0.9 points; P<0.001) and at 12-months of follow-up (mean between-group difference, −1.8 points; 95% CI, −3.1 to −0.6 points; P=0.003). Significant post-treatment differences were observed for pain but were not sustained at 12 months.

The results support provision of telephone CBT-I as an accessible, individualized, effective, and scalable insomnia treatment, according to the authors. “The ongoing coronavirus disease 2019 pandemic highlights the importance of being able to deliver effective health care remotely through a modality as widely available as the telephone,” they wrote. “Given abundant evidence that CBT-I is efficacious for persons with other comorbid conditions, including older adults with chronic pain, we believe [our] findings are likely to be generalizable beyond the present [osteoarthritis] study population.”