Telephone Coaching to Enhance Physiotherapy-Prescribed Physical Activity for Knee Osteoarthritis

Clinical and general health guidelines recommend physical activity (PA) and exercise for osteoarthritis (OA). Among people with OA, PA levels are low, there is a global underutilisation of exercise, and benefits are generally not sustained due to suboptimal adherence that declines over time. Telephone delivered health coaching can be used in chronic disease management to improve adherence to treatment recommendations and to facilitate health behaviour change. PURPOSE: To investigate whether telephone coaching improves effectiveness of a physiotherapy-prescribed home-based PA and exercise program for people with knee OA. METHODS: A 2-arm pragmatic randomised controlled trial was carried out with 168 inactive adults aged 50 years and older with knee pain and clinically-diagnosed knee OA. After randomisation to a Coaching (N=84) or Control (N=84) group, all participants received 5 x 30-minute individual consultations with a physiotherapist over 6 months for education, home-based exercise prescription, and advice to increase PA. Those in the Coaching group also received 6-12 telephone coaching sessions by trained health coaches for behaviour change support around PA. Primary outcomes were self-reported knee pain (numeric rating scale) and physical function (WOMAC) at 6 months. Secondary outcomes included these same measures at 12 and 18 months, other pain measures, PA, and quality of life. RESULTS: 142 (85%), 136 (81%), and 128 (76%) participants completed 6-, 12- and 18-month measurements, respectively. Change in pain (mean difference 0.4 units; 95%CI -0.4, 1.3) or WOMAC function (1.8; 95%CI -1.9, 5.5) did not differ between groups at 6 months, with both showing clinically relevant improvements. Results were similar at 12 and 18 months. Coaching improved self-reported PA (Physical Activity Scale for the Elderly -28.3; 95%CI -54.9, -1.8) more at 6 months, and home exercise adherence (percentage of prescribed sessions completed) was higher in Coaching (mean 69%; 95%CI 63, 75) versus Control (mean 55%; 95%CI 47, 61) during the 6-month intervention but not follow-up. CONCLUSION: Although addition of telephone coaching to a physiotherapist-prescribed PA program increased self-reported PA and exercise adherence in the shorter-term, it did not augment pain and function benefits.