Research Exercise January 27, 2025
Östlind et al. 2025

Self-Monitoring Physical Activity in Osteoarthritis

Monitoring physical activity in osteoarthritis (1)

Introduction

Physical activity is the recommended first-line treatment to improve symptoms and improve functioning, although many people do not meet the minimum amount of recommended activity levels. A study by Kanavaki et al. (2017) indicated that joint pain is an important barrier to engagement in physical activity and that some people struggle with finding the optimal level of physical activity. This indicates that a lot of people need guidance to get them towards adequate levels of exercise. However, since osteoarthritis is a chronic, incurable condition, self-management is favored over intensive and costly one-on-one guidance. Mercer et al. (2016) found that the use of wearable trackers could lead to behavioral change and improved physical activity levels. This concept was picked up in this study to see if people with osteoarthritis could also improve their physical activity levels when wearing a wearable activity tracker. Therefore, the current study aimed at investigating the effect of self-monitoring physical activity in osteoarthritis.

 

Methods

In a secondary analysis of a randomized controlled trial published in 2020, the authors looked closer at the outcomes of perceived joint function and health-related quality of life and tried to unravel whether adding self-monitoring physical activity in osteoarthritis could enhance those outcomes.

Eligible candidates were people with hip and/or knee osteoarthritis between the ages of 18 and 67 years. They had to be employed for at least 50% and had to be able to engage in physical activity.

Two groups were compared:

  1. Individuals participating in the Supported Osteoarthritis Self-management Program (SOASP)
  2. Individuals who participated in the SOASP and received a wearable activity tracker

Those in the group receiving the wearable activity tracker had to wear this device from waking to bedtime for 12 consecutive weeks. The device was programmed so that every participant started the trial with a predefined daily step goal of 7000 steps.

Sociodemographic variables were collected and the perceived joint function was assessed using the Hip Disability and Osteoarthritis Outcome Score (HOOS) or Knee Injury and Osteoarthrits Outcome Score (KOOS), depending on the most affected joint. Scores range from 0-100 where lower scores represent worse outcomes.

The self-rated health-related quality of life was captured using the Euroqol EQ-5D-3L questionnaire. This score ranges from 0-100 with lower scores indicating worse outcomes. This questionnaire has 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.

Outcomes were assessed at baseline, 3-, 6-, and 12-months.

 

Results

A total of 124 participants: 50 in the control group and 74 in the intervention group were analyzed. The majority of the included participants were female (87%). The ages of the participants ranged from 38 to 65 years, with the mean at 55.8 years. The knee was the most affected joint.

Monitoring Physical Activity in Osteoarthritis
From: Östlind et al., BMC Musculoskelet Disord. (2025)

 

The analysis indicated no statistically significant interaction effects for any of the HOOS or KOOS subscales, nor for the EQ-5D-3L. There were only small improvements over time, irrespective of group allocation, especially for the subscales pain, and symptoms. For the EQ-5D-3L, no improvements over time were observed. These findings indicate no benefits for self-monitoring physical activity in osteoarthritis.

Monitoring Physical Activity in Osteoarthritis
From: Östlind et al., BMC Musculoskelet Disord. (2025)

 

Questions and thoughts

Why is it so difficult to create meaningful changes for people affected by osteoarthritis? One possible explanation is that the HOOS and KOOS questionnaires are not well-suited to capture changes in people treated conservatively. But we can also be critical for the intervention used. In the 2022 trial, similarly, no benefits were observed between the intervention and control groups on the outcome workability. We must also critically review the intervention program. The individuals were supplemented with a wearable device. However, these people were already moderately active, yet the baseline daily step goal was regressed to 7000. Maybe, the program was just not intense enough to generate meaningful differences. Furthermore, every individual has other starting levels, so fine-tuning seems very important, yet, a one-size-fits-all approach was used. After all, in practice, you don’t give everyone the same starter kit, don’t you?

If we look into the components of the SOASP program, the study refers to Thorstensson et al. (2015) when the program was still named Better Management of Patients with Osteoarthritis (BOA). Interestingly, this program has an optional exercise component. The study mentions: The purpose of the theoretical sessions was to explain the mechanisms behind the possible benefits of specific exercises and to increase the patient’s motivation to exercise. However, patients could choose to decline exercise if they were not motivated at the time. Unfortunately, no such information was provided in the current study nor was it mentioned whether people declined exercise. This could be a major factor as to why no relevant improvements were observed.

 

Monitoring Physical Activity in Osteoarthritis
From: Thorstensson et al. (2015). https://pubmed.ncbi.nlm.nih.gov/25345913/

 

The results are very disappointing. However, we must take into account that the people participating in this trial were already active at baseline and a significant proportion of them had already regularly used a wearable activity tracker. It is possible that this sample was thus not well-suited for this RCT. It could have been possible that a sample of inactive participants from lower socioeconomic classes with limited access to healthcare would have been better suited.

 

Talk nerdy to me

You should also be aware that this study was a secondary analysis of an earlier RCT. The earlier trial did not find meaningful effects between the groups with or without wearable activity trackers. You could wonder why they still performed this analysis..

Apart from the secondary nature, which limits power since the original RCT was not powered for this analysis, no real methodological problems arose. The current study population might not be best for the scope of the study, but it might be interesting to learn what the use of wearable activity trackers might add in people who need it more, for instance, people with low activity levels, limited access to healthcare, low health literacy, etc.

 

Take-home messages

Self-monitoring physical activity in osteoarthritis did not lead to improved outcomes of joint function and health-related quality of life in this sample of already active individuals familiar with wearable activity trackers and exercise.

 

Reference

Östlind E, Eek F, Stigmar K, Ekvall Hansson E. Effects of self-monitoring physical activity with wearable activity trackers on perceived joint function and health-related quality of life in people with hip and knee osteoarthritis: a secondary analysis of a cluster-randomised clinical trial. BMC Musculoskelet Disord. 2025 Jan 9;26(1):33. doi: 10.1186/s12891-024-08238-8. PMID: 39789623; PMCID: PMC11715198.

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