People with knee Osteoarthritis (OA) often develop negative psychosocial beliefs like pain catastrophizing and fear avoidance that can interfere with engagement in physical activity and adherence to exercise. This can lead to further pain and disability since exercise and physical activity are the first line treatment for knee OA. Therefore, there is a need for interventions that address negative psychosocial beliefs related to exercise and low adherence along with addressing physical impairments of knee OA. This dissertation examined the safety, feasibility, and acceptability of a novel telehealth mindful exercise intervention for people with knee OA. The mindful exercise intervention trains individuals to incorporate concepts of mindfulness into strengthening exercises recommended for knee OA. The intervention was delivered via telehealth to facilitate access. Study 1 used a decentralized randomized controlled trial (RCT) of mindful exercise (n=21) vs. exercise alone (n=19) in people with knee OA. Mindful exercise was safe with 0 adverse events (vs. 4 in exercise group) and lower use of oral analgesics. The design was feasible for recruitment and retention, but adherence was suboptimal (53% in mindful exercise group) and the cohort was not racially diverse. Participants in the mindful exercise group reported larger clinically meaningful improvements in pain intensity, interference, catastrophizing, quality of life, and global assessment of knee OA compared to the exercise group. Study 2 was to qualitatively determine the acceptability of the mindful exercise intervention. Participants in the mindful exercise group of the RCT (n = 13 of 21) participated in individual interviews that were informed by the Theoretical Framework of Acceptability. Participants valued the content (exercise and mindfulness) and format (telehealth, group) of the intervention. Areas for further refinement included exercise selection and equipment, additional support and education on mindfulness, and greater flexibility with timing and nature of intervention sessions. Study 3 investigated the association between telehealth satisfaction and ehealth literacy in both groups. Participants in this cohort had high ehealth literacy (mean = 31.3 on a 8–40 scale) at baseline and high satisfaction with telehealth (mean = 5.6 on a 1–7 scale) at the end of the intervention. There was no association between ehealth literacy and telehealth satisfaction (R2=0.01, p=0.61). In conclusion, telehealth mindful exercise could be a safe and feasible intervention for people with knee OA. However, further refinement to improve adherence and acceptability are needed prior to efficacy studies.
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/47929 |
| Date | 11 January 2024 |
| Creators | Shah, Nirali |
| Contributors | Kumar, Deepak |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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