@Article{info:doi/10.2196/34654,
author="Mace, Ryan A
and Greenberg, Jonathan
and Lemaster, Nicole
and Duarte, Brooke
and Penn, Terence
and Kanaya, Millan
and Doorley, James D
and Burris, Jessica L
and Jacobs, Cale A
and Vranceanu, Ana-Maria",
title="Live Video Mind-Body Program for Patients With Knee Osteoarthritis, Comorbid Depression, and Obesity: Development and Feasibility Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="27",
volume="6",
number="4",
pages="e34654",
keywords="knee osteoarthritis; depression; obesity; mind-body; physical activity; mixed-methods; mobile phone",
abstract="Background: Knee osteoarthritis (KOA) is the most common joint disorder in the United States and a leading cause of disability. Depression and obesity are highly comorbid with KOA and accelerate knee degeneration and disability through biopsychosocial mechanisms. Mind-body physical activity programs can engage biological, mechanical, and psychological mechanisms to improve outcomes in KOA, but such programs are not currently available. Objective: This mixed methods study aims to adapt a mind-body activity program for the unique needs of patients with KOA, depression, and obesity (GetActive-OA) delivered via live video. Methods: Participants were adults (aged ≥45 years) from rural Kentucky with obesity (BMI≥30 kg/m2), idiopathic KOA with mild to moderate radiographic changes, and elevated depressive symptoms (9-item Patient Health Questionnaire ≥10) recruited from 2 orthopedic centers. In phase 1, we developed GetActive-OA and the study protocol using qualitative focus group feedback from the study population (N=9; 2 focus groups, 90 minutes) and multidisciplinary expertise from clinical psychologists and orthopedic researchers. In phase 2, we explored the initial feasibility, credibility, and acceptability of GetActive-OA, live video delivery, and study procedures via an open pilot with exit interviews (N=5; 1 group). This research was guided by National Institutes of Health (NIH) model stage IA. Results: Phase 1 qualitative analyses revealed nuanced information about challenges with coping and increasing activity, high interest in a mind-body activity program, program participation facilitators (flexibility with technology) and barriers (amotivation and forgetfulness), and perceived challenges with data collection procedures (blood and urine samples and homework). Phase 2 quantitative analyses showed that GetActive-OA met most a priori feasibility markers: acceptability (80{\%}), expectancy (100{\%}), credibility (100{\%}), clinician adherence (90{\%}), homework adherence (80{\%}), questionnaire data collection (100{\%}), program satisfaction (100{\%}), and safety (100{\%}). Adherence to ActiGraph wear (80{\%} baseline, 20{\%} posttest) and collection of blood samples (60{\%}) were low. Participation in GetActive-OA was associated with signals of improvements in general coping (Cohen d=2.41), pain catastrophizing (Cohen d=1.24), depression (Cohen d=0.88), anxiety (Cohen d=0.78), self-efficacy (Cohen d=0.73), pain (Cohen d=0.39), and KOA symptoms (Cohen d=0.36). Qualitative exit interviews confirmed quantitative findings and provided valuable information to optimize the program and protocol. Conclusions: Patients with KOA, depression, and obesity from rural Kentucky were interested in a live video mind-body activity program. GetActive-OA shows promise; however, the program and protocol require further NIH stage I refinement before formal efficacy testing (NIH model stage II). International Registered Report Identifier (IRRID): RR2-10.1016/j.conctc.2021.100720 ",
issn="2561-326X",
doi="10.2196/34654",
url="https://formative.jmir.org/2022/4/e34654",
url="https://doi.org/10.2196/34654",
url="http://www.ncbi.nlm.nih.gov/pubmed/35475787"
}