Exploring physical function, activity, and sustainable delivery of first-line treatment for patients with osteoarthritis

Abstract

Exercise is a cornerstone in the treatment of patients with osteoarthritis (OA). The patients need long-term support to adhere to prescribed exercise, but this need cannot be met solely within the healthcare system. Developing innovative and sustainable methods for delivery and support of exercise programs is urgently needed. The aim of this thesis was to contribute to development of feasible and sustainable management of OA. The research focuses were to explore physical function in patients with OA, to assess the validity of measures for assessing physical activity, and to examine the feasibility of and adherence to a web-based, peer-supported exercise program delivered by a patient organization. In a cross-sectional study, walking function was compared between 500 OA patients and 235 controls, and the association between walking function and arterial stiffness was tested in the OA group. In a methodological study, the validity of The International Physical Activity Questionnaire-Short Form (IPAQ-SF) was assessed in 93 patients, using an accelerometer as criterion method. The feasibility of and adherence to a 12-week, web-based, peer-supported exercise program delivered by a patient organization was assessed in 30 patients. Already from 40 years of age, OA patients had reduced walking function, and their walking function was associated with arterial stiffness. The criterion validity of IPAQ-SF was weak, and patients tended to over-report health-enhancing activity. The web-based exercise program delivered by the Norwegian Rheumatic Association was feasible, acceptable and safe, with half of the patients adhering to the exercise program. The findings emphasize the importance of early assessment of physical function and activity by use of appropriate and valid measures in order to provide tailored exercise programs. Patient organizations can be a valuable resource for support and follow-up of exercise programs, and thereby alleviate the healthcare system.