Infectious Disease
COVID-19 increases the profile and benefits of digital therapeutic approaches in OA
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Bennell K. Digital health approaches for the lifestyle management of osteoarthritis. Presented at: OARSI 2021 World Congress on Osteoarthritis; May 2nd to 5th; Toronto Canada. (virtual meeting).
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Bennell reports on associations with Medibank Private and Wolters Kluwer.
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The COVID-19 pandemic forced rheumatologists to adopt a range of telemedical and digital approaches to patient care, according to a spokesperson for the virtual meeting of the OARSI World Congress in 2021.
Kim Bennell, PhD, The Chair of Physiotherapy at the University of Melbourne suggested that osteoarthritis patients could benefit from real-time or asynchronous interventions, or a combination of these approaches. Doctors can also incorporate technology into a package of personal and out-of-office care. “There are a number of digital approaches,” she said.
“COVID has obviously dramatically changed the way health care is delivered around the world,” said Dr. Kim Bennell to the participants. “It was a good opportunity to examine the implementation of these telehealth approaches in practice.” Source: Adobe Stock
Bennell’s talk dealt with data sets related to telehealth, fully automated web-based interventions, and phone-based or wearable technologies. She acknowledged that most of the studies she discussed were done before the pandemic. “COVID-19 has apparently dramatically changed the way health care is delivered around the world,” she said. “It was a good opportunity to examine the implementation of these telehealth approaches in practice.”
When reviewing telehealth data, Bennell says it is important to note whether the study was conducted before or after COVID-19. Before the pandemic, skepticism and a lack of acceptance of telehealth were widespread in rheumatology. “Some doctors don’t like that they couldn’t use a typical practical approach,” she said.
However, since the pandemic, this thought process has changed across the discipline, including telemedicine calls. “It’s gratifying to show that if you can’t see the person you’re interacting with, the therapeutic relationship doesn’t necessarily suffer as much as some people might think,” said Bennell.
With regard to fully automated web-based interventions, Bennell suggested that a major advantage of these approaches is that they do not require a doctor at all. The downside, however, is that compliance can be “problematic” as nobody involves the patient.
This has been confirmed in some data sets. A study by Bossen and colleagues in the Journal of Medical Internet Research showed that physical activity improved in patients who participated in automated exercise programs. According to Bennell, however, compliance was “not optimal”.
Even so, Bennell suggested that automated interventions don’t necessarily have to involve hard outcomes like activity levels or pain and function. They can be used to develop pain management skills, promote relaxation or mindfulness, alleviate strategies for poorly adjusted pain, or promote “generally positive user experiences”.
Automated approaches can also be used as stand-alone treatments or as the first step in a step-by-step approach that involves a clinician.
By this second point, patients in a study by Allen and colleagues in the Annals of Internal Medicine had embarked on a fully automated exercise program. When they did not improve, they switched to telephone contact with a health coach. The third step was a personal visit to a physiotherapist. More self-motivated patients only needed the automated program to achieve the goals, while others benefited from the second or third step.
Regarding phone-based interventions and wearable devices, Bennell reported that a number of systematic reviews have shown that these strategies can lead to improvement in outcomes ranging from daily step counts to weight loss and exercise habits.
Given that there is a wide variety of commercial and clinical devices out there, clinicians and researchers should carefully consider what technology to use and how to use it for a particular patient. “We need to consider the target audience’s e-health literacy,” said Bennell.
Bennell says it is also important to include certain behavioral techniques such as goal setting, monitoring, feedback, and instruction. “We need to train doctors to get the most out of these interventions,” she said. “We need better patient selection to make sure it is safe or unsafe or appropriate.”
While licensing, funding, and reimbursement of such programs was challenging prior to the pandemic, COVID-19 has helped “advance the field,” according to Bennell.
In rheumatology, if there is one final component of technology, up to this point it concerns cost. There has been speculation that more automated digital services and fewer office visits could lower the overall financial burden from osteoarthritis, but that conclusion is far from certain. “Further studies need to examine the cost effectiveness of these digital approaches,” said Bennell.
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