Effects of a self-directed online Tai Chi program in people with knee osteoarthritis: randomised controlled trial (The RETREAT Trial)

INTERVENTION: Participants in the intervention group will have access to a bespoke website (“MyJoint Tai Chi”). The "MyJoint Tai Chi" website is designed specifically for this study. It contains i) educational information about osteoarthritis and exercise management and Tai Chi; ii) a self‐directed 12‐week progressive Tai Chi program; and iii) information about an app (“My Exercise Messages”) to support their adherence to the Tai Chi program. The educational materials on the website will be provided in online written format as well as online videos (each lasting no more than 5 minutes). The online videos contain interviews of people with osteoarthritis and osteoarthritis experts. The website recommends that participants read the educational material and watch the videos. The self‐directed Tai Chi program on the website is guided by an instructor delivering the program in a series of 12 pre‐recorded videos (one per week). Each video (40‐45 mins) includes a warm‐up consisting of an introduction by the instructor, standing meditation, breathing exercises, and Qigong. The central portion of each video utilises a modified 10‐form Yang style Tai Chi which involves slow and controlled movements. Modifications to the movements were made to ensure suitability for people with lower limb osteoarthritis and little prior Tai Chi experience. Each video ends with a cool‐down consisting of breathing practices and relaxation exercises. The 12‐week program starts with simple Tai Chi movements with new movements progressively added throughout the program. Participants will be able to undertake the program in their home using their own device at a time of their choosing. They will be asked to complete the Tai Chi program 3 times per week for 12 weeks. Google analytics will be used to track webs CONDITION: knee osteoarthritis; ; knee osteoarthritis Musculoskeletal ‐ Osteoarthritis Physical Medicine / Rehabilitation ‐ Other physical medicine / rehabilitation PRIMARY OUTCOME: Self‐reported overall knee pain during walking in the past week on an 11‐point numeric rating scale[Baseline, 12 weeks after randomisation (primary time‐point) ] The physical function sub‐scale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (extracted from the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire)[Baseline, 12 weeks after randomisation (primary time‐point)] INCLUSION CRITERIA: i) National Institute for Health and Care Excellence clinical criteria for knee osteoarthritis: a. aged 45 years and over; b. activity‐related knee joint pain; c. no morning knee stiffness or morning knee stiffness 30 minutes or less; ii) live in Australia; iii) report knee pain for 3 months or more; iv) report knee pain on most days in the past month; v) report overall average knee pain in the past week during walking equal to or greater than 4 on 11‐point numerical rating scale (NRS: 0 = no pain, 10 = worst pain possible); vi) have a home internet connection and a computer/tablet device that enables access to the internet vii) have a suitable smartphone to download an app viii) able to give informed consent. SECONDARY OUTCOME: Activities‐Specific Balance Confidence (ABC‐6) Scale[Baseline, 12 weeks after randomisation] Brief Fear of Movement Scale for Osteoarthritis[Baseline, 12 weeks after randomisation] Global rating of overall change in knee condition on a 5‐point Likert scale from “markedly improved” to “markedly worsened” when compared to baseline[12 weeks after randomisation] International Positive and Negative Affect Schedule ‐ Short form (IPANAS‐SF)[Baseline, 12 weeks after randomisation] Knee‐related Quality of Life subscale of the Knee Osteoarthritis Outcome Score (KOOS)[Baseline, 12 weeks after randomisation] Mental component Score of the Short Form 12 (SF‐12) [Baseline, 12 weeks after randomisation] Pain subscale of the Knee Osteoarthritis Outcome Score (KOOS)[Baseline, 12 weeks after randomisation] Physical component score of the Short Form 12 (SF‐12) [Baseline, 12 weeks after randomisation] Self‐Efficacy Pain subscale of the Arthritis Self Efficacy Scale[Baseline, 12 weeks after randomisation] Self‐reported use of oral pain medications for knee pain using study‐specific questionnaire[12 weeks after randomisation] Sleep quality ‐ a single modified sleep quality question taken from the Pittsburgh Sleep Quality of Inde X(PSQI)[Baseline, 12 weeks after randomisation] Sport and Recreation Function subscale of the Knee Osteoarthritis Outcome Score (KOOS)[Baseline, 12 weeks after randomisation]