Comparing effects of an online exercise plus education program to online education only in people with knee osteoarthritis: randomised controlled trial: The COPE Trial

INTERVENTION: Participants in both the intervention and controls groups will have access to online educational content for osteoarthritis management in the form of reading material. The online content will be based on current best‐practice research and resources that we have previously used for our other studies. Topics covered include: understanding osteoarthritis; osteoarthritis treatment options; exercise and physical activity; weight loss; understanding and managing pain; sleep; links to additional resources. The website can be accessed as many times as the participant wishes. The intervention group will also have access to a self directed online 12‐week progressive yoga program guided by an instructor delivering the program in a pre‐recorded video format. Videos of the yoga program will run approximately 30‐40 minutes each and will look like a class session with an instructor and a small group of people performing as people with knee osteoarthritis. Classes will be beginner to intermediate in level/intensity and will progress throughout the 12 weeks. Participants will be encouraged to monitor their intensity by focusing on the ability to breathe in a slow, controlled manner ‐ a common approach in yoga classes. Each class will have several modifications and progressions demonstrated so that participants may choose options that match their abilities as they progress. The intervention will include such things as "chair pose" (yogic squats), "warrior poses" (yogic lunges), "cat/cow pose" (yogic spine mobilization), and "downward dog pose". Breathing techniques will include things such as working to sync movements to breath cycles, and meditation techniques centred around monitoring of the breath. Participants will be able to undertake the program in their home at a time of their choosing. They will be asked to complete the yoga program 3 times per week (approx. 30‐40 minutes per session) for the 12 weeks and encouraged to continue with this during the CONDITION: Musculoskeletal ‐ Osteoarthritis osteoarthritis;knee osteoarthritis; ; osteoarthritis ; knee osteoarthritis Physical Medicine / Rehabilitation ‐ Other physical medicine / rehabilitation PRIMARY OUTCOME: Physical function sub‐scale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)[Baseline, 12 weeks after baseline (primary endpoint), 24 weeks after baseline] Self‐reported average walking pain in the past week on an 11‐point numeric rating scale[Baseline, 12 weeks after baseline (primary endpoint), 24 weeks after baseline] ; [Baseline, 12 weeks after baseline, 24 weeks after baseline] Self‐Efficacy Pain Scale of the Arthritis Self Efficacy Scale ; [Baseline, 12 weeks after baseline, 24 weeks after baseline] Self‐reported overall average knee pain in the last week on an 11‐point numeric rating scale[Baseline, 12 weeks after baseline, 24 weeks after baseline] Stiffness Sub‐scale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)[Baseline, 12 weeks after baseline, 24 weeks after baseline] Stress Sub‐scale of the Depression Anxiety Stress Scales (DASS‐21) [Baseline, 12 weeks after baseline, 24 weeks after baseline] INCLUSION CRITERIA: I. Meet the National Institute for Health and Care Excellence clinical criteria for diagnosing knee osteoarthritis: i. age >/=45; ii. activity‐related knee joint pain; iii. morning knee stiffness < /= 30 minutes II. report knee pain on most days of the past month; III. experienced knee pain for 3 months or more; IV. report a minimum average overall pain score of 4 on an 11‐point numeric rating scale (NRS) over the previous week (NRS 0=no pain, 10=worst pain possible) V. self‐reported difficulty with walking and/or climbing stairs VI. access to the internet SECONDARY OUTCOME: Activities‐Specific Balance Confidence (ABC) Scale[Baseline, 12 weeks after baseline, 24 weeks after baseline] Anxiety Sub‐scale of the Depression Anxiety Stress Scales (DASS‐21) [Baseline, 12 weeks after baseline, 24 weeks after baseline] Brief Fear of Movement Scale for Osteoarthritis [Baseline, 12 weeks after baseline, 24 weeks after baseline] Depression Sub‐scale of the Depression Anxiety Stress Scales (DASS‐21) [Baseline, 12 weeks after baseline, 24 weeks after baseline] Global Change Overall on a 7‐point global rating of change Likert scale from “much worseâ€? to “much betterâ€? when compared to baseline.[12 weeks after baseline, 24 weeks after baseline] Pain Sub‐scale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)[Baseline, 12 weeks after baseline, 24 weeks after baseline] Quality of life (AQoL‐6D)[Baseline, 12 weeks after baseline, 24 weeks after baseline] Self‐Efficacy Other Symptoms Scale of the Arthritis Self Efficacy Scale VII. written clearance from a general practitioner to participate in exercise will be required for anyone who: i. reports a fall in the past 12 months; ii. is house‐bound due to immobility iii. fails the Exercise and Sports Science Australia stage 1 pre‐exercise screening questions