Efficacy of an Evidence-Based Telehealth Intervention in Modifying Health Behaviors Associated with Post-Traumatic Osteoarthritis

Compared to the general population, military service members are at increased risk for acute traumatic knee joint injury, such ACL rupture. Those who sustain these injuries are more likely to develop post-traumatic osteoarthritis (PTOA) during their military career. PTOA is a major source of disablement and discharge. Current recommendations for managing PTOA include weight management, low impact exercise to reduce load on the affected joint, biomechanical corrections, and education about joint health. Despite widespread agreement on these treatments, their implementation in current clinical medicine is sporadic at best. Thus, these strategies, although effective, are widely under-utilized. Furthermore, the diagnosis of PTOA in an individual service member is often made late in the clinical course of the disease, when these approaches are less effective. There is a need for a novel therapeutic intervention to address prevention of PTOA post-injury. Increasing patient self-efficacy for managing PTOA is a highly promising approach.

Traditionally, the management of acute traumatic knee joint injuries has terminated when service members are returned to duty. Treatment has simply focused on restoring anatomic structures and initial functional capabilities through surgical repair and a course of rehabilitation. Thus, patients are often fully discharged from follow-up care approximately 6 months post-surgery. However, there is strong evidence that severe knee injuries are the starting point for a cascade of progressive degenerative joint changes that, over the course of several years, lead to chronic pain and impaired function, resulting in physical limitations that affect performance of duties and activities of daily living. As a result of this major gap in clinical care, acute knee joint injuries frequently progress into PTOA, resulting in high rates of dysfunction and discharge among military service members.

To address this gap in clinical care, we have developed a mobile device telehealth platform for service members at risk of PTOA. The intervention is designed to facilitate behavior change through increased knowledge and patient self-efficacy, integrated quantitative tools that allow patients and healthcare providers to monitor their OA risk factors. The telehealth platform utilizes a set of novel, evidence-based behavioral intervention strategies. These behavioral intervention strategies address known risk factors associated with OA initiation and progression. The telehealth education is supplemented by quantitative tools for physical activity tracking and assessing biomechanics. By actively engaging patients in their own care through novel technologies and strategies, we aim to address this major gap in clinical care and prevent progression to PTOA following knee injury. This study examines the effect of this therapeutic intervention that delivers novel, evidence-based behavioral health strategies through an innovative clinical intervention platform. The intervention is designed to be a major disease-prevention therapeutic tool that greatly reduces the onset of progression of PTOA following knee injury by empowering military service members to manage, and seek care for, their personal risk factors for PTOA.