THE EFFECTIVENESS OF AN INTERNET-BASED COGNITIVE BEHAVIOURAL THERAPY AND EXERCISE IN CHRONIC KNEE PATIENTS WITH PSYCHOLOGICAL DISTRESS

A. Alaradi¹, Y. Alkhabaz²

¹Primary Healthcare Centers, Physiotherapy Department, Manama, Bahrain, ²University of Bahrain, College of Health and Sport Sciences, Manama, Bahrain

Background: Internet-based cognitive behavioural therapy (iCBT) and exercises have been used widely to treat chronic musculoskeletal pain. Nonetheless, the evidence supporting the use of iCBT in the management of chronic pain is still considered limited and more studies are needed. No study has investigated the effects of a combined iCBT intervention and exercise in chronic knee pain patients with psychological distress.

Purpose: We aimed to examine the effects of a combined iCBT with a standardized exercise program on pain, function, depression, psychological distress, physical function, QoL, and quadriceps muscles strength in chronic knee patients with psychological distress.

Methods: This was a 2-arm quasi-randomized controlled trial of eight weeks of intervention involving eight sessions of standardized exercise program and either concomitant iCBT and educational sessions or educational sessions only. Measurements were taken at baseline and eight weeks immediately following the intervention. Primary outcome measures were a numerical pain rating scale, 40-m Fast-Paced Walk Test, Step Test, and 30 seconds Chair Stand Test. Secondary outcome measures were Patient Health Questionnaire, Psychological Distress, Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form, Health-Related Quality of Life-Short Form-12, and Quadriceps Maximum Isometric Muscle Strength.

Results: Thirty-seven participants aged (Mean ± SD) 55.5 ± 7.9 years with chronic knee pain at a certain level of psychological distress were enrolled. In the intervention group (19 participants), there were significant differences in all the primary and secondary outcome measures post-treatment. Furthermore, there were statistically significant differences between both groups in pain levels (MD = 1.79, [95%CI 0.5 to 3.08], P = 0.008), and step test (MD = -1.74, [95%CI -3.38 to -0,9], P = 0.04) favouring the intervention group post-treatment. Yet, there were no significant differences between both groups post-treatment in walking speed (MD = -0.07, [95%CI -0.24 to -0.11], P = 0.449) nor in 30s CST (MD = -1.86, [95%CI -3.99 to 0.26], P = 0.084). Lastly, there was no significant difference between the groups in any secondary outcome measure post-treatment.

Conclusions: A combined iCBT and a standardized exercise program intervention can effectively improve pain, function, patient’s reported outcomes and the quadriceps muscle strength in chronic knee patients with psychological distress. However, when compared to a control group, only pain and step test had improved significantly. Future studies should investigate the effects of the combined iCBT and standardized exercise program intervention on a larger number of participants. Additionally, longer term effects of the intervention should be investigated.

Implications: First, the intervention used can be easily applied in the primary health care settings for chronic musculoskeletal conditions. Implementing the treatment program used in this study will improve the efficacy and efficiency of care for chronic musculoskeletal conditions. Second, the resources developed in this study have the potential to be re-used by other researchers for conducting different types of studies. Lastly, the iCBT resources developed can be used as a community awareness program to optimize pain management.
Resources developed:https://www.youtube.com/channel/UCY-b9jHKDI_va6kXarbzycA
https://toalaradi.wixsite.com/website

Funding acknowledgements: None.

Keywords:
Chronic knee pain
Internet-based cognitive behavioral therapy
Psychological Distress

Topics:
Musculoskeletal: lower limb
Mental health
Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: Ministry of Health, Kingdom of Bahrain

Committee: Research Technical Support Team

Ethics number: 498 dt. Apr 8, 2021