610 - Evaluation of Patients’ Perceptions of Knee Osteoarthritis Diet and Exercise Interventions and Identifying Barriers to Optimal Treatment

Objectives: We aimed to determine the perceptions of patients with knee osteoarthritis with regards to diet and exercise treatments, assess barriers to optimal adherence, and determine relationships between these barriers and patient demographics.

Design: We conducted a cross-sectional survey to patients in a knee osteoarthritis database, and to patients in outpatient musculoskeletal clinics at Shirley Ryan AbilityLab.

Inclusion criteria were patients age >18 with a clinical diagnosis of knee osteoarthritis. Exclusion criteria were patients who had cognitive impairments that prevented completion of the survey. 100 survey responses were included in final data analysis.

We utilized descriptive statistics, Chi-square test, and Fisher’s Exact test for statistical analysis.

Results: A large majority of patients believed exercise and diet are important to improving knee OA symptoms, were interested in exercising more and eating a healthier diet. The most prevalent barrier to exercise was pain. The most prevalent barrier to eating healthy was lack of healthcare guidance. Respondents of non-white ethnicity were more likely than respondents of white ethnicity to report lack of healthcare guidance and pain as barriers to exercise (p=0.02). Respondents with a lower household income were more likely to report inadequate healthcare guidance about exercise compared to respondents with a higher household income (p=0.01), and they were also less confident about which foods to incorporate into their diet (p=0.04).

Conclusions: Patients with knee osteoarthritis value the importance of exercise and a healthy diet. The main barrier to exercise appears to be pain. Barriers to eating healthy are inadequate knowledge and healthcare guidance. Patients of non-white ethnicity and patients with a household income below the median of our geographic region may be at increased risk of experiencing pain and lack of healthcare guidance as barriers to optimal exercise and dietary interventions. Future research should focus on the most effective educational interventions to promote healthy lifestyle behaviors.

Scientific Paper Best Paper Award Abstract:

Introduction:

Knee osteoarthritis (OA) affects about 33.6% of adults greater than 65 years old, and it is one of the leading causes of decreased health-related quality of life worldwide. The disease contributes to $188 billion in lost wages and health care costs. Given the high prevalence, the negative impact on quality of life, and the economic burden it places on the healthcare system, it is prudent to investigate cost-effective measures to combat this disease.

First-line treatments for knee OA are lifestyle modifications. There is a preponderance of evidence, as outlined in the latest Osteoarthritis Research Society International guidelines, that support structured exercise programs and dietary weight loss management for treatment of knee OA. Despite this robust body of evidence, some studies illustrate that only one third of patients receive these first line interventions. Furthermore, there is a paucity of research investigating the barriers to exercise participation, and even less evidence about the barriers to eating an optimal diet to treat knee OA.

The primary objectives of the study were to determine the perceptions of patients with knee OA with regards to diet and exercise treatments, identify current diet and exercise behaviors among patients with knee OA, assess barriers to optimal diet and exercise treatment adherence, and determine relationships between these barriers and patient demographics. Our hypothesis was that patients with knee OA value the importance of exercise participation and eating a healthy diet, but they will not be attaining appropriate physical activity or dietary guidelines as determined based on survey findings. We also hypothesized that there will be a significant relationship between specific barriers and demographic factors.



Design:

Location:

The study was a cross-sectional survey from December 2022 to July 2023 that was administered to patients in a knee osteoarthritis database via email, as well as in-person via iPad to patients in outpatient musculoskeletal clinics at the Shirley Ryan AbilityLab.

Inclusion/Exclusion criteria:

Inclusion criteria were patients age >18 with a clinical diagnosis of knee OA. Exclusion criteria were patients who had cognitive impairments that prevented completion of the survey.

Survey

Design:

The survey was developed through Research Electronic Data Capture (REDCap) and included eight major domains: demographic information, current exercise behaviors, perceptions of exercise, barriers to exercise, current dietary behaviors, perceptions of diet, barriers to healthy eating, and self-efficacy.

Statistical Analysis:

We utilized descriptive statistics, Chi-square test, and Fisher’s Exact test.



Results:

The survey was emailed to 584 patients in a knee osteoarthritis database and offered to 30 patients in outpatient musculoskeletal clinics. A total of 100 survey responses were included in the final data analysis. The mean age was 66 (SD 10.5). 30% of respondents were male, 69% female, and 1% other. 64% of respondents were white, and 36% were non-white ethnicity. The mean BMI was 30.3 (SD 8.12). The mean household income based on patient zip code was $89,028 (SD 33,998). 71% of patients had either a bachelor’s or post-graduate degree. 82% of respondents believed exercise is important to improving knee OA symptoms, and 84% of patients were interested in exercising more than they were. 72% of respondents believed that eating a healthy diet is important to improving knee OA symptoms, and 77% of respondents were interested in finding ways to eat a healthier diet. The mean Godin-Leisure Time Exercise Questionnaire was 34.9 (SD 26.8), but 23% of respondents were classified as sedentary. Patients ate an average of 1-4 combined servings of fruits and vegetables per day. The most prevalent barriers to exercise were pain and time constraints (46.4% and 21.4% of respondents, respectively). The most prevalent barriers to eating healthy were lack of healthcare guidance and not knowing which foods to eat (28.6% and 26% of respondents, respectively). Respondents of non-white ethnicity were more likely than respondents of white ethnicity to report lack of healthcare guidance and pain as barriers to exercise (28.1% vs 7.7% p=0.02, and 62.5% vs 36.5% p=0.02, respectively). Respondents with a lower median household income were more likely to report inadequate healthcare guidance about exercise compared to respondents with a higher median household income (28.1% vs 7.7% p=0.01), and they were also less confident about which foods to incorporate into their diet (39.4% vs 18.4% p=0.04). Overall, respondents were more likely to perceive inadequate healthcare guidance about appropriate dietary behaviors when compared to inadequate guidance about optimal exercise behaviors (28.6% vs 15.5%, respectively, p=0.04).



Conclusions:

This study of perceptions of exercise and dietary interventions for knee OA is unique in its relative ethnic diversity and the evaluation of demographic subgroups that may be at increased risk of experiencing barriers to optimal dietary and exercise treatments. This study highlights that a large majority of patients with knee osteoarthritis value the importance of exercise and a healthy diet, are interested in exercising more, and want to find ways to eat a healthier diet. However, many patients are not meeting optimal benchmarks outlined by professional organizations such as the American Heart Association. Main barriers to exercise appear to be pain and time constraints. Prevalent barriers to eating a healthy diet appear to be inadequate knowledge and healthcare guidance about how to structure a healthy diet.

Our study also suggests that patients of non-white ethnicity and patients with a household income below the median household income of our geographic region may be at increased risk of experiencing pain and lack of healthcare guidance as barriers to optimal exercise and dietary interventions. Furthermore, our results highlight that patients perceive less healthcare guidance about dietary interventions when compared to guidance about exercise.

This study may provide insight to clinicians about which patient populations may need additional counseling, which can be helpful when deciding how to allocate time during busy clinic visits. The results can also help public health professionals decide where to prioritize certain community resources to better serve the population. Future research should focus on the most effective types of educational interventions to promote healthy lifestyle behaviors among patients with knee OA.