{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T11:55:41Z","timestamp":1791633341530,"version":"4.3.4"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Digital care platforms have been introduced, but there is limited evidence for their efficacy compared with traditional face-to-face treatment modalities.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare mean pain reduction among individuals with osteoarthritis (OA) of the knee or hip who underwent face-to-face vs digital first-line intervention.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This registry-based cohort study included all persons with knee or hip osteoarthritis who participated in structured first-line treatment for osteoarthritis in a primary care setting in Sweden. Inclusion criteria were as follows: the treatment was delivered face-to-face or digitally between April 1, 2018, and December 31, 2019; patients provided 3-month follow-up data for pain; and patients had program adherence of at least 80%. Data analysis was conducted in March 2021.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Participants completed a 3-month intervention, including education and exercise for hip or knee osteoarthritis, with program adherence of 80% or higher, delivered face-to-face or by a digital application.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Difference in change in joint pain (11-point numeric rating scale, with 0 indicating no pain and 10, the worst possible pain) between baseline and 3-month follow-up between the 2 intervention modalities. A minimal clinically important difference in pain change between groups was predefined as 1 point. Secondary outcomes were walking difficulties, health-related quality of life, willingness to undergo joint surgery, and fear avoidance behavior.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 6946 participants (mean [SD] age, 67 [9] years; 4952 [71%] women; 4424 [64%] knee OA; 2504 [36%] hip OA) were included, with 4237 (61%) receiving face-to-face treatment and 2709 (39%) receiving digital treatment. Both the face-to-face (mean change, \u22121.10 [95% CI \u22121.17 to \u22121.02] points) and digital interventions (mean change, \u22121.87 [95% CI, \u22121.94 to \u22121.79] points) resulted in a clinically important pain reduction at 3 months. Participants in the digitally delivered intervention experienced a larger estimated improvement at 3 months (adjusted mean difference, \u22120.93 [95% CI, \u22121.04 to \u22120.81] points). Results of secondary outcomes were broadly consistent with main outcome.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This Swedish national registry-based cohort study showed that people with knee or hip OA participating in first-line intervention experienced clinically relevant improvements in pain, whether delivered face-to-face or digitally. The increased benefit of digital delivery compared with face-to-face delivery was of uncertain clinical importance.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.40126","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T15:32:06Z","timestamp":1667489526000},"page":"e2240126","source":"Crossref","is-referenced-by-count":33,"title":["Comparison of Face-to-Face vs Digital Delivery of an Osteoarthritis Treatment Program for Hip or Knee Osteoarthritis"],"prefix":"10.1001","volume":"5","author":[{"given":"Therese","family":"J\u00f6nsson","sequence":"first","affiliation":[{"name":"Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Dell\u2019Isola","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Stefan","family":"Lohmander","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden"},{"name":"Arthro Therapeutics, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Wagner","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research, Uppsala University, V\u00e4ster\u00e5s, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Cronstr\u00f6m","sequence":"additional","affiliation":[{"name":"Division of Sport Sciences, Department of Health Sciences, Lund University, Lund, Sweden"},{"name":"Department of Community Medicine and Rehabilitation, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2022,11,3]]},"reference":[{"issue":"7","key":"zoi221136r1","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1136\/annrheumdis-2013-204763","article-title":"The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study.","volume":"73","author":"Cross","year":"2014","journal-title":"Ann Rheum Dis"},{"issue":"9","key":"zoi221136r2","doi-asserted-by":"publisher","first-page":"1500","DOI":"10.1016\/j.joca.2016.03.012","article-title":"Economic impact of lower-limb osteoarthritis worldwide: a systematic review of cost-of-illness studies.","volume":"24","author":"Salmon","year":"2016","journal-title":"Osteoarthritis Cartilage"},{"issue":"3","key":"zoi221136r3","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1136\/annrheumdis-2012-201472","article-title":"Risk of sick leave and disability pension in working-age women and men with knee osteoarthritis.","volume":"72","author":"Hubertsson","year":"2013","journal-title":"Ann Rheum Dis"},{"issue":"2","key":"zoi221136r4","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.semarthrit.2016.04.002","article-title":"Osteoarthritis and mortality: a prospective cohort study and systematic review with meta-analysis.","volume":"46","author":"Veronese","year":"2016","journal-title":"Semin Arthritis Rheum"},{"issue":"11","key":"zoi221136r5","doi-asserted-by":"publisher","first-page":"1578","DOI":"10.1016\/j.joca.2019.06.011","article-title":"OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.","volume":"27","author":"Bannuru","year":"2019","journal-title":"Osteoarthritis Cartilage"},{"issue":"2","key":"zoi221136r6","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1002\/art.v72.2","article-title":"2019 American College of Rheumatology\/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.","volume":"72","author":"Kolasinski","year":"2020","journal-title":"Arthritis Rheumatol"},{"issue":"3","key":"zoi221136r7","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1002\/art.v66.3","article-title":"Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials.","volume":"66","author":"Juhl","year":"2014","journal-title":"Arthritis Rheumatol"},{"issue":"1","key":"zoi221136r8","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/s12891-017-1439-y","article-title":"Good Life with osteoArthritis in Denmark (GLA:D\u2122): evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide.","volume":"18","author":"Skou","year":"2017","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"zoi221136r9","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008963.pub2","article-title":"Self-management education programmes for osteoarthritis.","author":"Kroon","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"zoi221136r10","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1136\/annrheumdis-2013-203628","article-title":"Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial.","volume":"74","author":"Svege","year":"2015","journal-title":"Ann Rheum Dis"},{"issue":"17","key":"zoi221136r11","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1056\/NEJMoa1505467","article-title":"A randomized, controlled trial of total knee replacement.","volume":"373","author":"Skou","year":"2015","journal-title":"N Engl J Med"},{"issue":"9","key":"zoi221136r12","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.1002\/acr.v71.9","article-title":"Factors associated with patients\u2019 willingness to consider joint surgery after completion of a digital osteoarthritis treatment program: a prospective cohort study.","volume":"71","author":"Cronstr\u00f6m","year":"2019","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"2","key":"zoi221136r13","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1002\/msc.v13.2","article-title":"Better management of patients with osteoarthritis: development and nationwide implementation of an evidence-based supported osteoarthritis self-management programme.","volume":"13","author":"Thorstensson","year":"2015","journal-title":"Musculoskeletal Care"},{"issue":"1","key":"zoi221136r15","doi-asserted-by":"publisher","DOI":"10.2196\/resprot.2267","article-title":"Improving primary health care in chronic musculoskeletal conditions through digital media: the PEOPLE Meeting.","volume":"2","author":"Li","year":"2013","journal-title":"JMIR Res Protoc"},{"issue":"10","key":"zoi221136r16","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1089\/tmj.2012.0288","article-title":"Self-management and rehabilitation in osteoarthritis: is there a place for internet-based interventions?","volume":"19","author":"Pietrzak","year":"2013","journal-title":"Telemed J E Health"},{"issue":"7","key":"zoi221136r17","doi-asserted-by":"publisher","DOI":"10.2196\/15365","article-title":"Digital self-management interventions for people with osteoarthritis: systematic review with meta-analysis.","volume":"22","author":"Safari","year":"2020","journal-title":"J Med Internet Res"},{"issue":"9","key":"zoi221136r18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0222657","article-title":"The Better Management of Patients With Osteoarthritis Program: outcomes after evidence-based education and exercise delivered nationwide in Sweden.","volume":"14","author":"J\u00f6nsson","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"zoi221136r19","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1186\/s12891-018-2098-3","article-title":"The effect of education and supervised exercise on physical activity, pain, quality of life and self-efficacy\u2014an intervention study with a reference group.","volume":"19","author":"J\u00f6nsson","year":"2018","journal-title":"BMC Musculoskelet Disord"},{"issue":"12","key":"zoi221136r20","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.9255","article-title":"A 6-week web-based osteoarthritis treatment program: observational quasi-experimental study.","volume":"19","author":"Nero","year":"2017","journal-title":"J Med Internet Res"},{"issue":"3","key":"zoi221136r21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0229783","article-title":"Improving osteoarthritis care by digital means\u2014effects of a digital self-management program after 24- or 48-weeks of treatment.","volume":"15","author":"Dahlberg","year":"2020","journal-title":"PLoS One"},{"issue":"2","key":"zoi221136r22","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.0012","article-title":"Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis: The iBEAT-OA randomized clinical trial.","volume":"4","author":"Gohir","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"12","key":"zoi221136r23","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.","volume":"12","author":"von Elm","year":"2014","journal-title":"Int J Surg"},{"issue":"2","key":"zoi221136r25","doi-asserted-by":"publisher","DOI":"10.2196\/resprot.5665","article-title":"A web-based platform for patients with osteoarthritis of the hip and knee: a pilot study.","volume":"5","author":"Dahlberg","year":"2016","journal-title":"JMIR Res Protoc"},{"key":"zoi221136r26","doi-asserted-by":"publisher","first-page":"S315","DOI":"10.1016\/j.joca.2018.02.632","article-title":"Joint academy\u2014a six-week online treatment program for osteoarthritis.","volume":"26","author":"Nero","year":"2018","journal-title":"Osteoarthritis Cartilage"},{"issue":"7","key":"zoi221136r28","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1111\/j.1365-2702.2005.01121.x","article-title":"Pain: a review of three commonly used pain rating scales.","volume":"14","author":"Williamson","year":"2005","journal-title":"J Clin Nurs"},{"issue":"1","key":"zoi221136r29","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1302\/0301-620X.54B1.61","article-title":"The long-term results of low-friction arthroplasty of the hip performed as a primary intervention.","volume":"54","author":"Charnley","year":"1972","journal-title":"J Bone Joint Surg Br"},{"issue":"11","key":"zoi221136r30","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1007\/s40273-015-0295-6","article-title":"Can the EQ-5D detect meaningful change? a systematic review.","volume":"33","author":"Payakachat","year":"2015","journal-title":"Pharmacoeconomics"},{"issue":"4","key":"zoi221136r31","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.ejpain.2003.09.004","article-title":"Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale.","volume":"8","author":"Salaffi","year":"2004","journal-title":"Eur J Pain"},{"issue":"3","key":"zoi221136r32","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/s10654-019-00494-6","article-title":"Principles of confounder selection.","volume":"34","author":"VanderWeele","year":"2019","journal-title":"Eur J Epidemiol"},{"issue":"3","key":"zoi221136r33","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1177\/0962280206074463","article-title":"Multiple imputation of discrete and continuous data by fully conditional specification.","volume":"16","author":"van Buuren","year":"2007","journal-title":"Stat Methods Med Res"},{"issue":"10182","key":"zoi221136r34","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1016\/S0140-6736(19)30417-9","article-title":"Osteoarthritis.","volume":"393","author":"Hunter","year":"2019","journal-title":"Lancet"},{"issue":"10","key":"zoi221136r35","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1002\/acr.22891","article-title":"Quality of community-based osteoarthritis care: a systematic review and meta-analysis.","volume":"68","author":"Hagen","year":"2016","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"2","key":"zoi221136r36","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocarto.2020.100056","article-title":"On the waiting list for joint replacement for knee osteoarthritis: are first-line treatment recommendations implemented?","volume":"2","author":"Cronstr\u00f6m","year":"2020","journal-title":"Osteoarthritis and Cartilage Open"},{"issue":"2","key":"zoi221136r37","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1002\/acr.v72.2","article-title":"Education, home exercise and supervised exercise for people with hip and knee osteoarthritis as part of a nationwide implementation programme: data from the Better Management of Patients With Osteoarthritis registry.","volume":"72","author":"Dell'Isola","year":"2020","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"6","key":"zoi221136r38","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzab053","article-title":"Effectiveness of telerehabilitation in physical therapy: a rapid overview.","volume":"101","author":"Seron","year":"2021","journal-title":"Phys Ther"},{"issue":"10","key":"zoi221136r39","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010203.pub2","article-title":"High-intensity versus low-intensity physical activity or exercise in people with hip or knee osteoarthritis.","author":"Regnaux","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"zoi221136r40","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-028388","article-title":"\u2018I would never have done it if it hadn\u2019t been digital\u2019: a qualitative study on patients\u2019 experiences of a digital management programme for hip and knee osteoarthritis in Sweden.","volume":"9","author":"Cronstr\u00f6m","year":"2019","journal-title":"BMJ Open"},{"issue":"1","key":"zoi221136r41","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.arr.2012.09.005","article-title":"Osteoarthritis of the knee: why does exercise work? a qualitative study of the literature.","volume":"12","author":"Beckw\u00e9e","year":"2013","journal-title":"Ageing Res Rev"},{"issue":"1","key":"zoi221136r42","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12955-019-1103-3","article-title":"Self-efficacy and health-related quality of life: a cross-sectional study of primary care patients with multi-morbidity.","volume":"17","author":"Peters","year":"2019","journal-title":"Health Qual Life Outcomes"},{"issue":"8","key":"zoi221136r43","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0236342","article-title":"Costing analysis of a digital first-line treatment platform for patients with knee and hip osteoarthritis in Sweden.","volume":"15","author":"Ekman","year":"2020","journal-title":"PLoS One"},{"key":"zoi221136r44","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1186\/s13012-016-0480-9","article-title":"Implementing shared decision-making: consider all the consequences.","volume":"11","author":"Elwyn","year":"2016","journal-title":"Implement Sci"},{"issue":"8","key":"zoi221136r45","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1136\/annrheumdis-2022-222341","article-title":"2022 EULAR points to consider for remote care in rheumatic and musculoskeletal diseases.","volume":"81","author":"de Thurah","year":"2022","journal-title":"Ann Rheum Dis"},{"issue":"6","key":"zoi221136r46","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1136\/bjsports-2017-098742","article-title":"Defining adherence to therapeutic exercise for musculoskeletal pain: a systematic review.","volume":"54","author":"Bailey","year":"2020","journal-title":"Br J Sports Med"},{"key":"zoi221136r14","unstructured":"World Health Organization. Recommendations on digital interventions for health system strengthening. June 6, 2019. Accessed September 27, 2022. https:\/\/www.who.int\/publications\/i\/item\/9789241550505"},{"key":"zoi221136r24","unstructured":"Socialstyrelsen. Nationella riktlinjer f\u00f6r r\u00f6relseorganens sjukdomar 2012: osteoporos, artros, inflammatorisk ryggsjukdom och ankyloserande spondylit, psoriasisartrit och reumatoid artrit: st\u00f6d f\u00f6r styrning och ledning. June 2012. Accessed September 27, 2022. https:\/\/registercentrum.blob.core.windows.net\/boa\/r\/Socialstyrelsens-riktlinjer-f-r-r-relseorganens-sjukdomar-rJBdxcrze.pdf"},{"key":"zoi221136r27","unstructured":"Socialstyrelsen. Nationella riktlinjer f\u00f6r r\u00f6relseorganens sjukdomar. January 2021. Accessed September 27, 2022. https:\/\/www.socialstyrelsen.se\/globalassets\/sharepoint-dokument\/artikelkatalog\/nationella-riktlinjer\/2021-1-7137.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2798148\/jnsson_2022_oi_221136_1666890208.06033.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T05:34:14Z","timestamp":1728279254000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2798148"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,3]]},"references-count":46,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2022,11,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.40126","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,3]]}}}