Research Profile – Timing is Everything

UBC researchers have developed a web-based program to boost physical activity in people with osteoarthritis.

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A major medical crisis can be frightening, but it can also be an opportunity for patients to make lifestyle changes. For example, research indicates that cancer patients and heart attack survivors are more likely to adopt healthy behaviours than people in the general population.

"It often times presents itself as a teachable moment," says Dr. Linda Li at the University of British Columbia.

Dr. Li and her colleagues are trying to determine whether being diagnosed with osteoarthritis (OA) can help motivate people to be more physically active.

For someone in the early stages of OA, regular physical activity can help decrease the stiffness and pain associated with the disease. But a 2008 survey conducted by Dr. Li's team and the BC Ministry of Health revealed that only 1 in 4 patients with hip or knee OA were getting the minimum amount of exercise required to reduce the severity of symptoms.

With funding from the Canadian Institutes of Health Research, Dr. Li began working with health psychologists and web-based program designers to develop a program that would help people who had recently been diagnosed with OA incorporate more exercise into their lives.

The resulting program is called Osteoarthritis Physical activity and Exercise Net (OPEN). OPEN includes information to help educate people about OA and the things they can do to manage it. Dr. Li says myths about the condition have created barriers to treatment.

"We want to get rid of the misconception that if you have arthritis, you should not be physically active because it will make it worse, which is not true," says Dr. Li.

OPEN also has a function that helps people set physical activity goals and monitor their progress. The program helps patients identify activities that they will enjoy and incorporate them into their lives. OPEN also gives users access to a registered physiotherapist, who serves as an online coach.

"People may have slightly increased or aggravated symptoms, such as muscle soreness, when they first start being physically active, and it may make them worry," says Dr. Li. "When this happens, they can email the physiotherapist for guidance about what to do next."

Dr. Li believes that one of the main benefits of a web-based intervention is that it allows people to access the information they need when and where they need it.

"I think timing is everything," says Dr. Li. "When you have a web-based intervention, it can be used in a clinic setting or it can be used at a time when the individual actually has the time and is ready to use the information."

Dr. Li and her team developed the OPEN program with students from the Masters of Digital Media Program at the Centre for Digital Media (CDM) in Vancouver. Many CDM graduates go on to develop digital media start-up companies or work in the game and entertainment industries, but an increasing number of students have expressed interest in health-related programs.

Dr. Li worked with CDM on a previous project called ANimated Self-serve WEb-based Research (ANSWER), a tool designed to help people with rheumatoid arthritis. This sort of collaboration is helping train a generation of digital media experts who understand the needs of patients with chronic diseases.

"The partnership allows us to tap into the skill sets of the trainees at the Centre for Digital Media, and at the same time we provide training opportunities for them to work with our patient collaborators while developing new programs," says Dr. Li.

They have completed development of OPEN, which is now undergoing usability testing. Next, the researchers will conduct a randomized controlled trial with 250 patients throughout British Columbia. They will be comparing rates of physical activity participation in two groups of patients: one group will use OPEN and receive a pamphlet on OA, and the other will just receive the pamphlet.

Following the trial, Dr. Li will be working with a number of partners, including The Arthritis Society, the Mary Pack Arthritis Program, the OsteoArthritis Service Integration System (OASIS) and the Canadian Arthritis Patient Alliance to get OPEN to the people who need it.

"We want to get rid of the misconception that if you have arthritis, you should not be physically active because it will make it worse, which is not true."
– Dr. Linda Li, University of British Columbia