Telehealth-delivered exercise and weight loss program for people with knee osteoarthritis or obesity

A randomized trial found that video-based, telehealth-delivered exercise and weight loss programs with online educational support improved pain and function in people with knee osteoarthritis and overweight or obesity. The intervention that included a dietary component conferred modest additional pain and function benefits and led to substantial weight loss. The findings are published in Annals of Internal Medicine.

Osteoarthritis affects more than 32.5 million adults in the United States and is a major public health problem around the world. Knee osteoarthritis is commonly associated with overweight and obesity, which aggravate pain and disability, accelerate osteoarthritis progression, and increase the likelihood of requiring costly knee surgery. Scalable knee osteoarthritis programs are needed to deliver recommended education, exercise, and weight loss interventions.

Researchers from the University of Melbourne recruited 416 people with persistent knee pain to participate in the Better Knee, Better Me trial. Patients were randomly assigned to one of two 6-month telehealth-delivered programs, one with and one without dietary intervention, compared with an information-only control group.

During the trial, participants in the intervention groups were provided support from physiotherapists and dietitians via Zoom and had a suite of educational resources available online. Those in the exercise plus diet group also received meal replacements so they could maintain a ketogenic, low calorie diet.

At 6 months, the researchers found that compared to control, participants in both programs had significant improvements in knee pain, physical function, and quality of life, which were maintained in the longer-term. Compared to the exercise only program, the combined exercise and diet program led to additional benefits – including a greater reduction in pain, greater improvements in physical function, lower use of pain medications, and an average weight loss of 22 lbs. over the 6-month program. According to the researchers, these findings suggest that telehealth programs represent potentially scalable and accessible ways for people with knee osteoarthritis to receive recommended interventions.

2. Sex/gender disparities in dolutegravir uptake persist despite WHO OK for women of reproductive age with HIV

An observational study found that gender/sex disparities in the use of dolutegravir-containing antiretroviral therapy (ART) persist despite World Health Organization (WHO) endorsement for its use among women with HIV of reproductive age. The study authors say this disparity greatly limits the population health benefits of dolutegravir for a substantial number of women with HIV around the world. Their findings are published in Annals of Internal Medicine.

The transition to dolutegravir in low- and middle-income countries was complicated by an initial safety signal in May 2018 suggesting that exposure to dolutegravir at conception was possibly associated with infant neural tube defects. Based on additional evidence, the WHO recommended dolutegravir for all adults and adolescents living with HIV in July 2019.

Researchers from the City University of New York studied health records for 134,672 patients aged 16 years or older who received HIV care from January 2017 through March 2020 to describe dolutegravir uptake and disparities by sex and age group in 11 low- and middle-income countries.

They found that Substantial disparities in dolutegravir uptake affecting females of reproductive age through early 2020 are documented. They found that differences in dolutegravir uptake among females of reproductive age emerged after the safety signal.

By the end of follow-up, the cumulative incidence of dolutegravir uptake among females 16 to 49 years old was 29.4% compared with 57.7% among males in the same age group. This disparity was greater in countries that began implementing dolutegravir before the safety signal and initially had highly restrictive policies versus countries with a later rollout.

The researchers note that although this disparity was anticipated because of country-level restrictions on access, the results highlight its extent and initial persistence. The WHO's revised has policy implications and program implementation considerations for national AIDS programs and large initiatives, such as the US PEPFAR program, which are striving to ensure that women with HIV get the most health benefit from their HIV treatment regimen.

3. Bariatric surgery highly effective for reducing fatty liver disease in patients with obesity and diabetes

A randomized controlled trial found that both gastric bypass and gastric sleeve surgery were highly effective in reducing nonalcoholic fatty liver disease in patients with type 2 diabetes and obesity. Both procedures led to substantial reduction in liver fat 5 weeks after surgery and almost complete clearance of liver fat 1 year after surgery. The effect of bariatric surgery on liver scarring, or cirrhosis, was not clear. The findings are published in Annals of Internal Medicine.

Nonalcoholic fatty liver disease is a significant problem because it leads to inflammation in the liver and cirrhosis, which may progress to liver failure or liver cancer. The condition is more commonly seen in people with diabetes or obesity, and moderate weight loss is the first-line treatment. The most common weight loss surgeries are Roux-en-Y gastric bypass and sleeve gastrectomy. Gastric bypass is more complicated and riskier than sleeve surgery, but some low-quality studies suggest that gastric bypass may be superior to gastric sleeve surgery in improving liver fat content.

Researchers from Vestfold Hospital Trust, Tønsberg, Norway recruited 109 patients with type 2 diabetes and obesity who were scheduled to undergo weight loss surgery to their study. Patients in the trial were randomly assigned to undergo either gastric bypass (54 patients) or gastric sleeve surgery (55 patients). The researchers followed the study patients for 1 year after weight loss surgery and compared changes in liver fat content and the amount of liver scarring between the groups.

The researchers found that both procedures effectively reduced liver fat. Bariatric surgery had less influence on degree of scarring in the short term, but researchers plan to follow participants for 5 more years to gather further insights about the comparative effectiveness of the two procedures.

Source:
Journal reference:

Bennell, K. L., et al. (2021) Comparing Video-Based, Telehealth-Delivered Exercise and Weight Loss Programs With Online Education on Outcomes of Knee Osteoarthritis. A Randomized Trial. Annals of Internal Medicine. doi.org/10.7326/M21-2388.

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