Background & Aims

Knee osteoarthritis (OA) is a leading cause of pain and disability in older adults. While exercise is a core treatment for knee OA to reduce pain and improve function, acute exercise often hurts. Pain is a known barrier to exercise engagement in people with knee OA. Innovative interventions to reduce knee pain prior to exercise (or during exercise itself) are needed to improve exercise adherence. New mediated reality (MeR) technology shows clinical promise: visuo-tactile (VT) illusions that alter the viewed morphology of the knee have been shown to reduce pain by up to 40%, with analgesia lasting 2-20 minutes [1]. Such findings raise the possibility that this technology could be used to create an analgesic window in which to exercise. There has been limited clinical translation of current MeR systems due to difficulties adapting them to clinical contexts. We aimed to co-design a clinic-ready version of the MeR system in collaboration with end-users (knee OA consumers and clinicians).

Methods

An iterative co-design process with clinicians (n=6; 3 female, 3 male, mean age 39.7 ±9.50 years, 6-28 years clinical experience) and knee OA consumers (n=15; 10 female, 5 male, mean age 69.4 ±4.41 years, average pain 4.93 ± 2.64) was used to refine the MeR system. Qualitative and quantitative data were evaluated over 3 phases, with the MeR system iteratively updated using end-user feedback after each phase. In Phase 1 (research setting) the researcher used the MeR system to provide VT illusions to both clinicians and consumers. In Phases 2 and 3 (clinical setting), clinicians independently used the MeR system to provide VT illusions to knee OA consumers. MeR safety (cyber sickness, 0-100 scale), feasibility (number of technical/physical set-up issues), credibility (4-20 scale), and acceptability (8-40 scale) were evaluated as primary outcomes (all Phases). Knee pain intensity (0-100 NRS) during the VT illusions (Phase 2, 3) was a secondary outcome.

Results

Over the codesign process, changes were made to the MeR interface/stand, to the dosage of VT illusions, and to practical set-up to promote ownership of the viewed knee and improve the ease of intervention delivery. The final system used bespoke software on a portable tablet, connected to an adjustable stand.

The MeR system was safe, there were no adverse events and minimal cyber sickness (mean=2.6). In Phase 2 and 3 clinicians delivered all interventions as planned, with no technical issues. Challenges with physical set-up occurred in Phase 2 (n=2), but following integration of a new stand, Phase 3 was without issue. The MeR system was rated to have high treatment credibility (mean=16.1) and acceptability (mean=32.6) amongst knee OA consumers, with ~90% of consumers reporting they would recommend this treatment to friends (n=10/11). Most OA consumers (n=7/11) had modest reductions in pain with VT illusions (mean=5.9) likely due to low baseline pain levels (mean=11.5).

Conclusions

The co-design process highlighted a number physical and technical issues with the initial MeR prototype. Collaboration with clinicians and consumers generated several ideas to rectify these issues, which were implemented by the research team. This resulted in a final, clinic-ready version of the MeR system which was found to be a safe, feasible, acceptable, and credible intervention amongst end-users. However, efficacy was uncertain, and therefore further testing is required prior to clinical implementation.

References

1. Stanton, T. R., Gilpin, H. R., Edwards, L., Moseley, G. L., & Newport, R. (2018). Illusory resizing of the painful knee is analgesic in symptomatic knee osteoarthritis. PeerJ, 6, e5206.

Presenting Author

Oscar Hutton

Poster Authors

Erin MacIntyre

BSc(Hons)

IIMPACT in Health, The University of South Australia, Adelaide, Australia

Lead Author

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Oscar Hutton

School of Sport, Exercise, and Health Sciences, Loughborough University, UK

Lead Author

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Roger Newport

BA PhD FHEA

School of Sport, Exercise, and Health Sciences, Loughborough University, UK

Lead Author

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Felicity Braithwaite

BPT (Hons)

IIMPACT in Health, The University of South Australia, Adelaide, Australia

Lead Author

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Tasha Stanton

IIMPACT in Health, The University of South Australia, Adelaide, Australia

Lead Author

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Topics

  • Specific Pain Conditions/Pain in Specific Populations: Rheumatology, Arthritis, and Other

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