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PubMed · 42373005

Effectiveness of a blended care intervention in physiotherapy with exercise and education for patients with hip or knee osteoarthritis (SmArt-E): A multicentre pragmatic randomized controlled trial.

Franziska Weber·Corelien J J Kloek·Sara Neumann·Carolin Bahns·Hannes Böbinger·Freya Diederich·Valerie Dieter·Paul Gellert·Christian Kopkow·Inga Krauss·Sonia Lech·Remi Luschei·Johanna Pleus·Ute Repschläger·Heinz Rothgang·Martin Scharpenberg·Christian Thiel·Maria Valk-Draad·Cindy Veenhof·Horst Christian Vollmar·Dirk Peschke·Christian Grüneberg·SmArt-E study group
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Abstract

OBJECTIVE: To evaluate the effectiveness of a twelve-month smartphone-assisted physiotherapy (SmArt-E) intervention versus usual care in hip and/or knee osteoarthritis (OA), and to assess usability and patient satisfaction with the digital support. METHOD: We conducted a multicentre, pragmatic, parallel-group randomized controlled trial in 27 physiotherapy practices in Germany. Patients with physician-diagnosed hip and/or knee OA aged ≥50 (hip) or ≥38 years (knee) were randomly allocated to SmArt-E (IG; n=166) or usual care (CG; n=164). The twelve-month intervention combined supervised and smartphone-assisted training and education (blended care). Primary outcomes were pain (NRS, 0-10) and physical function (HOOS/KOOS-ADL, 0-100) at twelve months. Secondary outcomes followed OARSI domains; usability and patient satisfaction were also assessed. RESULTS: Among 330 participants (mean age 64±8 years), baseline NRS was 3.2±2.3 in the CG and 3.5±2.4 in the IG; HOOS/KOOS-ADL was 71.6±17.7 and 69.4±17.5, respectively. No significant between-group differences were found for pain (-0.36; 95% CI: -0.84 to 0.12; p=0.14) or physical function (2.66; 95% CI: -0.46 to 5.77; p=0.09). Among 13 secondary outcomes, significant differences favouring the IG emerged at three and twelve months for several domains; however, effect sizes were small and unlikely to be clinically meaningful. CONCLUSION: SmArt-E did not demonstrate superior effectiveness over usual care in mild hip and/or knee OA. Both groups improved over time, with slightly more favourable but clinically inconclusive outcomes in the IG. Findings highlight the need to refine the intervention, better identify eligible patients, and optimize digital and in-person components.

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HumansOsteoarthritis, KneeOsteoarthritis, HipFemaleMiddle AgedPatient Education as TopicMaleAgedPatient SatisfactionExercise TherapyPhysical Therapy ModalitiesTreatment OutcomeSmartphonePain MeasurementBlended CareEducationOsteoarthritisPhysical TherapymHealthJournal ArticleMulticenter StudyPragmatic Clinical TrialRandomized Controlled Trial

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Franziska Weber, Corelien J J Kloek, Sara Neumann, Carolin Bahns, Hannes Böbinger, Freya Diederich, Valerie Dieter, Paul Gellert, Christian Kopkow, Inga Krauss, Sonia Lech, Remi Luschei, Johanna Pleus, Ute Repschläger, Heinz Rothgang, Martin Scharpenberg, Christian Thiel, Maria Valk-Draad, Cindy Veenhof, Horst Christian Vollmar, Dirk Peschke, Christian Grüneberg, SmArt-E study group. 2026-06-29. Effectiveness of a blended care intervention in physiotherapy with exercise and education for patients with hip or knee osteoarthritis (SmArt-E): A multicentre pragmatic randomized controlled trial.. https://doi.org/10.1016/j.joca.2026.06.010

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Aged subjectEducation subjectExercise Therapy subjectFemale subjectHumans subjectJournal Article subjectMale subjectMiddle Aged subjectMulticenter Study subjectPain Measurement subjectPatient Education as Topic subjectPatient Satisfaction subjectRandomized controlled trials study

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