Maintaining knee improvement after physical therapy for Veterans
A Remotely - Applied Behaviorally- Designed Intervention Incorporating Gamification, Social Incentives, and Health Coaching to Improve Durability of Physical Therapy for Knee Osteoarthritis (ReAKTIV)
This trial tests whether gamified social incentives and optional health coaching help Veterans with knee osteoarthritis stick with prescribed exercises and stay more active after physical therapy.
Quick facts
| Phase | Phase 3 |
|---|---|
| Study type | Interventional |
| Enrollment | 254 (estimated) |
| Ages | 40 Years to 90 Years |
| Sex | All |
| Sponsor | VA Office of Research and Development Federal |
| Locations | 5 sites (Birmingham, Alabama and 4 other locations) |
| Trial ID | NCT06488144 on ClinicalTrials.gov |
What this trial studies
This is a randomized, factorial Phase 3 trial of 254 Veterans with knee osteoarthritis who have recently started physical therapy. Participants use a smartphone platform and Fitbit to capture activity and patient-reported outcomes remotely and are randomized to receive behaviorally-designed gamification with social incentives, health coaching, both, or control (Fitbit only). The interventions target long-term adherence to prescribed exercises and greater overall physical activity after the typical 6–8 week PT course. Outcomes will compare adherence, activity levels, and symptom/function measures over the follow-up period.
Who should consider this trial
Good fit: Ideal candidates are Veterans aged 40–90 with a clinical diagnosis of knee osteoarthritis who are beginning or recently began physical therapy, can walk independently, own a smartphone, and can sync a Fitbit monthly.
Not a fit: Patients unlikely to benefit include those with inflammatory arthritis, inability to walk two blocks without help, no smartphone access, or severe comorbid illness that limits exercise participation.
Why it matters
Potential benefit: If successful, the interventions could help people maintain the functional gains from physical therapy, reduce pain and medication reliance, and improve long-term mobility.
How similar studies have performed: Previous studies of incentives, gamification, and health coaching show mixed short-term improvements in physical activity, but sustained long-term benefit in knee osteoarthritis remains limited and incompletely proven.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Clinical diagnosis or chronic knee osteoarthritis. * Age between 40-90 years * Initiating physical therapy for KOA (has initial appointment within the next month or had first PT visit within the last 7 days) * To be randomized: PT feels that they are able to safely and reliably participate in ongoing exercise. * To be randomized: must have completed at least 4 virtual or in-person appointments with PT * To be randomized: must sync their Fitbit at least monthly. Exclusion Criteria: * Lack of a smart phone allowing interaction with the WTH platform * Inability to walk 2 blocks without assistance * Poorly controlled crystalline arthritis or other diagnosis of inflammatory arthritis. * Treating provider or LSI believes life-expectancy is \<1 year * Based on LSI or treating provider discretion: exclusions may occur for severe heart failure, unstable angina, end stage renal disease, severe chronic obstructive or other pulmonary disease, or other chronic illness felt to limit participants ability to participate in exercise or resulting in potential safety risk * Severe pain in a non-knee area limiting daily function * Non-English speakers or poor reading ability limiting ability to interact with text messages. * Pregnancy * Receiving physical therapy outside of the VA.
Where this trial is running
Birmingham, Alabama and 4 other locations
- Birmingham VA Medical Center, Birmingham, AL — Birmingham, Alabama, United States (Not_yet_recruiting)
- Omaha VA Nebraska-Western Iowa Health Care System, Omaha, NE — Omaha, Nebraska, United States (Not_yet_recruiting)
- VA Portland Health Care System, Portland, OR — Portland, Oregon, United States (Not_yet_recruiting)
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA — Philadelphia, Pennsylvania, United States (Recruiting)
- VA Puget Sound Health Care System Seattle Division, Seattle, WA — Seattle, Washington, United States (Not_yet_recruiting)
Study contacts
- Principal investigator: Joshua F. Baker, MD MSCE — Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Study coordinator: Joshua F Baker, MD MSCE
- Email: Joshua.Baker@va.gov
- Phone: (215) 823-5800
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.