A randomized controlled trial has demonstrated the effectiveness of a digital mindset intervention, named Rethinking Osteoarthritis, in improving mindsets and increasing physical activity among individuals suffering from knee osteoarthritis. The study, published in Nature Digital Medicine, highlights the potential of this self-guided online intervention as an accessible tool for enhancing knee osteoarthritis management.
The research involved 458 participants who were randomized into three groups: a mindset intervention group, an education intervention group, and a no-intervention control group. Outcomes were evaluated on 408 participants who completed all surveys. The mindset intervention consisted of four modules featuring short films and reflective activities designed to address misconceptions about osteoarthritis and promote the benefits of exercise. The education intervention involved educational videos on osteoarthritis pathology, risks, symptoms, and treatment strategies.
Impact on Mindset and Physical Activity
The digital mindset intervention significantly improved exercise and osteoarthritis mindsets compared to both the education and no-intervention groups. Specifically, the exercise mindset measure improved significantly in the mindset group (mean change, 0.5 [95% CI, 0.4–0.6]; d = 1.04) compared to the education group (between-group difference, 0.2 [0.1, 0.3], P < 0.001) and the no-intervention group (0.4 [0.3, 0.5], P < 0.001). Osteoarthritis mindsets also showed significant improvement in the mindset group across measures such as Osteoarthritis is a Catastrophe Mindset, Osteoarthritis is Manageable Mindset, and Osteoarthritis is an Opportunity Mindset (P < 0.001 for all comparisons with control groups).
Physical activity levels increased from baseline to one-month follow-up in the mindset group (38.9 [24.3, 53.6]; d = 0.46). The mindset group showed a significantly greater increase in physical activity compared to the no-intervention group (28.6 [24.2, 53.6], P = 0.001). However, the increase in activity levels in the mindset group was not significantly greater than in the education group (6.4 [−1.9, 22.6], P = 0.266).
Secondary Outcomes and Qualitative Feedback
Compared to the no-intervention group, the mindset group showed significantly greater improvements in activity-related knee pain, physical and mental health, fear of movement, pain self-efficacy, other symptoms self-efficacy, reduced perceived need for surgery, knee osteoarthritis knowledge, and body mindsets. Qualitative feedback from participants in the mindset group indicated an increased motivation for physical activity and new perspectives on exercise. One participant noted, "I realize that exercise will not further damage my joints, and by changing my mindset, I can exercise more and improve my strength, which will better support my joints."
Study Limitations and Future Directions
The study's generalizability may be limited by the voluntary nature of participation and the recruitment format, which targeted individuals with social media accounts. The sample was predominantly white (90%), which limits the generalizability of the findings to more diverse populations. The researchers also noted that the one-month follow-up duration was a limitation, and longer follow-ups are needed to assess the durability of physical activity and pain improvements. Future studies could explore synergies of the mindset intervention with complementary behavioral strategies, such as structured exercise and behavioral feedback, to further enhance patient engagement and knee osteoarthritis management outcomes.
