Experiences of Persons with Knee Osteoarthritis Using a Wearable-Enabled Intervention Involving Counselling by a Physiotherapist to Support Physical Activity: a Secondary Analysis Using an Ethics Lens

Purpose: Although practice guidelines strongly recommend physical activity for the optimal self-care of knee osteoarthritis (OA), physical activity levels among persons with knee OA typically fall below expert recommendations. Preliminary evidence indicates wearable technology could support persons with knee OA to be physically active. It remains unclear, however, how they experience benefits or downsides of using wearables to improve physical activity. If wearable-enabled interventions are to be successfully incorporated into everyday self-care of knee OA, better understanding of a fuller spectrum of experiences encountered by persons with knee OA is needed. To address this gap, our aim is to gain in-depth understanding of the experiences of persons with knee OA who used a wearable to support their physical activity as part of a multi-faceted intervention involving counselling with a physiotherapist (PT). Methods: We conducted a secondary analysis of semi-structured qualitative interviews with persons with knee OA living in British Columbia, Canada following their participation in a 6-month randomized controlled trial (RCT). Eligible individuals were those who had a physician-confirmed diagnosis of knee OA or passed two validated criteria for early OA: 1) aged 50 years; 2) had experienced pain or discomfort in or around the knee during the previous year lasting more than 28 separate or consecutive days. The RCT involved them pairing up with a PT to set physical activity goals, using a Fitbit Flex, and receiving four biweekly phone calls for activity counselling by the PT in an 8-week period. Consent to use these data for the purpose of secondary analysis was obtained from participants at the time of the original study. In-person or phone interviews lasted approx. 60-90 mins. Participants shared experiences of using the wearable, and its impact on their communication with the PT. Analysis was guided by a relational ethics conceptual lens (including key concepts such as choice, interdependence, trust, uncertainty) and a phenomenographic approach to gain insight into the qualitatively different ways in which participants experienced benefits and downsides of the intervention in the context of their OA self-care. Results: Interviews of 20 participants (11 female; 9 male) aged 40-82 years were analyzed. Our analysis identified three early categories of description: 1) Negotiating with my wearable: Participants often viewed their Fitbit as having human-like qualities (e.g., stubbornness, or nagging, or providing encouragement “just like a friend”). Tensions were experienced by some participants when their wearable’s prompts to be active were at odds with other priorities they were juggling in their everyday lives. Others experienced their wearable as a trusted support and source of motivation to reach shared physical activity goals; 2) Having a new self-awareness: Participants expressed interest in learning about themselves by using a Fitbit to monitor their physical activity and sleep, and some viewed their new awareness as a step in taking back control over their OA. Some felt uncertain about how to act on the new information; 3) Feeling accountable to others: Many participants described situations in which they used their wearable data to prove or justify their physical activity levels to others who they felt a responsibility to (e.g., the PT, research staff, family members). Conclusions: Findings describe different ways in which persons with knee OA can experience their use of a wearable as a source of tension at odds with their other priorities, or as a beneficial support for their capacity to take control in their everyday self-care with a health professional. Drawing on a relational ethics lens, our study sheds some light on how persons with knee OA experience relational aspects (i.e. choice, interdependence, trust, uncertainty) that can facilitate or limit their capacity for autonomy when using a wearable-enabled physical activity counselling intervention. It raises questions, based on the experiences of persons with knee OA, about what it means to respect a person’s capacity for autonomy when incorporating the use of a wearable-enabled intervention into everyday self-care of knee OA.