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Purpose: 1) To collate into a repository, best-evidence online osteoarthritis management programmes (OAMPS), and 2) facilitate their implementation, in the context of the COVID-19 pandemic The Osteoarthritis Research Society International Joint Effort Initiative (OARSI JEI) is a collaboration between international researchers, clinicians and knowledge brokers with an interest in the implementation of OAMPS OAMPs are defined by the OARSI JEI as “models of evidence-based, non-surgical care that have been implemented in a real world setting and include the following four components: personalised OA care;delivered as a package of care with longitudinal reassessment and progression;comprising two or more elements of the core non-surgical, non-pharmacological interventions (education, exercise and weight loss);with optional adjunct treatments as required (e g assistive devices and psychosocial support)” In 2020, COVID-19 presented a major barrier to the clinical delivery of traditional “in-person” OAMPS In response, the OARSI JEI implementation group sought to create a repository resource for healthcare professionals (HCPs) seeking to access and signpost patients with OA to online, high-quality OAMPS The resource also provided access to online HCP training Methods: An existing community of practice (OARSI JEI implementation group) with access to patient and public involvement, was utilised to create and share an evidence-informed online OAMP repository via social media and OARSI networks The project involved 5 key stages Online OAMPS resource investigation: International research, implementation and HCP experts from the JEI implementation group (n=32) were invited to send all online OAMP resources that they were aware of to the reviewers (LS, JQ) These were captured in a spreadsheet with data extracted on programme name;country of origin;whether the resource targeted patients or HCPs;access details relating to required technology, sign in and any access costs;weblink;brief programme content summary;OARSI expert advocating for the programme quality (including whether the content is evidence informed) Screening for repository inclusion: Two reviewers (JQ, LS) screened the resources received against inclusion criteria (matching the OAMP definition, remotely deliverable via the internet, OARSI expert endorsed) Disagreements were resolved through discussion Creating the online OA repository resource: Academics (JQ, LS, KD) provided content and feedback for a knowledge broker (LC) to create a pdf repository containing included online OAMP information, weblinks and summary information in the form of an infographic Rapid social media knowledge mobilisation: The repository resource was initially hosted on the Keele Impact Accelerator Unit website and shared on completion with existing OARSI member JEI networks via social media (Twitter)(LC) Owners of online OAMPS also promoted their own programmes via social media Reflection and learning: Project method strengths and limitations were discussed, critiqued and captured during an OARSI JEI community of practice meeting Results: The final OARSI online repository included 7 OAMPS and linked training resources The online repository is available at: with ongoing plans for hosting on the OARSI website Fig 1 illustrates the repository cover and Fig 2 is the infographic repository summary A relative dearth of online OAMPS meeting our prespecified criteria were identified which included: ESCAPE pain;The Joint Academy;JIGSAW-E (for pharmacists and physiotherapists);PEAK: Join2Move;Osteoarthritis Management Healthy Weight for life Only JIGSAW-E, PEAK and the Join2Move app were widely available free resources for HCPs at the early stage of the COVID-19 pandemic All online OAMPs were in English except the Join2Move app which is in Dutch Content details of the included online OAMPs and online OAMP HCP training packages are summarised in Table 1 The initial Twitter launch tweet sharing the repository infographic and repository link has had 5,679 impre sions and 334 engagements to date and has been shared globally Reflections and limitations: There is an urgent requirement for more high-quality OAMPs to be freely available for remote delivery and in a wider range of languages This has relevance both during the COVID pandemic and more generally for rural, geographically isolated populations and low- and middle-income countries In reacting to an emergency, rapidly evolving, time-pressured clinical pandemic context, there was a tension in matching the highest quality methods for searching, evaluating and synthesising online OAMPs in the shortest possible time For example, full systematic review methods were deemed inappropriate and the project was not explicitly informed a-priori by a protocol or knowledge mobilisation theory, however, members of the team had knowledge mobilisation expertise It is possible that we did not identify all online OAMPs For example, no online OAMPS from South America, Africa or Asia were identified which may, in part, be explained by the geographical representation within the community of practice, with participants mostly from Europe, North America and Australasia It is acknowledged that the pragmatic and rapid OAMP resource identification, screening and knowledge mobilisation from this project does not guarantee implementation into clinical practice The existence of the OARSI JEI implementation group facilitated the timely execution of this project whilst the use of social media allowed the repository to be shared rapidly with many stakeholders Future plans include the hosting of the repository and future JEI work on the OARSI website (to increase resource access);the formal synthesis of knowledge mobilisation metrics relating to the online repository and included OAMPS, and;the ongoing review of repository content in the light of new OAMPS Conclusions: The OARSI-endorsed JEI implementation group facilitated the creation of an online OAMP repository in response to the COVID-19 pandemic and need for remotely delivered care There is a dearth of widely available and remotely deliverable OAMPs internationally This is likely to present a significant barrier to the delivery of best OA care, especially during COVID-19 OARSI can have a key role in supporting the implementation of best OA care There is a need to actively broaden the diversity and national representation within the JEI implementation group and increase patient and public involvement to best serve the international OA populations, particularly from low- and middle-income countries, it seeks to inform [Formula presented] [Formula presented] [Formula presented]

E-Exercise is an effective 12-week blended intervention consisting of around five face-to-face physiotherapy sessions and a web-based application for patients with hip/knee osteoarthritis. In order to facilitate effective implementation of e-Exercise, this study aims to identify physiotherapists' experiences and determinants related to the usage of e-Exercise. Methods: An explanatory sequential mixed methods design embedded in a randomized controlled trial comparing e-Exercise with usual physiotherapy in patients with hip/knee osteoarthritis. Usage of e-Exercise was based on recruitment rates of 123 physiotherapists allocated to e-Exercise and objective web-based application usage data. Experiences and determinants related to e-Exercise usage were investigated with a questionnaire and clarified with semi-structured interviews. Results: Of the 123 physiotherapists allocated to e-Exercise, 54 recruited more than one eligible patient, of whom 10 physiotherapists continued using e-Exercise after the study period. Physiotherapists had mixed experiences with e-Exercise. Determinants related to intervention usage were appropriateness, added value, time, workload, professional autonomy, environmental factors, and financial consequences. Physiotherapists recommended to improve the ability to tailor e-Exercise to the individual needs of the patient patients' individual needs. Discussion: Determinants related to the usage of e-Exercise provided valuable information for the implementation of e-Exercise on broader scale. Most importantly, the flexibility of e-Exercise needs to be improved. Next, there is a need for education on how to integrate an online program within physiotherapy.

The guideline 'The chronically ill and work' gives insight into disease-overarching factors and interventions that can promote or impede the participation in the work process of workers and those looking for work who have a chronic condition. - In particular, the guideline focuses on the role taken on by workers or those looking for work themselves during the process of keeping or resuming work. - The guideline gives recommendations for the daily practice of healthcare providers which are based on knowledge from disease-specific guidelines, the international literature and the experiences of healthcare providers, and workers and those looking for work with a chronic condition.

e-Exercise zorgt voor vergelijkbare vooruitgang bij artrose met minder bezoeken aan de fysiotherapeut Patiënten met artrose aan de heup, knie of beiden die e-Exercise volgen gaan ongeveer evenveel vooruit als patiënten die reguliere fysiotherapie volgen, terwijl ze veel minder vaak bij de fysiotherapeut komen. Dit blijkt uit onderzoek van Nivel en Hogeschool Utrecht-onderzoeker Corelien Kloek, die hierop 4 april promoveert aan Tilburg University. Binnen e-Exercise worden reguliere fysiotherapiebehandelingen gecombineerd met een web-applicatie waarmee de patiënt thuis toegang heeft tot beweegopdrachten, oefeningen en informatie. Herinneringsmailtjes, video’s, monitoring door de fysiotherapeut en gepersonaliseerde feedback stimuleren de patiënt om met de opdrachten aan de slag te gaan. Lagere kosten Uit het onderzoek van Kloek blijkt dat patiënten met e-Exercise in vergelijkbare mate vooruitgaan in fysiek functioneren, pijn, vermoeidheid, zelf-effectiviteit en kwaliteit van leven, als mensen die reguliere fysiotherapiesessies volgen. De kosten van de interventie e-Exercise vielen significant lager uit dan die van reguliere fysiotherapie. Dit komt doordat het behandelgemiddelde bij e-Exercise op 5 sessies lag en bij reguliere fysiotherapie op 12. e-Exercise bleek voor de maatschappij echter niet significant kosteneffectiever dan reguliere fysiotherapie. Stimulans om aan de slag te gaan Patiënten die meededen aan het onderzoek hebben gemiddeld 10 van de 12 online modules gevolgd en gaven aan dat e-Exercise stimuleerde om thuis actief met de informatie en opdrachten aan de slag te gaan. Het gebruik van e-Exercise door fysiotherapeuten na afloop van het onderzoek viel tegen en behoeft nog aandacht. Zo gaven fysiotherapeuten aan behoefte te hebben aan een platform dat inzetbaar is voor meerdere doelgroepen, maar ook aan businessmodellen die aansluiten bij deze nieuwe manier van werken. Beschikbaar vanaf april 2018 Sinds het begin van het project is er in een werkgroep nagedacht over de implementatie van e-Exercise. Als resultaat hiervan worden er momenteel gesprekken gevoerd met zorgverzekeraars, wordt e-Exercise vanuit de Hogeschool Utrecht, het UMC Utrecht en Fontys Paramedische Hogeschool uitgebreid naar andere doelgroepen en wordt er scholing gegeven over e-Exercise. Vanaf april 2018 komt e-Exercise beschikbaar in de HWO-Afsprakenapp, een bestaande applicatie waarmee fysiotherapeuten hun patiënt kunnen herinneren aan opdrachten, oefeningen en afspraken. Artrose toenemend probleem Artrose is een chronische aandoening die zich kenmerkt door pijn en stijfheid in de gewrichten. Fysiotherapie, bestaande uit voorlichting, oefeningen en beweegopdrachten, is effectief in het verbeteren van het dagelijks functioneren en het verminderen van pijn bij mensen met artrose aan de heup en/of knie. Gezien het toenemende aantal mensen met artrose, is er behoefte aan interventies die die enerzijds stimuleren dat mensen in hun eigen omgeving actief met hun aandoening aan de slag gaan, en anderzijds ook nog eens goedkoper zijn. Onderzoek Binnen het e-Exercise project is door onderzoekers van het onderzoeksinstituut Nivel en Tilburg University (Tranzo) onderzocht of de integratie van een web-applicatie binnen reguliere fysiotherapie, ook wel blended care, een potentiële oplossing is. Tijdens het e-Exercise project is in samenwerking met patiënten, fysiotherapeuten en experts de interventie e-Exercise ontwikkeld. Na een pilot-fase is e-Exercise in 143 praktijken onderzocht op (kosten-)effectiviteit in vergelijking met reguliere face-to-face therapie. De 208 patiënten die mee hebben gedaan zijn door de onderzoekers 12 maanden gevolgd. Dit onderzoek is gefinancierd vanuit ZonMw Onderzoeksprogramma Sport, het Reumafonds en het Koninklijk Genootschap voor Fysiotherapie. Hoe werkt e-Exercise? https://www.youtube.com/watch?v=4l9GoQWWy58