Open Access Highly Accessed Study protocol

Effectiveness and cost-effectiveness of a blended exercise intervention for patients with hip and/or knee osteoarthritis: study protocol of a randomized controlled trial

Corelien JJ Kloek12*, Daniël Bossen2, Cindy Veenhof2, Johanna M van Dongen3, Joost Dekker4 and Dinny H de Bakker12

Author Affiliations

1 Tilburg University, Tranzo, PO Box 90153, Tilburg, LE, 5000, The Netherlands

2 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands

3 Department of Health Sciences, EMGO Institute, VU University Medical Center Amsterdam, Amsterdam, The Netherlands

4 Department of Rehabilitation Medicine & Department of Psychiatry, EMGO Institute, VU University Medical Center Amsterdam, Amsterdam, The Netherlands

For all author emails, please log on.

BMC Musculoskeletal Disorders 2014, 15:269  doi:10.1186/1471-2474-15-269

Published: 8 August 2014



Exercise therapy in patients with hip and/or knee osteoarthritis is effective in reducing pain, increasing physical activity and physical functioning, but costly and a burden for the health care budget. A web-based intervention is cheap in comparison to face-to-face exercise therapy and has the advantage of supporting in home exercises because of the 24/7 accessibility. However, the lack of face-to-face contact with a professional is a disadvantage of web-based interventions and is probably one of the reasons for low adherence rates. In order to combine the best of two worlds, we have developed the intervention e-Exercise. In this blended intervention face-to-face contacts with a physical therapist are partially replaced by a web-based exercise intervention. The aim of this study is to investigate the short- (3 months) and long-term (12 months) (cost)-effectiveness of e-Exercise compared to usual care physical therapy. Our hypothesis is that e-Exercise is more effective and cost-effective in increasing physical functioning and physical activity compared to usual care.


This paper presents the protocol of a prospective, single-blinded, multicenter cluster randomized controlled trial. In total, 200 patients with OA of the hip and/or knee will be randomly allocated into either e-Exercise or usual care (physical therapy). E-Exercise is a 12-week intervention, consisting of maximum five face-to-face physical therapy contacts supplemented with a web-based program. The web-based program contains assignments to gradually increase patients’ physical activity, strength and stability exercises and information about OA related topics. Primary outcomes are physical activity and physical functioning. Secondary outcomes are health related quality of life, self-perceived effect, pain, tiredness and self-efficacy. All measurements will be performed at baseline, 3 and 12 months after inclusion. Retrospective cost questionnaires will be sent at 3, 6, 9 and 12 months and used for the cost-effectiveness and cost-utility analysis.


This study is the first randomized controlled trial in the (cost)-effectiveness of a blended exercise intervention for patients with osteoarthritis of the hip and/or knee. The findings will help to improve the treatment of patients with osteoarthritis.

Trial registration


Osteoarthritis; Physical activity; Blended care; e-Health