디지털 기술 기반 중재가 무릎 골관절염에 미치는 영향:체계적 검토 및 메타 분석

Abstract

Knee osteoarthritis (KOA) is one of the leading causes of chronic pain and functional impairment worldwide, significantly affecting patients' mobility and quality of life. Treatments include pharmacotherapy, physiotherapy, and surgery, with recent advances in digital technology (e.g., telemedicine, mobile applications, virtual reality, and wearable devices), digital platform-based interventions have emerged as novel adjunctive approaches for KOA management. These interventions have distinct advantages in tailored approaches, accessibility, and broad applicability. Nevertheless, due to the broad definition of digital technology and rapid evolution, a limited number of systematic reviews has evaluated the integrated efficacy of digital-based interventions in patients with KOA. This study aims to conduct a systematic review and meta-analysis in order to assess the effects of digital technology on the physical, psychological, and functional aspects of patients with KOA, integrating and classifying various types of digital interventions. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive serch was undertaken in PubMed, Embase, the Cochrane Library, and Web of Science for randomized controlled trials (RCTs) published before May 2024 that used digital technology as an intervention for KOA. The inclusion criteria were: (1) participants with knee OA, (2) human subjects, (3) use of digital technology as an intervention tool, (4) studies with a control group, and (5) randomized allocation to interventions. Methodological quality and risk of bias were assessed for each study using the Cochrane risk of bias tool. A meta-analysis was performed using either fixed-effect or random-effect models according to heterogeneity. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated, and the results were presented through forest plots. Out of 3,400 articles, 27 RCTs (6,725 participants) were eligible in final analysis. Extensive characteristics of these studies were extracted, including participants’ demographics, diagnostic criteria, intervention protocols, and outcomes. In addition, digital technology was categorized into five groups: (A) Remote physical activity motivation by telephone or text messages (B) Simple educational content by mobile application of video conference (C) Telephone-based remote exercise coaching and monitoring (D) Online- and App-based real-time remote exercise coaching and monitoring (E) Exercise game Meta-analysis showed that digital technology–based interventions significantly improved pain (SMD -0.52; 95% CI -0.85 to -0.20; P = 0.001) and function (SMD -0.40; 95% CI -0.64 to -0.16; P = 0.001) in patients with KOA. These interventions also produced a significant increase in physical activity (SMD 0.21; 95% CI 0.08 to 0.34; P = 0.002), but did not show significant effects on mobility (SMD 0.02; 95% CI -0.29 to 0.33; P = 0.89), fear of movement (SMD -0.42; 95% CI -1.19 to 0.35; P = 0.28), negative emotions (SMD = -0.35; 95% CI -0.73 to 0.03; P = 0.07), body composition (SMD 0.01; 95% CI -0.20 to 0.17; P = 0.98), or balance (SMD 0.09; 95% CI -0.17 to 0.34; P = 0.51). In conclusion, digital technology–based interventions demonstrated significant effects on pain reduction, functional improvement, and increased physical activity in patients with KOA. These findings provide robust scientific evidence for the clinical use of digital healthcare technologies as an adjunct to conventional treatment for KOA, suggesting that such interventions may improve patient accessibility, adherence, and potentially reduce healthcare costs in the long term. However, additional long-term research on diverse digital intervention techniques is needed to address outcomes that did not show significant improvement. Keywords: Digital technology, Knee osteoarthritis, Pain, Function, Systematic review, Meta-analysis