Development, validation and feasibility of Whatsapp-based self-management and exercise programme for older adults living with chronic knee pain

Abstract

Background: Chronic knee pain significantly impacts the well-being of older adults, with its prevalence increasing annually. Despite numerous intervention programes for chronic knee pain, the efficacy of those that are mobile technology-supported remains under-assessed. Moreover, the opportunities and challenges of such programmes, specifically those using mobile instant messaging application (WhatsApp) as a tool, are lacking for health research and most importantly are not known for chronic knee pain. Purpose: This study aims to develop and evaluate the feasibility and potential effects of a WhatsApp-based self-management and exercise programme for older adults living with chronic knee pain. Methods: The development of the programme module was guided by the UK Medical Research Council (MRC) framework. This feasibility study involved 41 older adults with chronic knee pain recruited from selected activity centres in Kuantan, Pahang. Participants engaged in a structured five-week self-management and exercise programme delivered via WhatsApp . Outcomes: Pain intensity was measured using the Numerical Rating Scale (NRS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS-pain). Physical function was assessed via KOOS subscales: symptoms, activities of daily living (ADL), and sport/recreation. Meanwhile the psychological disabilities were measured by the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). Other outcomes were health beliefs and self-efficacy scale, and the KOOS subscales quality of l ife (KOOS-QoL) for quality of life measurement. Results: Post-intervention analysis revealed a significant reduction in pain as measured by NRS (Median: pre = 4.00, post = 3.00, p < 0.001) and KOOS-pain scores (Mean diff = 6.50, p = 0.035). Physical function improved significantly across KOOS-symptoms (Mean diff = 6.62, p = 0.034), KOOS-ADL (Median diff, p = 0.007), and KOOS-sport (Mean diff = 15.60, p < 0.001).The mean SWEMWBS score increased from 29.19 (SD = 5.24) to 30.53 (SD = 3.85) post-intervention, though the change was not statistically significant (p = 0.108). Self-efficacy improved significantly from 65.70 (SD = 8.13) to 71.26 (SD = 8.57) (p = 0.001). Similarly, the KOOS-QoL subscale showed a significant increase from 56.50 (SD = 26.38) to 69.51 (SD = 30.65) (p = 0.019), indicating improved knee-related quality of life. Conclusions: This study demonstrates that a WhatsApp-based self-management and exercise programme is a feasible intervention that shows positive potential in reducing pain and improving functional outcomes, self-efficacy, and quality of life among older adults. These findings support the use of mobile messaging platforms as accessible tools for delivering self-management interventions in the older adult population.

Keywords: Older Adults, Exercise, Knee pain, Self-management, WhatsApp