User Engagement and Experiences With an Online Unsupervised Tai Chi Program for People With Knee Osteoarthritis: Mixed Methods Process Evaluation Nested in a Randomized Controlled Trial.

BACKGROUND: Knee osteoarthritis is a major global health burden, and exercise is a core recommended treatment. Tai Chi is an evidence-based exercise shown to improve symptoms in people with knee osteoarthritis. However, traditional in-person delivery can limit accessibility. To address this, we developed a 12-week unsupervised online Tai Chi intervention and demonstrated its clinical effectiveness in a randomized controlled trial (RCT). This RCT compared the Tai Chi program plus educational information and an exercise adherence support app (intervention) with online education alone (control) for people with knee osteoarthritis. While the intervention improved pain and function, participants' engagement and experiences with the online delivery format remain unclear. Understanding these perspectives is critical for improving future digital exercise interventions. OBJECTIVE: This study aims to explore user engagement and experiences with an online unsupervised Tai Chi program among people with knee osteoarthritis. METHODS: Quantitative and qualitative process measures were collected via self-report questionnaires from 89 participants who were randomized into the intervention arm of the RCT. User engagement was assessed using quantitative measures, including the number of days per week Tai Chi was undertaken (with adherence defined as ≥ 2 days per week), use of the My Exercise Messages App (The University of Melbourne), and scores from the Exercise Adherence Rating Scale Section B. User experience was assessed using quantitative measures of satisfaction, likelihood of recommending the program, and perceived credibility, usability, and acceptability. Qualitative content analysis of open-text responses was conducted to explore both positive and negative aspects of the program. RESULTS: Sixty-four (72%) participants completed the process measures. Among those, the mean (SD) age was 62.5 (6.6) years, and 42/64 (66%) were females. The mean (SD) number of days Tai Chi was undertaken per week was 2.3 (1.1), with 54/74 (73%) classified as "adherent." Participants reported high satisfaction (median 9, IQR 7-10), a strong likelihood of recommending it to others (median 9, IQR 8-10), and perceived it as credible, usable, and acceptable. Many participants described the program as engaging and well-delivered, reporting a positive experience overall and gaining improvements in their knee condition. However, some expressed concerns with aspects of the program delivery (eg, sessions were too long and slow), encountered learning and technological challenges, and a few were dissatisfied with their outcomes. CONCLUSIONS: Of participants who completed the process measures, most were highly engaged with the Tai Chi program and reported a positive experience, although some had a less favorable experience. This free online Tai Chi program has the potential to enhance patient access to guideline-recommended exercise for osteoarthritis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1016/j.ocarto.2024.100536.