Effectiveness of a Smartphone Application to Improve Home Exercise Adherence in Adults with Knee Osteoarthritis in Saudi Arabia: A Randomized Controlled Trial

Background: Knee osteoarthritis (OA) is a prevalent condition globally, with poor adherence to home exercise programs (HEPs) posing a major barrier to effective management. This study examined the impact of a smartphone-based HEP with motivational text messaging on adherence, pain, and physical function among adults with knee OA in Saudi Arabia. Methods: A randomized controlled trial was conducted with 42 participants diagnosed with knee OA, recruited from a clinic at King Fahad Medical City (KFMC). Participants were randomized into two groups: the intervention group (n = 21) received a HEP delivered via WhatsApp with motivational text messages, while the control group (n = 21) received a paper-based HEP. Outcomes included self-reported adherence, pain (measured by visual analogue scale), and physical function (assessed using the Arabic version of the WOMAC physical function subscale). Assessments were conducted at baseline and at 6 weeks by a physical therapist with six years of experience. Results: At 6 weeks, the intervention group demonstrated significantly greater adherence (p = 0.001), lower pain scores (p = 0.017), and improved physical function (p = 0.001) compared to the control group. Conclusion: Delivering a HEP via a smartphone application with motivational text messaging may significantly improve adherence, reduce pain, and enhance physical function in adults with knee OA.   Keywords Knee Osteoarthritis, Tele Rehabilitation, Exercise Therapy, Smartphone, Mobile Applications, Treatment Adherence and Compliance.