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The use of electronic health (eHealth) and Web-based resources for patients with knee pain is expanding. Padlet is an online noticeboard that can facilitate patient interaction by posting virtual “sticky notes.”
The primary aim of this study was to determine feasibility of patients in a 6-week knee exercise program using Padlet as an online forum for self-reporting on outcome progression.
Undergraduate manual therapy students were recruited as part of a 6-week study into knee conditioning. Participants were encouraged to post maximum effort readings from quadriceps and gluteal home exercises captured from standard bathroom scales on a bespoke Padlet. Experience and progression reporting were encouraged. Posted data were analyzed for association between engagement, entry frequency, and participant characteristics. Individual data facilitated single-subject, multiple-baseline analysis using statistical process control. Experiential narrative was analyzed thematically.
Nineteen participants were recruited (47%, 9/19 female); ages ranged from 19 to 53 years. Twelve individuals (63%) opted to engage with the forum (range 4-40 entries), with five (42%) reporting across all 6 weeks. Gender did not influence reporting (odds ratio [OR] 0.76, 95% CI 0.06-6.93). No significant difference manifested between body mass index and engagement
Patients will engage with an online forum for reporting progress when undertaking exercise programs. In contrast to related literature, no significant association was found with reporting and gender, age, or body mass index. Individual posted data allowed multiple-baseline analysis and experiential induction from participants. Conditioning responses were evident on visual inspection. The importance of individualized visual data to patients and the role of forums in monitoring patients’ progress in symptomatic knee pain populations need further consideration.
The use of Web-based resources and eHealth apps for patients with knee pain is an area of expansion [
The cost of developing and delivering eHealth resources is considered to be offset by the ease of patient accessibility [
Educational research and pedagogic practice have been fruitful areas of exploration around Web 2.0 apps [
Padlet is a Web 2.0 online noticeboard that can be used to facilitate participant interaction by posting of multimedia files as virtual “sticky notes” with mediation by an administrator [
The aim of this study was to determine the feasibility of patients engaging with an online forum to report progress using biofeedback as part of a 6-week exercise program to improve knee function.
The primary objective was to facilitate a moderated, online community and explore participant characteristics that reportedly influence engagement, with a view to answer the following research question: is there a difference in reporting progress in an online forum based on gender, age, and BMI. A secondary objective was to ascertain if sufficient individual data were reported to complete a multiple-baseline case study for participants in the study. A tertiary objective was to establish if sufficient qualitative data were posted to allow induction of descriptive themes.
This was a mixed-methods, quasi-experimental feasibility study with an integrated single-case, multiple-baseline, ABCD analysis and descriptive thematic summary.
As part of a parallel study into the effects of biofeedback on knee function, participants were recruited from current year 1 to 4 undergraduate students in the osteopathy program at the European School of Osteopathy and year 2 undergraduates in the sports therapy program at the University of Kent. Recruitment took place from August 2016 to January 2017, and student participants were invited to take part in the study via email and notices placed around campus. The inclusion criteria were male and female adult students who had daily access to bathroom scales, permitted receipt of reminders via text message, and had online access via any suitable device. The exclusion criteria were if they were suffering with bilateral knee or hip pain, undertook recurrent high-intensity physical training, or had an underlying metabolic disorder or neuromuscular condition.
The Padlet Web 2.0 app (Padlet Co, Sunnyvale, CA, USA) was used to develop the forum for posting of participant data; the Padlet platform facilitates multiple users sharing information and resources in a discrete environment. From the main site page, accessed via a personalized user and password, the “+make a Padlet” option was selected and a freeform option for the forum was selected as demonstrated in
As users were encouraged to share information and experiences. The posts were not anonymized, but oversight of the activity was conducted by the lead researchers on the study (PB, KH). A code of conduct was posted on the webpage to ensure acceptable standards of behavior were adopted. The details of this can be viewed in
The following characteristic data were collected at baseline: height (cm), weight (kg), waist circumference (cm), BMI (kg/m2), activity levels (11-point numerical rating scale), age, and gender. Participants were inducted into a knee program consisting of staged repetitions of a seated clamshell exercise (an adaptation from Distefano et al [
Both exercises were repeated in sets of 12 and on both legs with a 60-second relaxation phase between sets. The progression phases are depicted in
Participants were sent text reminders on the days they were required to perform the exercises. The text messages included a hyperlink to the bespoke Padlet forum with instructions detailing their exercise and video guidance materials (see
Creation page for Padlet wallpaper is indicative of background themes that can be customized.
The use of this moderated forum is to: provide information to study participants; allow a medium for recording progress; facilitate sharing of experiences during the course of the study. The exchanges should remain respectful and courteous at all times. Banter is encouraged but the study moderators policing activity will ensure any offensive or inappropriate comments or images are removed.
Participants that persist in posting such material will be asked to withdraw from the study.
Seated clamshell and short-arc quadriceps exercise.
Exercise progression details for participants.
Week | Exercise progression | Phase |
Weeks 1 and 2 | Maintain 2 sets of 12 repetitions every other day | Phase A |
Weeks 3 and 4 | Maintain 3 sets of 12 repetitions every other day | Phase B |
Week 5 | Maintain 4 sets of 12 repetitions every other day | Phase C |
Week 6 | Maintain 5 sets of 12 repetitions every other day | Phase D |
The primary outcome measure was the number of recorded entries detailing progression with the exercise schedule. A secondary outcome measure was the maximum voluntary contraction reading as captured from the bathroom scales from each exercise session. This was provided by the participants over all stages of engagement within the study.
The study protocol was submitted to and approved by the Research Ethics Committees of the European School of Osteopathy and the School of Sport and Exercise Sciences, University of Kent, as part of a larger study exploring the use of biofeedback in a knee conditioning program.
The Padlet postings were exported to a spreadsheet and aligned to participant baseline data. Summary and inferential statistics were calculated using Excel version 16 (Microsoft Corporation, Redmond, WA, USA) and Analyse-it version 4.65.3 (Analyse-it Software, Ltd, Leeds, UK). The numbers of recorded entries and BMI were assessed for distribution and equality of variance; gender group relationships and differences in reporting were explored using odds ratios with 95% confidence intervals and the Mann-Whitney
The staged recordings of maximum voluntary isometric contractions were extracted from the forum-recorded entries and three consistent datasets were analyzed using a multiple-baseline [
A total of 19 participants were recruited. The group was 47% female (9/19); age ranged from 19 to 53 years (mean 32.79, SD 10.78 years) and BMI ranged between 16.63 and 33.83 kg/m2 (mean 25.02, SD 4.39 kg/m2); eight individuals (42%) were over the desired 25 kg/m2. Mean height was 173.47 (SD 10.06) cm, mean weight was 75.65 (SD 16.20) kg, and median waist circumference was 84.0 (IQR 12.7) cm. Participant’s mean activity rating was 4.42 (SD 1.30) and the median number of Padlet entries was 8 (IQR 16).
Twelve individuals (63%) opted to engage with the Padlet forum with entry frequency ranging from 4 to 40. Follow-up on the seven who did not report outcomes elicited four replies; time constraints (n=3) and technophobia (n=1) were cited as reasons for nonresponse. All individuals that initially reported outcomes went on to complete the exercise program regardless of dropout from the forum. The depiction of the finalized notice board entries can be viewed in
Bespoke Padlet forum with participant and moderator posts.
Inferential analysis of the influences on reporting by gender and age showed no statistical significance. The odds for male and female responders demonstrated that gender was not a factor in this sample for engaging with the forum activity (OR 0.76, 95% CI 0.06-6.93). There was no significant difference between genders and entry frequency (
Consistent data were reported across all 6 weeks of the study by five of the 12 participants who engaged with the forum (58% attrition rate); three were selected for SPC analysis due to their staggered recruitment dates. The multiple-baseline analysis demonstrated the training effects of participants undertaking the staged exercises and the duration of their engagement with the short arc extension quadriceps exercise.
A progressive conditioning response is demonstrated in
Six participants (50%, 6/12) provided limited commentary during their engagement with the online forum; examples are presented in
The individuals provided reflection on their experiences and progress in response to the exercises (female, age 22). The mitigating effects of pain were commonly reported in response to perceived decline in performance and reporting (male, age 29). A stoic sense of perseverance was interpreted from the commentary with an adaptation of technical approach when required (female, age 21; male, age 41).
Multiple-baseline analyses of single participant data with statistical thresholds and linear trend lines. SPC: statistical process control.
Illustrative quotes from online forum.
Participant | Theme | Quote |
Female, age 22 | Mitigation | “Been getting more hypermobile in the last few days, which shows in the results” |
Male, age 41 | Response | “Feedback is good, I push harder” |
Mitigation/pain | “I changed how I was bracing myself and used a cushion on the scales for the glute exercise so it hurts less” | |
Female, age 21 | Mitigation | “Get a cold, feeling weak but the exercises are fine” |
Male, age 42 | Mitigation | “A bit weaker over the last couple of days because of flu” |
Male, age 29 | Pain | “I had an injury while climbing...it’s painful” |
The primary aim of this study was to determine the feasibility of patients using an online forum for reporting progress when engaging with a 6-week exercise program for managing knee pain. No statistically significant difference was found in reporting progress based on gender, age, or BMI. It was possible to use individuals’ posted progress data to complete a multiple-baseline case study for a selection of participants in the study. Participants were willing to engage in limited discussion posts during their progression on the program.
Posting to the forum was initially at a moderate level and attrition rates were comparable with other studies exploring engagement with online discussion boards. The 58% reported in this study is in the range of the 12 studies exceeding the 20% attrition rate in the review of Williams et al [
Exercise adherence has been identified as a major contributor to exercise efficacy [
Age and social media engagement have been reported as conflicting characteristics in studies engaging eHealth with usage mediated by generation. Although engagement activity profiles may differ, those older than 65 years are comparable to those younger than 30 years in terms of the proportions reporting the use of the Internet for health-related information (53% and 56%, respectively) [
Gender and BMI may indicate a barrier to information technology use in adolescents and practitioners [
The provision of individualized single-case data fed back to patients contributes to the ideal of personalized, preventive health care planning [
This study’s sample reported experiences around pain, mitigation, and responsiveness and this was within a recruitment strategy of asymptomatic participants. Subjective and objective pain measures have been widely explored in knee condition sufferers [
Limitations of this study include selection bias with a convenience sample of undergraduate students. Only those prepared to commit to the program were included indicating that participants had an underlying motivation toward exercise. All participants were asymptomatic implicating the diversity in compliance; attrition could be further mitigated with a motivated symptomatic patient population. The extension to engage with people older than 65 years in future studies would allow the development of this type of online health community in condition-specific scenarios. Socioeconomic status was not captured by this study and this is seen as a key influence on access and engagement in the field of eHealth; such barriers to engagement have to be explored further. This study was able to demonstrate that a low-cost solution to developing an online health community is feasible and that individualized, patient-centric data can be produced from reporting biofeedback data on an online forum. Future research should look to investigate discordance between attitudes to technology-assisted health care, the importance of individualized visual data to patients, and the role of forums in monitoring patient engagement and progress in symptomatic populations.
Patients can engage with an online forum for reporting progress when complying with exercise programs for managing knee pain. No significant influence was found on reporting progress in an online forum based on gender, age, or BMI. It was possible to use individual posted progress data to complete a multiple-baseline case study for a selection of participants in the study. Participants were willing to engage in limited discussion posts during their progression on the program. The parochial nature of the sample is a limitation; future work in the area should look to address discordance between attitudes to technology-assisted health care, the importance of individualized visual data to patients, and the role of forums in monitoring patient engagement and progress in symptomatic knee pain populations. Socioeconomic background and other barriers to accessing these community forums need to be considered in this exploration.
Powerpoint presentation of study.
body mass index
statistical process control
The authors would like to thank Hannah Epps and Lee Thompson for their assistance in the recruitment of participants for this study.
None declared.