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Digital technologies for managing mild to moderate symptoms of hip or knee osteoarthritis: early value assessment

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1 Recommendations

Can be used with evidence generation

1.1

Eight technologies can be used in the NHS during the evidence generation period as options to manage mild to moderate symptoms of hip or knee osteoarthritis in adults. The technologies are:

1.2

The companies must confirm that agreements are in place to generate the evidence. NICE will contact the companies annually to confirm that evidence is being generated and analysed as planned. NICE may revise or withdraw the guidance if these conditions are not met.

1.3

At the end of the evidence generation period (3 years), the companies should submit the evidence to NICE in a format that can be used for decision making. NICE will review the evidence and assess if the technology can be routinely adopted in the NHS.

More research is needed

1.4

More research is needed on Pathway Through Arthritis to manage mild to moderate symptoms of hip or knee osteoarthritis before it can be funded by the NHS.

What this means in practice

Can be used with evidence generation

The 8 digital technologies for managing mild to moderate symptoms of hip or knee osteoarthritis in recommendation 1.1 can be used as an option in the NHS during the 3-year evidence generation period and paid for using core NHS funding. During this time, more evidence will be collected to address any uncertainties. Companies are responsible for organising funding for evidence generation activities.

After this, NICE will review this guidance and the recommendations may change. Take this into account when negotiating the length of contracts and licence costs.

Potential benefits of use in the NHS during the evidence generation period

  • Access and equality: Digital technologies may help to remove some barriers to accessing face-to-face care and improve engagement with non-pharmacological treatment options, such as therapeutic exercise. This could benefit people in rural communities and people who have limited mobility or other time commitments. Exercises can be tailored to people's needs without further appointments because the programmes can be adjusted remotely.

  • System benefit: Healthcare professionals may be able to access user data to track the user's progress and follow up where needed. People using digital technologies to manage their condition may be less reliant on other healthcare resources. The technologies are not intended to replace face-to-face care but may help reduce the number of appointments someone needs.

  • Clinical benefit: Using digital technologies may improve mild to moderate symptoms of hip or knee osteoarthritis and slow disease progression.

Managing the risk of use in the NHS during the evidence generation period

  • Training: Healthcare professionals would need training in, or a familiarity with, any technologies they recommend. This is to ensure the technologies are appropriate and meet the needs of people with mild to moderate symptoms of hip or knee osteoarthritis.

  • Costs: The costs of the technologies vary widely. Commissioners should factor this into their purchasing decisions.

  • Safety and suitability for patients: Digital technologies may be unsuitable for some people with mild to moderate symptoms of hip or knee osteoarthritis. Screening questionnaires should be used to check if the technology is suitable for the person before it is offered. The technologies have safety features to identify poor engagement or progress. These can alert company physiotherapists or NHS healthcare professionals (where configured) to review the information or suggest to the user to contact their healthcare professional for advice.

  • Workforce: For the technologies that provide clinical support or offer physiotherapy as part of their service, commissioners should verify that the companies have an appropriately skilled workforce available.

  • Equality: Some people may find it more difficult to use or engage with digital technologies and may need additional support. This includes:

    • people who are less familiar with using digital technologies or have limited access to equipment or the internet

    • neurodivergent people

    • people with learning disabilities

    • people with visual, hearing or cognitive impairments

    • people who have problems with manual dexterity

    • people who have difficulties reading, writing or understanding health-related information (including people who cannot read English).

More research is needed

There is not enough evidence to support funding Pathway Through Arthritis in the NHS.

Access to Pathway Through Arthritis should be through company, research or non-core NHS funding, and clinical or financial risks should be managed appropriately.

What evidence generation and research is needed

More evidence generation and research is needed on the technologies, including:

  • their effect on patient-reported outcomes such as pain and stiffness, physical function and health-related quality of life, including in the long term

  • their effect on healthcare resource use and services, including additional care needed (for example, medicine use and referrals to other specialist services)

  • the amount people use and engage with them, how easy they find them to use and the benefits of additional technology features

  • any adverse events.


The evidence generation plan gives further information on the prioritised evidence gaps and outcomes, ongoing studies and potential real-world data sources. It includes how the evidence gaps could be resolved through further studies.

Why the committee made these recommendations

People with mild to moderate symptoms of knee or hip osteoarthritis may find it difficult to travel and attend healthcare appointments in person. Digital technologies for managing mild to moderate symptoms of knee or hip osteoarthritis could help remove this barrier to accessing care because people can use the digital technologies when it is convenient for them. Some technologies allow healthcare professionals to remotely monitor a user's progress. These technologies may also allow treatment to be started when symptoms first occur.

Clinical trial evidence for 8 of the technologies is limited. But it suggests that these technologies improve physical function and reduce pain and stiffness. They may also improve quality of life, but this is more uncertain.

Early results from economic modelling show that these digital technologies could be cost effective. But the model includes some assumptions and estimates from experts because the economic data is limited. Also, the model used an average cost for 7 technologies with non-confidential cost data, so it does not reflect the wide range of technology costs.

Because of their potential benefits and low risk of harm for users, getUBetter, Good Boost, Hinge Health, Joint Academy, Phio Engage, re.flex, Thrive and Track Active Me can be used as options in the NHS while more evidence is generated.

No evidence was found for Pathway Through Arthritis. So, it can only be used in research.