Implementation and Evaluation of a Mobile-Based Exercise Intervention for Knee Osteoarthritis in Rural Communities: A Mixed-Methods Study

Background Osteoarthritis (OA) is a common and disabling joint disorder, particularly in rural areas where access to healthcare is limited. Digital health interventions, including mobile applications, offer a potential approach to support self-management, improve mobility, and reduce pain. This study aimed to evaluate the effectiveness, acceptability, and user experiences of a mobile-based exercise intervention for individuals with knee OA in rural communities. Methods A community-based mixed-methods study was conducted in Mangalore Village and M. Puthur, Tamil Nadu. Fifty adults (≥ 40 years) with mild knee OA were recruited. Participants underwent a one-week orientation and performed app-guided exercises thrice weekly for twelve weeks. Pain and functional mobility were assessed pre- and post-intervention using the Numerical Pain Rating Scale (NPRS) and Timed Up and Go (TUG) test. A subset of ten participants was selected for in-depth qualitative interviews exploring perceptions, challenges, and suggestions for improvement. Quantitative data were analyzed using paired t-tests and Wilcoxon Signed Rank tests. Qualitative data underwent thematic analysis with open, axial, and selective coding. Results TUG scores improved significantly from 17.62 ± 1.29 s to 16.50 ± 1.36 s (mean difference = 1.12 s, p < 0.001), and NPRS scores decreased from 8.1 ± 1.45 to 5.9 ± 1.3 (p < 0.001). Three qualitative themes emerged: (1) insights and perceived benefits, including flexibility and reduced hospital visits; (2) challenges such as language barriers, limited digital literacy, and network issues; and (3) suggestions for improvement, including local language support, video demonstrations, and reminders. Conclusion Mobile-based exercise interventions can improve pain and mobility in rural adults with knee OA. Future adaptations should address cultural, linguistic, and infrastructural barriers to enhance usability and adherence.