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Telerehabilitation consultations with a physiotherapist for chronic knee pain versus in-person consultations in Australia: the PEAK non-inferiority randomised controlled trial.

Hinman, Rana S; Campbell, Penny K; Kimp, Alexander J; Russell, Trevor; Foster, Nadine E; Kasza, Jessica; Harris, Anthony; Bennell, Kim L

Authors

Rana S Hinman

Penny K Campbell

Alexander J Kimp

Trevor Russell

Nadine E Foster

Jessica Kasza

Anthony Harris

Kim L Bennell



Abstract

Telerehabilitation whether perceived as less effective than in-person care for musculoskeletal problems. We aimed to determine if physiotherapy video conferencing consultations were non-inferior to in-person consultations for chronic knee pain. In this non-inferiority randomised controlled trial, we recruited primary care physiotherapists from 27 Australian clinics. Using computer-generated blocks, participants with chronic knee pain consistent with osteoarthritis were randomly assigned (1:1, stratified by physiotherapist and clinic) in-person or telerehabilitation (ie, video conferencing) physiotherapist consultations. Participants and physiotherapists were unmasked to group assignment. Both groups had five consultations over 3 months for strengthening, physical activity, and education. Primary outcomes were knee pain (on a numerical rating scale of 0-10) and physical function (using the Western Ontario and McMaster Universities osteoarthritis index of 0-68) at 3 months after randomisation. Primary analysis was by modified intention-to-treat using all available data. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12619001240134. Between Dec 10, 2019, and June 17, 2022, 394 adults were enrolled, with 204 allocated to in-person care and 190 to telerehabilitation. 15 primary care physiotherapists were recruited. At 3 months, 383 (97%) participants provided information for primary outcomes and both groups reported improved pain (mean change 2·98, SD 2·23 for in-person care and 3·14, 1·87 for telerehabilitation) and function (10·20, 11·63 and 10·75, 9·62, respectively). Telerehabilitation was non-inferior for pain (mean difference 0·16, 95% CI -0·26 to 0·57) and function (1·65, -0·23 to 3·53). The number of participants reporting adverse events was similar between groups (40 [21%] for in-person care and 35 [19%] for telerehabilitation) and none were serious. Telerehabilitation with a physiotherapist is non-inferior to in-person care for chronic knee pain. National Health and Medical Research Council. [Abstract copyright: Copyright © 2024 Elsevier Ltd. All rights reserved.]

Citation

Hinman, R. S., Campbell, P. K., Kimp, A. J., Russell, T., Foster, N. E., Kasza, J., …Bennell, K. L. (in press). Telerehabilitation consultations with a physiotherapist for chronic knee pain versus in-person consultations in Australia: the PEAK non-inferiority randomised controlled trial. The Lancet, 403(10433), 1267-1278. https://doi.org/10.1016/S0140-6736%2823%2902630-2

Journal Article Type Article
Acceptance Date Nov 21, 2023
Online Publication Date Mar 7, 2024
Deposit Date Apr 9, 2024
Journal Lancet (London, England)
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 403
Issue 10433
Pages 1267-1278
DOI https://doi.org/10.1016/S0140-6736%2823%2902630-2



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