May 2024
In-person and remote physical therapy are equally effective for chronic knee pain

Remote therapy might be more convenient without sacrificing improvements in pain and function.

Like telemedicine, telerehabilitation (remotely delivered physical therapy) became more popular during the COVID-19 pandemic and allowed many patients to continue their rehabilitation despite quarantines and lockdowns. Telerehabilitation could have a continuing role in improving patient access to care, but the relative effectiveness of remote and in-person rehabilitation has not been studied in rigorous clinical trials.

In a noninferiority trial, researchers in Australia randomised 394 adults with chronic knee pain (consistent with osteoarthritis) to in-person rehabilitation or remote treatment using videoconferencing software. Both groups had five consultations during three months for strengthening, physical activity and education. Fifteen therapists were trained to provide remote services, and they treated patients in both groups using uniform protocols. Participants knew their group assignment but were masked to the trial hypothesis and the alternate treatment.

Both groups showed similar improvements in pain and function on standardised scales after three months, and outcomes remained similar at nine months. All comparisons met criteria for noninferiority of remote (compared with in-person) physical therapy.

Comment: Remote physical therapy is increasingly available and might help mitigate barriers to access, such as travel time and distance, mobility and scheduling. Patients can be reassured that obtaining physical therapy remotely from trained clinicians for chronic knee pain will not compromise their outcomes.

Bruce Soloway, MD, Associate Professor Emeritus of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.

Hinman RS, et al. Telerehabilitation consultations with a physiotherapist for chronic knee pain versus in-person consultations in Australia: the PEAK non-inferiority randomised controlled trial. Lancet 2024; 403; 1267-1278.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.