Telerehabilitation is as clinically effective and safe as in-person physio and possibly cheaper
Specially trained physiotherapists who deliver structured telerehabilitation courses to people with chronic knee pain they are as ‘clinically effective and safe’ as their counterparts offering traditional in-person care and might even offer a more cost-effective option.
That is the conclusion of leading researchers from Australia and the UK who say their randomised controlled study involving several hundred patients refutes claims that telerehabilitation might damage therapeutic alliances between clinicians and patients. Similarly, it also serves to debunk fears that patient satisfaction levels would be compromised.
The results of the study were published earlier this month in an article in The Lancet. The first author – Rana Hinman from the Centre for Health, Exercise and Sports Medicine at the Department of Physiotherapy at the University of Melbourne – is one of seven solely Australia-based contributors.
Nadine Foster, from Keele University’s Primary Care Centre Versus Arthritis, is only the only author with a base outside Australia, but she also works at the University of Queensland’s Surgical Treatment and Rehabilitation Service at Metro North Health in Brisbane. Both Professor Hinman and Professor Foster are physiotherapists by background, as are some of their co-authors.
Professor Hinman and her colleagues argue that the available evidence has ramifications for the delivery of musculoskeletal (MSK) rehabilitation services. They note that ‘routine telerehabilitation training is warranted for physiotherapists to facilitate [the] implementation and delivery of safe and effective telerehabilitation services’.
Physios from practices in Queensland and Victoria took part
The team recruited 15 experienced physiotherapists based in Queensland and Victoria to take part in the study before the onset of the Covid-19 pandemic, nine (60 per cent) of whom had no prior telerehabilitation experience. The recruits received training in the intervention protocols, which covered strength exercise, education and physical activity, and learned how to deliver these interventions using Zoom video conferencing.
Though the Covid-19 pandemic interrupted the progress of the study at times, it also provided an unexpected boon for telerehabilitation as an approach as there was no face-to-face contact and travel was unnecessary.
The authors note that telerehabilitation can increase access to care and reduce the patient burden of time and financial costs for travelling to a clinic. People with MSK pain and physios alike prefer video conferencing to telephone calls as it helps physiotherapists to monitor patients’ progress by having visual cues.
While Professor Hinman and her colleagues acknowledge that it remains unclear whether the trial’s findings can be generalised to physiotherapists who lack telerehabilitation training, they note that their e-learning course on trial interventions is available in four languages at no cost to users.
They found that there was a ‘small increase in initial consultation duration’ when using telerehabilitation compared with in-person care, but stress that technical difficulties were usually due to audio or video issues which can be resolved speedily when physiotherapists are trained and patients are told in advance how to prepare for telerehabilitation.
‘Our moderation analysis showed, contrary to hypotheses, that participant confidence, experience, and beliefs about video conferencing were not associated with differential effects of the intervention on outcomes, suggesting that the physiotherapist training and participant resources were sufficient.’
Convenience could help to boost attendance
The authors say their findings build on prior research showing that patients find that telerehabilitation is a convenient model, noting that this might partly explain why attendance rates with telerehabilitation were slightly better. Participants, on average, travelled 28 km in major cities for an in-person consultation and two to three times that distance in inner or outer regional locations. This resulted in an estimated mean cost of travel time and transport of $218 [Australian dollars] over the trial period.
‘When private travel costs are considered with health-system costs, telerehabilitation offers significant cost savings compared with in-person care and probable environmental benefits via reduced carbon emissions from travel avoided, although this was not measured in this study,’ the authors note.
For people with chronic knee pain consistent with osteoarthritis ... telerehabilitation is non-inferior to in-person care. [It] is a safe and effective option for the provision of rehabilitation services in people with chronic knee pain [Rana Hinman et al]
Conclusion
Professor Hinman and her colleagues note: ‘High-quality trials with large sample sizes that evaluate the cost-effectiveness and long-term sustainability of clinical outcomes are recommended to improve the certainty of evidence and confidence in video conferencing effectiveness.’
In their conclusion, they state: ‘In summary, to our knowledge, PEAK [Physical Activity for Knee Osteoarthritis] is the first non-inferiority randomised controlled trial comparing video conferencing to in-person consultations with a physiotherapist for non-surgical musculoskeletal rehabilitation.'
They add: ‘For people with chronic knee pain consistent with osteoarthritis, this study showed that telerehabilitation is non-inferior to in-person care. Telerehabilitation is a safe and effective option for the provision of rehabilitation services in people with chronic knee pain.’
Fact file
- some 2.5 billion people worldwide had a health condition requiring rehabilitation in 2019 – a 63 per cent increase from 1990 due to population growth and ageing
- musculoskeletal conditions are key driver due to the pain and dysfunction they cause
- one adult in five in the USA is affected by chronic pain – with knees being one of the most common pain sites and physiotherapy the most common management strategy
- chronic joint pain in adults is typically caused by osteoarthritis, with knee osteoarthritis accounting for 62 per cent of the 595 million people with osteoarthritis worldwide in 2020
To access the full version of the article [which is behind a paywall] – titled Telerehabilitation consultations with a physiotherapist for chronic knee pain versus in-person consultations in Australia: the PEAK non-inferiority randomised controlled trial – click
Author: I A McMillan
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