Study Review: Is online physiotherapy effective for chronic knee pain?
Virtual physiotherapy session.
Lockdown of 2020 has seen a boom in the development of online physiotherapy services across the UK. Similar to many professions, physiotherapists have had to adapt accordingly to the ongoing pandemic. Understandably, some patients who have been used to traditional face to face therapy in the past remain sceptical about the delivery of physiotherapy by virtual means.
Anecdotally, physiotherapists have reported fantastic results working in a virtual setting. Extra emphasis has been placed on exercise-based interventions, which are by far the most effective tool in a physio’s toolbox (from an evidence point of view). Sceptical patients may still remain dubious and point a finger of bias towards this anecdotal feedback.
Although virtual physiotherapy services were used pre Covid-19 (see our previous blog on the history of online physiotherapy), they were relatively scarce and subsequently there was little evidence to support or refute their effectiveness. We are quite confident there’ll be a plethora of solid evidence this time next year. Hopefully, various teams of researchers are scuttling to collate evidence/data following a year of physiotherapy being widely delivered remotely.
Anyway, we found a nice little study that was conducted back in 2017 looking at the effectiveness of virtual physiotherapy on chronic knee pain. We’ve broken it down, taken out all the confusing lingo and summarised it below. We are confident that online physiotherapy services are here to stay post lockdown and with the arrival of more solid evidence, hopefully the more sceptical traditional patients may be open to virtual input.
“We are confident online physiotherapy services are here to stay”
PhysioHub research team 2020.
Why?
Way back in 2017 an Australian research team highlighted that people with chronic knee pain who lived remotely struggled to access physiotherapy services and pain coping skills training. A plethora of evidence is available to support the effectiveness of exercise therapy for chronic knee pain and also to support pain coping skills training. The research group wanted to measure whether when these services were delivered in an online fashion, they would remain effective.
Who?
The research team rounded up 148 participants all aged 50 and over and all suffering with knee pain for at least 3 months. They assigned the participants to either an exercise group or an advice group.
What was provided?
Over a 3 month period, the exercise group were provided with:
· 7 exercise based online sessions with a physiotherapist.
· Pain coping skills training program.
· Internet based educational material
Over a similar time period, the control group were provided with:
· Internet based educational material alone
What was measured?
The following primary outcomes were recorded at 3 months and 9 months:
· Pain whilst walking (11 point numerical scale)
· Physical function (WOMAC questionnaire)
Secondary outcomes also measured at 3 months and 9 months included:
· Knee pain,
· Quality of life,
· Global change (overall, pain, and functional status),
· Arthritis self-efficacy
What was found?
· The intervention group reported significantly more improvement in pain and physical function than the control group at 3 months, and improvements were sustained at 9 months.
· Intervention participants showed significantly more improvement in most secondary outcomes than control participants.
What was concluded?
For persons with chronic knee pain, Internet-delivered, physiotherapist-prescribed exercise and pain control skills training provide clinically meaningful improvements in pain and function that are sustained for at least 6 months.
Study details
Kim L Bennell 1, Rachel Nelligan 1, Fiona Dobson 1, Christine Rini 1, Francis Keefe 1, Jessica Kasza 1, Simon French 1, Christina Bryant 1, Andrew Dalwood 1, J Haxby Abbott 1, Rana S Hinman 1
Ann intern Med. 2017 Apr 4;166(7):453-462.
doi: 10.7326/M16-1714. Epub 2017 Feb 21.
Physiohub is an online physiotherapy company. We offer a 100% virtual service providing remote physiotherapy assessments, online physiotherapy treatment and rehabilitation sessions and online DSE assessments. To learn more about the services we provide, see our services page below.