Clinical Studies

Home exercise programs, such as the ones you create with Physitrack®,
have been shown to increase patient adherence. 
Below, we reference several studies which confirm this.

Evaluating the effectiveness of home exercise programmes using an online exercise prescription tool in children with cerebral palsy: protocol for a randomised controlled trial

Abstract

Introduction Children with cerebral palsy (CP) and other neurodevelopmental disabilities often receive a home programme of exercises to assist in reaching their therapy goals. Adherence to exercise programmes is necessary to attain the level of practice required to achieve goals; however, adherence can be difficult to accomplish. In this paper, we describe the protocol for a randomised controlled trial to evaluate the effectiveness of delivering a home exercise programme to school-age children with disabilities using Physitrack, an online exercise prescription tool with a website or app interface.

Methods and analysis

Participants aged 6–17 years, with CP or other neurodevelopmental disabilities, receiving community physiotherapy services in Western Australia, will be recruited. Participants will be stratified by age and functional mobility and randomised to either the intervention group, who will complete an 8-week home exercise programme using Physitrack, or the control group, who will complete an 8-week exercise programme without Physitrack. Researcher blinding to group allocation, and participant blinding to outcome, will be maintained. The primary outcome measures are adherence to the home exercise programme with weekly collection of home exercise logs; achievement of individualised goals by phone interview before and after intervention; and correctness of exercise performance by collection and analysis of videos of participants performing home exercises. Secondary outcome measures include enjoyment of physical activity, confidence to complete exercise programme, preferred method of delivery of programme and usability of Physitrack. A sample size of 58 participants will be necessary to see an effect on home programme adherence. Data will be analysed using the intention-to-treat principle.

Ethics and dissemination

Ethical approval was obtained from Curtin University Human Research Ethics Committee in July 2016 (10391).

Outcomes will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences.Trial registration number ACTRN12616000743460; Pre-results.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ and http://dx.doi.org/10.1136/bmjopen-2017-018316

Rowan W Johnson, Sian A Williams, Daniel F Gucciardi, Natasha Bear, Noula Gibson
BMJ Open
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Whitepaper: Opportunities for Telehealth and Physical Therapy: What a New Patient Survey Reveals

Bay State Physical Therapy, leading Physical Therapy care provider in the US North East, used Physitrack Telehealth (PTT) and patient engagement systems to stay connected to their patients during the Covid-19 global pandemic – with great success.

Within a matter of a few days, Physitrack was able to get all BSPT practitioners set-up, and trained on using Telehealth. By mid-March BSPT was 100% virtual – using Physitrack’s award-winning technology and patient apps.

You can read more about the research that was done in this published study, which highlights the objective success BSPT has had with PTT and virtual care.

Bay State Physical Therapy
Whitepaper
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Whitepaper: Telehealth by physiotherapists in Australia during the COVID-19 pandemic

The research study was developed with input from clinicians, telehealth experts, business owners and funding bodies to evaluate the effectiveness and value of physiotherapy treatment delivered via telehealth during the COVID-19 pandemic.

The project measured the following objectives:
• the characteristics of physiotherapists who implemented telehealth services
• the nature of the services
• the types of patients who utilised telehealth physiotherapy services
• the types of conditions that were treated and their management
• patient outcomes and experiences
• consultation features

This information will be used to advocate for ongoing
funding of telehealth services by physiotherapists. It
is a cross-sectional online survey with ethics approval
obtained through the University of Melbourne.

APA Physiotherapy Research Foundation
Whitepaper
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Effectiveness of physiotherapy with telerehabilitation in surgical patients: a systematic review and meta-analysis

Background: Over the last few years, telerehabilitation services have developed rapidly, and patients value benefits such as reduced travelling barriers, flexible exercise hours, and the possibility to better integrate skills into daily life. However, the effects of physiotherapy with telerehabilitation on postoperative functional outcomes compared with usual care in surgical populations are still inconclusive.

Objectives: To study the effectiveness of physiotherapy with telerehabilitation on postoperative functional outcomes and quality of life in surgical patients.

Data sources: Relevant studies were obtained from MEDLINE, EMBASE, CINAHL, the Cochrane Library, PEDro, Google Scholar and the World Health Organization International Clinical Trials Registry Platform.

Study selection: Randomised controlled trials, controlled clinical trials, quasi-randomised studies and quasi-experimental studies with comparative controls were included with no restrictions in terms of language or date of publication.

Data extraction and synthesis: Methodological quality was assessed using the Cochrane risk of bias tool. Twenty-three records were included for qualitative synthesis. Seven studies were eligible for quantitative synthesis on quality of life, and the overall pooled standardised mean difference was 1.01 (95% confidence interval 0.18 to 1.84), indicating an increase in favour of telerehabilitation in surgical patients.

Limitations: The variety in contents of intervention and outcome measures restricted the performance of a meta-analysis on all clinical outcome measures.

Conclusions: Physiotherapy with telerehabilitation has the potential to increase quality of life, is feasible, and is at least equally effective as usual care in surgical populations. This may be sufficient reason to choose physiotherapy with telerehabilitation for surgical populations, although the overall effectiveness on physical outcomes remains unclear. PROSPERO registration number: CRD42015017744.

Keywords: Exercise; Functional status; Physiotherapy; Surgery; Telehealth; Telemedicine; Telerehabilitation.

Copyright © 2018 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Maarten A van Egmond, Raoul H H Engelbert, Jean H G Klinkenbijl, Mark I van Berge Henegouwen, Marike van der Schaaf # 1 2
PubMed
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Comparing the results of virtual and in-person treatment

Background

A comparative observational study was conducted using data collected from routine care provided by qualified Ascenti physiotherapy practitioners. Patients involved in the study were referred to Ascenti for a range of needs.

The study involved exporting anonymised data that mapped the treatment journeys of 27,096 patients who had accessed virtual physiotherapy support before and during the Covid-19 crisis - running up until 10 June 2020. Of this population, 9,506 had received virtual-only treatment, while 17,590 had received a mix of virtual and face-to-face care.

A control group was then built using the data of 6,226 patients who had been treated with in-person physiotherapy only.

Results

Measured on a 10-point pain Numerical Rating Scale (NRS) all patient groups saw significant reductions in their levels of pain following treatment, regardless of what type of treatment they accessed and regardless of the severity of their injury or condition.

In the population-level analysis, patients that combined face-to-face treatment with virtual sessions delivered through the app saw the biggest improvements, moving from a 5.4 NRS score at initial assessment to 1.8 at discharge - an improvement of 3.6 points on average. Patients who only accessed face-to-face treatment reduced their pain by 3.4 points on average, while people who were treated virtually and didn’t see a physio in-person improved by an average of 3.1 points.

Ascenti
Ascenti
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A proximal progressive resistance training program targeting strength and power is feasible in people with patellofemoral pain

Objectives:

To evaluate the feasibility of a 12-week progressive resistance training program for people with patellofemoral pain (PFP) targeting proximal muscle strength and power; and resulting clinical and muscle capacity outcomes.

Main outcome measures:

Feasibility outcomes included eligibility, recruitment rate, intervention adherence, and drop-outs. Secondary outcomes included perceived recovery, physical function (AKPS and KOOS-PF), worst pain (VAS-cm), kinesiophobia (Tampa), physical activity (IPAQ), and hip strength (isometric and 10 repetition maximum) and power.

Results:

Eleven people, from 36 who responded to advertisements, commenced the program. One participant withdrew. Ten participants who completed the program reported improvement (3 completely recovered; 6 marked; and 1 moderate). Higher AKPS (effect size [ES] = 1.81), improved KOOS-PF (ES = 1.37), and reduced pain (ES = 3.36) occurred alongside increased hip abduction and extension dynamic strength (ES = 2.22 and 1.92, respectively) and power (ES = 0.78 and 0.77, respectively). Isometric strength improved for hip abduction (ES = 0.99), but not hip extension.

Conclusion

A 12-week progressive resistance training program targeting proximal muscle strength and power is feasible and associated with moderate-large improvements in pain, function, and hip muscle capacity in people with PFP. Further research evaluating the efficacy of progressive resistance training is warranted.

Christian J. Barton, Danilo de Oliveira Silva, Brooke E. Patterson, Kay M. Crossley, Tania Pizzari, Guilherme S. Nunes
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PaTIO: Physiotherapeutic Treat-to-target Intervention after Orthopaedic surgery; a cost-effectiveness study

Background

Physiotherapy is a proven effective treatment strategy after total knee and hip arthroplasty (TKA/THA), however there is considerable practice variation regarding its timing, content and duration. This study aims to compare the (cost-) effectiveness of a standardized, treat-to-target postoperative physiotherapy strategy with usual postoperative care.

Methods

Using a cluster randomized study design, consecutive patients scheduled for a primary TKA/THA in 18 hospitals in the Netherlands will be assigned to the treat-to-target physio therapy strategy or usual postoperative care. With the treat-to-target strategy a standardized, individually tailored, exercise program is aimed at the attainment of specific functional milestones. Assessments are done at baseline, 6 weeks and 3, 6, 9 and 12 months follow up. The primary outcome will be the Knee injury / Hip disability and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS / HOOS-PS) at 3 months follow up. Secondary outcomes are the numeric rating scale for pain, the Oxford Knee and Hip Scores, performance-based test and the EuroQol 5D-5L for quality of life. Healthcare use, productivity and satisfaction with postoperative care are measured by means of questionnaires. In total, 624 patients will be needed of which 312 TKA and 312 THA patients.

Discussion

The study will provide evidence concerning the (cost-) effectiveness of the treat-to-target postoperative physiotherapy treatment compared to usual postoperative care. The results of this study will address an important evidence gap and will have a significant impact in daily practice of the physio therapist.

Trial registration

Registered in the Dutch Trial Registry on April 15, 2018. Registration number: NTR7129.

Groot, Gademan, Peter, Van den Hout, Verburg, Vliet Vlieland, Reijman and on behalf of the PaTIO study group.
Pubmed
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Patient AdhereNce To Home Exercise pRograms (PANTHER)

Exercise is an integral component of the conservative management of most musculoskeletal conditions. However adherence to exercises is often low and this impacts on treatment effectiveness. The aim of this randomised controlled trial is to evaluate whether the addition of a web-based system, Physitrack, to usual physiotherapy treatment improves patient adherence levels to exercises compared to the usual non web-based methods physiotherapists use to deliver exercise programs to people with musculoskeletal conditions.

PANTHER was a a 2-year study run by the University of Melbourne, comparing exercise prescription via Physitrack to paper handouts and the effect that has on patient adherence and other outcomes.

Conclusions: A web-based exercise programming system improved home exercise adherence and confidence in ability to undertake exercise, although the clinical relevance of the results needs to be established.

Prof Kim Bennell, Prof Rana Hinman, Dr Fiona Dobson, Mrs Charlotte Marshall
PubMed
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Engagement with digital exercise

Implementation of a web and smartphone based exercise prescription program in MSK Physiotherapy.

St George’s serves a population of 1.3 million patients in southwest London. To help the team to manage an ever growing caseload, St George’s embarked on a study to look at the engagement with a digital exercise prescription tool versus paper based programmes.

Adherence to exercise was better for patients using the digital platforms compared to a paper version.

You can see the poster presented here: https://www.dropbox.com/s/lztj7mzl9hughqm/Physiouk%20poster%202017%203.pdf?dl=0

B Wanless, St. George’s University Hospital NHS Trust, London
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Implementing a web based and mobile application exercise prescription programme in Fracture Clinic at St Thomas’ Hospital

With over 2 million patient contacts each year, GSTT is one of the busiest NHS trusts in the UK. The Fracture Clinic set out to establish patient exercise adherence and staff satisfaction with the use of Physitrack in treating Achilles tendon ruptures, anterior glenohumeral joint dislocations, Weber A ankle fractures and distal radius fractures.

Jack Grodon, Senior Specialist MSK Physiotherapist
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Charles Sturt University

A study in partnership with NSW Ambulance to investigate the effects of different types of exercise training on a range of cardio-metabolic and musculoskeletal health outcomes in regional and rural paramedics.

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Ability Centre

A randomised controlled trial to evaluate the effectiveness of delivering a home exercise programme to school-age children with disabilities (cerebral palsy) using Physitrack.

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FASHIoN

This study focuses on the delivery of physiotherapy and dietitian interventions remotely to measure cost-effectiveness and outcomes of remote health interventions for patients with chronic conditions. Physitrack is used to deliver the exercise interventions and educational content to participants, track adherence to the exercise interventions and have video calls with patients.

Murphy, Eyles, Bennell et al.
PDF article
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Flitz!-project

Objective: The aim of this study was to evaluate the feasibility and preliminary effects of a multicomponentintervention to decrease sedentary time during and shortly after hospitalization.

Design: This is a quasi-experimental pilot study comparing outcomes in patients admitted before andafter the implementation of the intervention.

Setting: The study was conducted in a university hospital.

Subjects: Participants were adult patients undergoing elective organ transplantation or vascular surgery.

Interventions: In the control phase, patients received usual care, whereas in the intervention phase,patients also received a multicomponent intervention to decrease sedentary time. The interventioncomprised eight elements: paper and digital information, an exercise movie, an activity planner, apedometer and Fitbit Flex™, a personal activity coach and an individualized digital training program.

Measures: Measures of feasiblity were the self-reported use of the intervention components (yes/no) and satisfaction (low–high = 0–10). Main outcome measure was the median % of sedentary timemeasured by an accelerometer worn during hospitalization and 7–14days thereafter.

Results: A total of 42 controls (mean age = 59 years, 62% male) and 52 intervention patients (58years,52%) were included. The exercise movie, paper information and Fitbit Flex were the three most frequentlyused components, with highest satisfaction scores for the fitbit, paper information, exercise movie anddigital training. Median sedentary time decreased from 99.6% to 95.7% and 99.3% to 91.0% between Days 1 and 6 in patients admitted in the control and intervention phases, respectively. The difference a Day 6 reached statistical significance (difference = 41min/day, P=0.01). No differences were seen afterdischarge.

Conclusion: Implementing a multicomponent intervention to reduce sedentary time appeared feasibleand may be effective during but not directly after hospitalization.

Conijn, Van Bodegom-Vos, Volker, Mertens, Vermeulen, Huurman, Van Schaik, Vliet Vlieland & Meesters
Published article
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GAP4

INTRODUCTION: Preliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC).

METHODS AND ANALYSIS: Participants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Patients can be treatment-naïve for mCRPC or on first-line androgen receptor-targeted therapy for mCRPC (ie, abiraterone or enzalutamide) without evidence of progression at enrolment, and with no prior chemotherapy for mCRPC. Patients will receive psychosocial support and will be randomly assigned (1:1) to either supervised exercise (high-intensity aerobic and resistance training) or self-directed exercise (provision of guidelines), stratified by treatment status and site. Exercise prescriptions will be tailored to each participant's fitness and morbidities. The primary endpoint is OS. Secondary endpoints include time to disease progression, occurrence of a skeletal-related event or progression of pain, and degree of pain, opiate use, physical and emotional quality of life, and changes in metabolic biomarkers. An assessment of whether immune function, inflammation, dysregulation of insulin and energy metabolism, and androgen biomarkers are associated with OS will be performed, and whether they mediate the primary association between exercise and OS will also be investigated. This study will also establish a biobank for future biomarker discovery or validation.

ETHICS AND DISSEMINATION: Validation of exercise as medicine and its mechanisms of action will create evidence to change clinical practice. Accordingly, outcomes of this RCT will be published in international, peer-reviewed journals, and presented at national and international conferences. Ethics approval was first obtained at Edith Cowan University (ID: 13236 NEWTON), with a further 10 investigator sites since receiving ethics approval, prior to activation.

TRIAL REGISTRATION NUMBER: NCT02730338.

Dimensions
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Fysio Future Lab

For the Fysio Future Lab, a group of innovative physiotherapists test technological applications in daily practice. By means of short questionnaires and interviews, the user-friendliness, applicability and physiotherapeutic added value are mapped out for each application. These pilot studies focus on the perspective of the therapist and the patient. In addition, it is possible for both patients and therapists to complete a short questionnaire for technological applications that are already used. Physitrack was subject of the first study.

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Fast@Home

FAST @ HOME wants to enable rehab at home after getting a stroke through a composite program of digital, already existing interventions. Based on the wishes of professionals, stroke patients and informal caregivers, multiple existing and evaluated interventions are combined in a digital environment.

In an effect study with 150 rehabilitants, the effectiveness of this platform will be tested: "To what extent is the quality of care improved as a result of digital support for home rehabilitation for stroke patients?" This question is answered from the perspective of the patient and from the healthcare providers.

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HIPARTI

Through a global collaboration, HIPARTI aims to determine the efficacy of hip arthroscopic surgery compared to a sham surgery (diagnostic arthroscopy only) for patients with symptomatic and radiological findings related to impingement (FAI) and/or labral tears using a randomized controlled design. Physitrack is used to deliver standardised exercise programs and collect outcomes data for analysis.

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PhysioFIRST

PhysioFIRST is an assessor and participant blinded randomised controlled trial comparing the effectiveness of two physiotherapy interventions for hip pain (FAI) in adults aged 18-50 years. The physitrack app is being used to deliver the exercise interventions to participants in both groups, and to track adherence to the exercise interventions.

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Project VEERKRACHT

The project VEERKRACHT aims to develop physiotherapeutically supported interventions for women with metastatic breast cancer. The aim is to promote fitness and well-being in order to maintain or improve the quality of life.

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“Sounds a Bit Crazy, But It Was Almost More Personal”: A Qualitative Study of Patient and Clinician Experiences of Physical Therapist–Prescribed Exercise For Knee Osteoarthritis Via Skype

Arthritis Care & Research 2017; 69(12): 1834-1844, https://doi.org/10.1002/acr.23218

This qualitative study focused in investigating the perceptions of physiotherapist and patients in using videoconferencing for supervised knee OA exercise interventions.

Individual semi-structured interviews were carried out with 12 patients (mean age 62, 50% women) and 8 physiotherapists and the data was analyzed qualitatively using a thematic approach.

Six themes were identified:

Structure:

  1. technology (easy to use, variable quality, set-up assistance helpful)
  2. patient convenience (time efficient, flexible, increased access)

Outcomes:

  1. satisfaction with care (satisfying, enjoyable, patients would recommend, therapists felt videoconferencing more useful as adjunct to usual practice)
  2. patient benefits (reduced pain, improved function, improved confidence and self-efficacy)

Process:

  1. empowerment to self-manage (facilitated by home environment and therapists focusing on effective treatment)
  2. positive therapeutic relationships (personal undivided attention from therapists, supportive friendly interactions)
  3. (from therapists interviews only) adjusting routine treatment (need to modify habits, discomfort without hands-on, supported by research environment)

Patient and practitioner experiences observed in this study were mostly positive.  Videoconferencing using familiar technology (in this case Skype) seems to be a feasible and acceptable method for delivering exercise intervention by both the patients with knee OA as well as the care providers. Videoconferencing as a feasible delivery method for exercise interventions can increase the reach and ease of access to physiotherapy for individuals with knee OA. Exercise intervention via videoconferencing was perceived as empowering for patients and it allowed the development of positive therapeutic relationships despite the lack of face-to-face access.

In summary, benefits of the delivery method were e.g.

  • Time-efficiency, increased access, flexibility for patients
  • Exercising in the home environment was perceived as empowering for patients
  • Physiotherapists could focus on facilitating supporting the self-management of the patient and there was no need to spend time on hands-on treatments that were seen as adjuncts
  • Shift in relationship power balance - focus shift from therapist-centered to patient-centered
  • The physiotherapists shifted more focus on listening the patient's story as opposed to relying on physical tests
  • The patients appreciated the technical support they received in the beginning of the rehabilitation to set up and use the videoconferencing system.
  • The patients felt the remote rehab was efficient and effective. From the physiotherapists perspective remote rehab was seen as effective too, but it also provided a physically less demanding option.
Hinman RS, Nelligan RK, Bennell KL, Delany C
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Physiotherapists and patients report positive experiences overall with Telehealth during the COVID-19 pandemic: a mixed-methods study

Journal of Physiotherapy 2021;67:201–209, https://doi.org/10.1016/j.jphys.2021.06.009

In this cross-sectional study using both quantitative and qualitative methods the authors wanted to learn more about how videoconferencing was used in physiotherapy during COVID-19 pandemic and how the physiotherapists and patients experienced it.

A total of 207 physiotherapists, both private practice and community settings, and 401 patients (adults ≥ 18 years ) participated in an online survey. The online survey included questions regarding the implementation of videoconferencing, e.g. cost and software used (in physiotherapist version) and the perceived effectiveness, safety, ease of use and comfort communicating using the videoconferencing.

The results indicated that majority of the physiotherapists had the intention to continue using videoconferencing for individual consultations also after the pandemic. Two out of three also intended to use videoconferencing to deliver group classes.

The experiences of the physiotherapists and patients were positive. Physiotherapists gave moderate-to-high ratings for the effectiveness of and satisfaction with videoconferencing as a physiotherapy delivery method. Also the patients mostly gave moderate-to-high ratings for the ease of technology use,  comfort communicating, satisfaction with management, satisfaction with privacy/security, safety and effectiveness for both individual and group sessions.

Technology was seen as the strongest factor promoting as well as reason for using videoconference. Risk of falling was the main safety factor.

Clinical implications: According to the authors ”patients and physiotherapists had overall positive experiences using videoconferencing for individual consultations and group classes. The results suggest that videoconferencing is a viable option for the delivery of physiotherapy care in the future.”
Bennell KL, Lawford BJ, Metcalf B, Mackenzie D, Russell T, van den Berg M, Finnin K, Crowther S, Aiken J, Fleming J, Hinman RS
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Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview

Phys Ther. 2021 Jun 1;101(6):pzab053,  https://doi.org/10.1093/ptj/pzab053

This ‘Rapid review’ aimed to summarize the available evidence from telerehabilitation in physiotherapy.

The authors carried out a search to several databases and included systematic reviews (SRs) where physiotherapy delivered via telerehabilitation methods was evaluated. The outcomes of interest were ’clinical effectiveness’ (e.g. pain), ‘functionality’, ‘quality of life’ (QOL), ‘satisfaction’, ‘adherence’, and ‘safety’. The analysis of the findings was qualitative.

The authors included 53 SRs of which 17 had a low risk of bias. The SRs included the following areas: cardiorespiratory (n=15), musculoskeletal (n=14), and neurological (n=13). The rest (n=11) addressed other types of conditions and rehabilitation.

Only one SR with low risk of bias compared telerehabilitation to in-person rehabilitation in MSK setting. The results favored telerehabilitation over in-person rehabilitation in clinical effectiveness and function, but not for QOL. Seven SRs with low risk of bias compared telerehabilitation to no rehabilitation in MSK setting and found no difference between the groups when it came to clinical effectiveness and conflicting results for function. Five out of the 6 low risk SRs reported telerehabilitation superior to no rehabilitation for QOL and one SR with no difference between the interventions…

Access the ‘open access’ article here and read more and find out how telerehabilitation works in cardiac and pulmonary settings.“

As the authors stated, it is crucial to continue the research and in the future carry out high quality clinical trials investigating the effectiveness of telerehabilitation in physiotherapy.

Seron P, Oliveros MJ, Gutierrez-Arias R, Fuentes-Aspe R, Torres-Castro RC, Merino-Osorio C, Nahuelhual P, Inostroza J, Jalil Y, Solano R, Marzuca-Nassr GN, Aguilera-Eguía R, Lavados-Romo P, Soto-Rodríguez FJ, Sabelle C, Villarroel-Silva G, Gomolán P, Huaiquilaf S, Sanchez P. E
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Effectiveness of exercise via telehealth for chronic disease: a systematic review and meta-analysis of exercise interventions delivered via videoconferencing

Br J Sports Med. 2022;bjsports-2021-105118, doi:10.1136/bjsports-2021-105118

In this systematic review and meta-analysis the authors evaluated the effectiveness of exercise interventions delivered via teleconferencing (i.e. health professional supervising participants through an exercise session using video-linked remote appointment) in people with chronic diseases.

They carried out a systematic literature search and included trials where participants with chronic diseases received exercise interventions (aerobic and/or resistance training) delivered via teleconferencing methods. The trials had to also evaluate exercise capacity, and/or quality of life (QOL).

The meta-analyses were carried out for between-group comparisons of exercise capacity and QOL. Risk of bias was analysed hand the certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

They found 32 trials that matched the inclusion criteria. The studies had moderate risk of bias and the GRADE certainty ratings were from low to moderate (learn more about GRADE here. The adherence was reported in 23 trials and in average it was 70%.

For exercise capacity and QOL the results from the meta-analyses favored videoconferencing when exercise intervention was compared to intervention without exercise component (small to moderate effect: standardized mean difference (SMD)=0.616, 95% CI 0.278 to 0.954; p=<0.001), SMD=0.400, 95% CI 0.099 to 0.701; p=0.009, respectively). When videoconferencing was compared to an exercise intervention delivered in-person, the results favored videoconferencing, with effects being small (QOL SMD=0.271, 95% CI 0.028 to 0.515; p=0.029, exercise capacity SMD=0.242, 95% CI 0.059 to 0.426; p=0.009).

No serious adverse events relating to videoconferencing were found.

Clinical implications: It seems that videoconferencing as a delivery method for exercise interventions might be a feasible as well as safe and effective method in people with chronic diseases. However, more high quality studies are still needed.

Brown RC, Coombes JS, Jungbluth Rodriguez K, Hickman IJ, Keating SE.
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Real-Time Telerehabilitation in Older Adults With Musculoskeletal Conditions: Systematic Review and Meta-analysis

JMIR Rehabil Assist Technol . 2022;9(3):e36028.  doi:10.2196/36028

Synchronous telerehabilitation (TR) offers flexibility to traditional rehabilitation and may support rehabilitation continuity by removing barriers such as travelling to in person face-to-face appointments. Synchronous telerehabilitation is rehabilitation provided using telecommunication tools in real-time, so for example appointments via phone or video calls.

This systematic review aimed therefore to evaluate the effectiveness of synchronous TR on physical performance compared to usual care. They also aimed to assess the completion rates and cost-effectiveness of TR compared to usual care. The usual care could be physiotherapy delivered in traditional manner, educational intervention or no care.

This systematic review  searched for randomized controlled trials (RCTs) and included studies where synchronous TR was used in older adults seeking care for musculoskeletal conditions. The studies with physical function/performance outcomes (not self-reported), intervention completion rate and/or cost-effectiveness outcomes were included. The quality of included studies was evaluated using Cochrane’s risk-of-bias tool.Ten studies that met the inclusion criteria were included in the systematic review and meta-analysis (4 studies had low risk of bias). Most of the studies focused on rehabilitation before or after knee or hip replacement surgery.

Based on the results usual care was not superior to rehabilitation delivered using synchronous TR. The outcomes (balance, range of motion, strength) were similar between the groups or even slightly better among the TR groups. There was no major difference between intervention completion rates and the results on cost-effectiveness (from 2 studies) favored TR over usual care.

Clinical implications drawn from this review could be that synchronous TR is a feasible alternative delivery method for rehabilitation in older adults with MSK conditions, especially before or after TKR/THR operation as it seems to result in at least similar physical improvements as usual care.

Synchronous telerehabilitation (TR) offers flexibility to traditional rehabilitation and may support rehabilitation continuity by removing barriers such as traveling to in person face-to-face appointments. Synchronous telerehabilitation is rehabilitation provided using telecommunication tools in real-time, so for example appointments via phone or video calls.

This systematic review aimed therefore to evaluate the effectiveness of synchronous TR on physical performance compared to usual care. They also aimed to assess the completion rates and cost-effectiveness of TR compared to usual care. The usual care could be physiotherapy delivered in a traditional manner, educational intervention or no care.

This systematic review searched for randomized controlled trials (RCTs) and included studies where synchronous TR was used in older adults seeking care for musculoskeletal conditions. The studies with physical function/performance outcomes (not self-reported), intervention completion rate and/or cost-effectiveness outcomes were included. The quality of included studies was evaluated using Cochrane’s risk-of-bias tool.

Ten studies that met the inclusion criteria were included in the systematic review and meta-analysis (4 studies had low risk of bias). Most of the studies focused on rehabilitation before or after knee or hip replacement surgery.

Based on the results, usual care was not superior to rehabilitation delivered using synchronous TR. The outcomes (balance, range of motion, strength) were similar between the groups or even slightly better among the TR groups. There was no major difference between intervention completion rates and the results on cost-effectiveness (from 2 studies) favored TR over usual care.

Clinical implications drawn from this review could be that synchronous TR is a feasible alternative delivery method for rehabilitation in older adults with MSK conditions, especially before or after TKR/THR operation as it seems to result in at least similar physical improvements as usual care.

Jirasakulsuk N, Saengpromma P, Khruakhorn S.
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Comparison of Face-to-Face vs Digital Delivery of an Osteoarthritis Treatment Program for Hip or Knee Osteoarthritis

Osteoarthritis. JAMA Netw Open. 2022;5(11):e2240126. https://doi.org/10.1001/jamanetworkopen.2022.40126

In this registry-based cohort study from Sweden the aim was to evaluate the effectiveness of digital intervention compared to traditional face-to-face intervention in reducing pain among individuals with osteoarthritis (OA) of the knee or hip.

All patients with knee or hip OA who participated in structured first-line treatment, either face-to-face (F2F) or digital, in a primary care setting in Sweden (between April 1, 2018, and December 31, 2019) were included. Participants were excluded if they had not reported pain at 3-month follow-up, or if the adherence to intervention was less than 80%.

The F2F intervention included exercise and education with exercise being  individually tailored and supervised twice a week for 6 to 8 weeks. The Digital intervention was delivered via mobile app. The intervention included education and exercise content and quizzes about the education topics delivered daily. The exercise level was based on the participants progression in the program. All participants had also access to physiotherapists via asynchronous chat in the app and/or via telephone. The intervention lasted for 12 weeks.

The primary outcome was between-group difference in ‘change  in pain’ measured with 11-point NRS at baseline and at 3-month follow-up. The other outcomes evaluated were walking difficulties, health-related quality of life, willingness for surgery, and fear avoidance behavior.

The study included 6946 participants, with mean age of 67 (SD=9). Little over half of the participants received the F2F intervention and  approximately 3/4 were female.

Both interventions resulted in clinically meaningful improvements in pain over the 3-months. The digitally delivered intervention resulted in slightly larger improvements than the F2F intervention (adjusted mean difference, −0.93 [95% CI, −1.04 to −0.81] points). There were no major between-group differences in the secondary outcomes.

Clinical implications This registry-based cohort study showed that people with knee or hip OA can benefit from exercise and education intervention delivered via mobile app to the same extent as for F2F intervention with twice a week supervised exercise training. Therefore, digitally delivered hip/knee OA rehabilitation can be a feasible method for individuals who prefer to commit to a program that might offer more flexibility.

Jönsson T, Dell'Isola A, Lohmander LS, Wagner P, Cronström A.
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An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial

Abstract

Question: Do people with musculoskeletal conditions better adhere to their home exercise programs when these are provided to them on an app with remote support compared to paper handouts?

Design: Randomised, parallel-group trial with intention-to-treat analysis.

Participants: Eighty participants with upper or lower limb musculoskeletal conditions were recruited to the trial. Each participant was prescribed a 4-week home exercise program by a physiotherapist at a tertiary teaching hospital in Australia. Participants were randomly assigned via a computer-generated concealed block randomisation procedure to either intervention (n=40) or control (n=40) groups.

Intervention: Participants in the intervention group received their home exercise programs on an app linked to the freely available website www.physiotherapyexercises.com. They also received supplementary phone calls and motivational text messages. Participants in the control group received their home exercise programs as a paper handout.

Outcome measures: Blinded assessors collected outcome measures at baseline and 4 weeks. The primary outcome was self-reported exercise adherence. There were five secondary outcomes, which captured functional performance, disability, patient satisfaction, perceptions of treatment effectiveness, and different aspects of adherence.

Results: Outcomes were available on 77 participants. The mean between-group difference for self-reported exercise adherence at 4 weeks was 1.3/11 points (95% CI 0.2 to 2.3), favouring the intervention group. The mean between-group difference for function was 0.9/11 points (95% CI 0.1 to 1.7) on the Patient-Specific Functional Scale, also favouring the intervention group. There were no significant between-group differences for the remaining outcomes.

Conclusion: People with musculoskeletal conditions adhere better to their home exercise programs when the programs are provided on an app with remote support compared to paper handouts; however, the clinical importance of this added adherence is unclear.

Trial registration: ACTRN12616000066482. [Lambert TE, Harvey LA, Avdalis C, Chen LW, Jeyalingam S, Pratt CA, Tatum HJ, Bowden JL, Lucas BR (2017) An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial. Journal of Physiotherapy 63: 161-167].

Keywords: Exercise therapy; Mobile applications; Patient compliance; Physical therapy modalities.

Tara E Lambert, Lisa A Harvey, Christos Avdalis, Lydia W Chen, Sayanthinie Jeyalingam, Carin A Pratt, Holly J Tatum, Jocelyn L Bowden & Barbara R Lucas
PubMed
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Exploring patients' and clinicians' experiences of video consultations in primary care: a systematic scoping review

Abstract

Background

Video consultation (VC) is an emerging consultation mode in general practice. The challenges and benefits of implementing it are not necessarily realised until it is in use, and being experienced by patients and clinicians. To date, there has been no review of the evidence about how patients and clinicians experience VC in general practice.


Aim

The study aimed to explore both patients' and clinicians' experiences of VCs in primary care.


Design & setting

A systematic scoping review was carried out of empirical studies.


Method

All major databases were searched for empirical studies of any design, published from 1 January 2010 to 11 October 2018 in the English language. Studies were included where synchronous VCs occurred between a patient and a clinician in a primary care setting. Outcomes of interest related to experience of use. The quality of included studies were assessed. Findings were analysed using narrative synthesis.


Results

Seven studies were included in the review. Patients reported being satisfied with VC, describing reduced waiting times and travel costs as a benefit. For patients and clinicians, VC was not deemed appropriate for all presentations and all situations, and a face-to-face consultation was seen as preferable where this was possible.


Conclusion

The findings of this scoping review show that primary care patients and clinicians report both positive and negative experiences when using VCs, and these experiences are, to a certain extent, context dependent. VC is potentially more convenient for patients, but is not considered superior to a face-to-face consultation. Accounts of experience are useful in the planning and implementation of any VC service.

Arun Thiyagarajan, BSc, MRCP, MRCGP, MPH, 1 Calum Grant, MPhys (Hons), 2 Frances Griffiths, PhD FRCGP, 3 , 4 and Helen Atherton, BSc (Hons), MSc, MPH, PhD 5 ,*
PubMed
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Patient reported outcomes with remote orthopaedic consultations by telemedicine: A randomised controlled trial

Abstract

Introduction: Decentralised services through outreach clinics or modern technology reduce patient travel time and cost to society. Telemedicine consultation through videoconference is one such modality. Here, we compared patient-reported health outcomes and satisfaction between video-assisted remote and standard face-to-face orthopaedic consultations.


Methods: This randomised controlled trial included two parallel groups: (1) patients receiving video-assisted remote consultation at a regional medical centre (RMC); and (2) patients receiving standard consultation at the orthopaedic outpatient clinic of the University Hospital of North Norway (UNN). This study included patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. After each consultation, patient satisfaction was determined using patient-completed questionnaires containing questions on patient-reported health (three-level European quality of life five-dimension index (EQ-5D-3L)/European quality of life visual analogue scale (EQ-VAS)) and questions from a validated OutPatient Experiences Questionnaire (OPEQ).


Results: This study included 389 patients, of which 199 received remote consultation and 190 received standard consultation (total of 559 consultations). In all, 99% RMC-randomised patients and 99% UNN-randomised patients evaluated the consultation as very satisfactory or satisfactory. Moreover, 86% RMC-randomised patients preferred video-assisted consultation as the next consultation. No difference was observed in patient-reported health after 12 months between the two groups. EQ-5D index scores were 0.77 and 0.75 for RMC- and UNN-randomised patients, respectively (p = 0.42).


Discussion: We did not observe any difference in patient-reported satisfaction and health (EQ-5D/EQ-VAS) between video-assisted and standard consultations, suggesting that video-assisted remote consultation can be safely offered to some orthopaedic patients. Moreover, a significantly high proportion of patients selected video-assisted remote consultation as their next consultation, thus strengthening the findings of this study. However, economic aspects should be assessed before widely recommending video-assisted consultation.


Keywords: Telemedicine; orthopaedic; outpatients; patient satisfaction; quality of life; randomised controlled trial; remote consultations; videoconference.

Astrid Buvik 1, Einar Bugge 2, Gunnar Knutsen 1, Arvid Småbrekke 1, Tom Wilsgaard 2 3
PubMed
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Patients' Satisfaction with and Preference for Telehealth Visits

Abstract

Background: One-quarter of U.S. patients do not have a primary care provider or do not have complete access to one. Work and personal responsibilities also compete with finding convenient, accessible care. Telehealth services facilitate patients' access to care, but whether patients are satisfied with telehealth is unclear.


Objective: We assessed patients' satisfaction with and preference for telehealth visits in a telehealth program at CVS MinuteClinics.

Design: Cross-sectional patient satisfaction survey.


Participants: Patients were aged ≥18 years, presented at a MinuteClinic offering telehealth in January-September 2014, had symptoms suitable for telehealth consultation, and agreed to a telehealth visit when the on-site practitioner was busy.


Main measures: Patients reported their age, gender, and whether they had health insurance and/or a primary care provider. Patients rated their satisfaction with seeing diagnostic images, hearing and seeing the remote practitioner, the assisting on-site nurse's capability, quality of care, convenience, and overall understanding. Patients ranked telehealth visits compared to traditional ones: better (defined as preferring telehealth), just as good (defined as liking telehealth), or worse. Predictors of preferring or liking telehealth were assessed via multivariate logistic regression.


Key results: In total, 1734 (54 %) of 3303 patients completed the survey: 70 % were women, and 41 % had no usual place of care. Between 94 and 99 % reported being "very satisfied" with all telehealth attributes. One-third preferred a telehealth visit to a traditional in-person visit. An additional 57 % liked telehealth. Lack of medical insurance increased the odds of preferring telehealth (OR = 0.83, 95 % CI, 0.72-0.97). Predictors of liking telehealth were female gender (OR = 1.68, 1.04-2.72) and being very satisfied with their overall understanding of telehealth (OR = 2.76, 1.84-4.15), quality of care received (OR = 2.34, 1.42-3.87), and telehealth's convenience (OR = 2.87, 1.09-7.94) CONCLUSIONS: Patients reported high satisfaction with their telehealth experience. Convenience and perceived quality of care were important to patients, suggesting that telehealth may facilitate access to care.


Keywords: access to care; patient satisfaction; telehealth.

Jennifer M Polinski 1, Tobias Barker 2, Nancy Gagliano 2, Andrew Sussman 2, Troyen A Brennan 2, William H Shrank 2
PubMed
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Systematic review of patient and caregivers' satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients' health

Abstract
Telehealth is an alternative method of delivering health care to people required to travel long distances for routine health care. The aim of this systematic review was to examine whether patients and their caregivers living in rural and remote areas are satisfied with telehealth videoconferencing as a mode of service delivery in managing their health. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42017083597) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of Ovid Medline, Embase, CINAHL, ProQuest Health Research Premium Collection, Joanna Briggs Institute and the Cochrane Library was conducted. Studies of people living in rural and remote areas who attended outpatient appointments for a health condition via videoconference were included if the studies measured patient and/or caregivers' satisfaction with telehealth. Data on satisfaction was extracted and descriptively synthesised. Methodological quality of the included studies was assessed using a modified version of the McMaster Critical Review Forms for Quantitative or Qualitative Studies. Thirty-six studies of varying study design and quality met the inclusion criteria. The outcomes of satisfaction with telehealth were categorised into system experience, information sharing, consumer focus and overall satisfaction. There were high levels of satisfaction across all these dimensions. Despite these positive findings, the current evidence base lacks clarity in terms of how satisfaction is defined and measured. People living in rural and remote areas are generally satisfied with telehealth as a mode of service delivery as it may improve access to health care and avoid the inconvenience of travel.

Joseph F Orlando 1, Matthew Beard 1, Saravana Kumar 2
PubMed
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Effectiveness of physiotherapy with telerehabilitation in surgical patients: a systematic review and meta-analysis.

BACKGROUND:

Over the last few years, telerehabilitation services have developed rapidly, and patients value benefits such as reduced travelling barriers, flexible exercise hours, and the possibility to better integrate skills into daily life. However, the effects of physiotherapy with telerehabilitation on postoperative functional outcomes compared with usual care in surgical populations are still inconclusive.

OBJECTIVES:

To study the effectiveness of physiotherapy with telerehabilitation on postoperative functional outcomes and quality of life in surgical patients.

DATA SOURCES:

Relevant studies were obtained from MEDLINE, EMBASE, CINAHL, the Cochrane Library, PEDro, Google Scholar and the World Health Organization International Clinical Trials Registry Platform.

STUDY SELECTION:

Randomised controlled trials, controlled clinical trials, quasi-randomised studies and quasi-experimental studies with comparative controls were included with no restrictions in terms of language or date of publication.

DATA EXTRACTION AND SYNTHESIS:

Methodological quality was assessed using the Cochrane risk of bias tool. Twenty-three records were included for qualitative synthesis. Seven studies were eligible for quantitative synthesis on quality of life, and the overall pooled standardised mean difference was 1.01 (95% confidence interval 0.18 to 1.84), indicating an increase in favour of telerehabilitation in surgical patients.

LIMITATIONS:

The variety in contents of intervention and outcome measures restricted the performance of a meta-analysis on all clinical outcome measures.

CONCLUSIONS:

Physiotherapy with telerehabilitation has the potential to increase quality of life, is feasible, and is at least equally effective as usual care in surgical populations. This may be sufficient reason to choose physiotherapy with telerehabilitation for surgical populations, although the overall effectiveness on physical outcomes remains unclear. PROSPERO registration number: CRD42015017744.

M.A. van Egmond, M. van der Schaaf, T. Vredeveld, M.M.R. Vollenbroek-Hutten, M.I. van Berge Henegouwen, J.H.G. Klinkenbijl & R.H.H. Engelbert
PubMed
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International core capability framework for physiotherapists to deliver quality care via videoconferencing

The core capability framework for physiotherapists to deliver quality care via videoconferencing was developed using an international consensus process. The international Delphi panel consisted of a steering group, physiotherapy clinicians and researchers, physiotherapy representatives, a private health insurer and consumers. The final framework comprised 60 specific capabilities across several domains including: compliance, patient privacy/confidentiality, patient safety, technology skills, Telehealth delivery, assessment/diagnosis and care planning and management. This framework provides guidance for the knowledge and skills required by physiotherapists and other allied health professionals to deliver care via videoconferencing.

This study was funded by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence.

Davies, L., Hinman, R.S., Russell, T., Lawford, B., Bennell, K., (2021). An international core capability framework for physiotherapists to deliver quality care via videoconferencing: A Delphi Study. Journal of physiotherapy. DOI: https://doi.org/10.1016/j.phys.2021.09.001
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Home-based exercise rehabilitation with telemedicine following cardiac surgery.

We evaluated the feasibility of a home-based rehabilitation programme, which was designed to resemble an in-hospital rehabilitation programme. Patients who underwent cardiac surgery (EuroSCORE 0-10) followed a one-month home rehabilitation programme supervised by a nurse-tutor and a physiotherapist. Physiotherapy was performed at home with calisthenic exercises and bicycle-ergometer tests. Patients transmitted the recorded ECGs by telephone to a service centre. They also performed a 6-minute walking test and filled in a satisfaction questionnaire at the end of the programme. A total of 47 patients were enrolled in the study. There were 3050 telephone calls, of which 3012 (99%) were scheduled and 38 were unscheduled. No further action was required in 95% of calls. There were 809 sessions for calisthenic exercises and 1039 for exercise training. There was a significant increase in the 6-minute walking test distance at the end of the programme compared to the baseline (404 m vs. 307 m, P < 0.001). Patient satisfaction, as measured in a questionnaire, was about 95% overall. This type of home rehabilitation using telemedicine appears to be worth implementing in selected categories of patients.

Scalvini S1, Zanelli E, Comini L, Tomba MD, Troise G Giordano A
PubMed
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Effectiveness of an Internet-Delivered Exercise and Pain-Coping Skills Training Intervention for Persons With Chronic Knee Pain: A Randomized Trial

Background: Effective, accessible biopsychosocial treatments are needed to manage chronic knee pain on a population level.

Objective: To evaluate the effectiveness of Internet-delivered, physiotherapist-prescribed home exercise and pain-coping skills training (PCST).

Design: Pragmatic parallel-group randomized, controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12614000243617)

Setting: Community (Australia).

Patients: 148 persons aged 50 years or older with chronic knee pain.

Intervention: The intervention was delivered via the Internet and included educational material, 7 videoconferencing (Skype [Microsoft]) sessions with a physiotherapist for home exercise, and a PCST program over 3 months. The control was Internet-based educational material.

Measurements: Primary outcomes were pain during walking (11-point numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index) at 3 months. Secondary outcomes were knee pain, quality of life, global change (overall, pain, and functional status), arthritis self-efficacy, coping, and pain catastrophizing. Outcomes were also measured at 9 months.

Results: Of participants enrolled, 139 (94%) completed primary outcome measures at 3 months and 133 (90%) completed secondary outcome measures at 9 months; multiple imputation was used for missing data. The intervention group reported significantly more improvement in pain (mean difference, 1.6 units [95% CI, 0.9 to 2.3 units]) and physical function (mean difference, 9.3 units [CI, 5.9 to 12.7 units]) than the control group at 3 months, and improvements were sustained at 9 months (mean differences, 1.1 units [CI, 0.4 to 1.8 units] and 7.0 units [CI, 3.4 to 10.5 units], respectively). Intervention participants showed significantly more improvement in most secondary outcomes than control participants. At both time points, significantly more intervention participants reported global improvements.

Limitation: Participants were unblinded.

Conclusion: For persons with chronic knee pain, Internet-delivered, physiotherapist-prescribed exercise and PCST provide clinically meaningful improvements in pain and function that are sustained for at least 6 months.

Primary Funding Source: National Health and Medical Research Council.

Kim L. Bennell, BAppSci(Physio), PhD; Rachel Nelligan, BPhysio; Fiona Dobson, BAppSci(Physio), PhD; Christine Rini, PhD; Francis Keefe, BA, MS, PhD; Jessica Kasza, BSc(Hons), PhD; Simon French, BAppSc(Chiro), MPH, PhD; Christina Bryant, MA(Clin Psych), PhD; Andrew Dalwood, BAppSci(Physio), GradDipManipTherapy; J. Haxby Abbott, PhD, DPT; Rana S. Hinman, BPhysio(Hons), PhD
Annals of Internal Medicine
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A randomized controlled trial of home telerehabilitation for post-knee arthroplasty.

Home telerehabilitation is at least as effective as usual care, and has the potential to increase access to therapy in areas with high speed Internet services.

Tousignant M, Moffet H, Boissy P, Corriveau H, Cabana F, Marquis F.
J Telemed Telecare. 2011;17(4):195-8. Epub 2011 Mar 11.
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Benefits of a home-based physical exercise program in elderly subjects with type 2 diabetes mellitus

A home-based physical exercise program improves quality of life, glycemic control, and weight in type 2 diabetic patients older than 60 years.

Ferrer-García JC1, Sánchez López P, Pablos-Abella C, Albalat-Galera R, Elvira-Macagno L, Sánchez-Juan C, Pablos-Monzó A.
Endocrinol Nutrition
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Does commitment to rehabilitation influence clinical outcome of total hip resurfacing arthroplasty?

Patients who were more committed to their therapy after hip resurfacing returned to higher levels of functionality and were more satisfied following their surgery.

Marker DR, Seyler TM, Bhave A, Zywiel MG, Mont MA.
J Orthop Surg Res. 2010 Mar 22;5:20.
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Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial.

A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention.

Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC.
Ann Intern Med. 2000 Feb 1;132(3):173-81.
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Effects of live, videotaped, or written instruction on learning an upper-extremity exercise program.

Live and videotaped modeling are more effective than a handout alone for achieving performance accuracy of a basic exercise program, as measured by immediate and delayed retention tests.

Reo JA, Mercer VS.
Physical Therapy 2004; 84:622-33.
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Effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis: randomized controlled trial.

Join2move (Web-based intervention) resulted in changes in the desired direction for several primary and secondary outcomes. Given the benefits and its self-help format, Join2move could be a component in the effort to enhance PA in sedentary patients with knee and/or hip OA.

Bossen D1, Veenhof C, Van Beek KE, Spreeuwenberg PM, Dekker J, De Bakker DH.
Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
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Effects of a home program on strength, walking speed, and function after total hip replacement.

The designed home program was effective in improving hip muscle strength, walking speed, and function in patients after THR who practiced the program at least 3 times a week, but adherence to this home program may be a problem.

Jan MH, Hung JY, Lin JC, Wang SF, Liu TK, Tang PF.
J Orthop Surg Res. 2010 Mar 22;5:20.
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Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture.

Importance  For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established.

Objective  To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended.

Design, Setting, and Participants  Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture.

Interventions  The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education.

Main Outcomes and Measures  Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function).

Results  Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P < .001; mean AM-PAC mobility scores for intervention group: 56.2 [SD, 7.3] at baseline, 58.1 [SD, 7.9] at 6 months; control group: 56 [SD, 7.1] at baseline, 56.6 [SD, 8.1] at 6 months; and between-group difference, 1.3 [95% CI, 0.2 to 2.4], P = .03; and mean AM-PAC daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and between-group difference, 3.5 [95% CI, 0.9 to 6.0], P = .03). In multiple imputation analyses, between-group differences remained significant for SPPB and AM-PAC daily activity, but not for mobility. Significant between-group differences persisted at 9 months for all functional measures with and without imputation.

Conclusions and Relevance  Among patients who had completed standard rehabilitation after hip fracture, the use of a home-based functionally oriented exercise program resulted in modest improvement in physical function at 6 months after randomization. The clinical importance of these findings remains to be determined.

Trial Registration  clinicaltrials.gov Identifier: NCT00592813

Nancy K. Latham, Bette Ann Harris, et al.
JAMA, 2014; 311 (7): 700 DOI: 10.1001/jama.2014.469
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Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication.

A Test-in/Train-out program provided favourable patient compliance, QoL impact and cost-effectiveness in patients with IC.

Malagoni AM, Vagnoni E, Felisatti M, Mandini S, Heidari M, Mascoli F, Basaglia N, Manfredini R, Zamboni P, Manfredini F.
Circ J. 2011;75(9):2128-34. Epub 2011 Jun 28.
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Exercise in combination with education is likely to prevent the risk of lower back pain

The results of this systematic review and meta-analysis of RCTs indicate that exercise in combination with education is likely to reduce the risk of LBP and that exercise alone may reduce the risk of an episode of LBP and sick leave due to LBP, at least for the short-term. The available evidence suggests that educa- tion alone, back belts, shoe insoles, and ergonomics do not pre- vent LBP. It is uncertain whether education, training, or ergo- nomic adjustments prevent sick leave due to LBP because the quality of evidence is very low.

Daniel Steffens, PhD; Chris G. Maher, PhD; Leani S. M. Pereira, PhD; Matthew L Stevens, MScMed (Clin Epi); Vinicius C. Oliveira, PhD; Meredith Chapple, BPhty; Luci F. Teixeira-Salmela, PhD; Mark J. Hancock, PhD
Prevention of Low Back Pain. A Systematic Review and Meta-analysis
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Knee stiffness following anterior cruciate ligament reconstruction: the incidence and associated factors of knee stiffness following anterior cruciate ligament reconstruction.

We reviewed 100 patients retrospectively following primary ACL reconstruction with quadruple hamstring autografts to evaluate the incidence and factors associated with postoperative stiffness. Stiffness was defined as any loss of motion using the contra-lateral leg as a control. The median delay between injury and operation was 15 months. The incidence of stiffness was 12% at 6 months post-reconstruction. Both incomplete attendance at physiotherapy (p<0.005) and previous knee surgery (p<0.005) were the strongest predictors of the stiffness....

(You can also check https://linkinghub.elsevier.com/retrieve/pii/S0968016008002469)

Robertson GA, Coleman SG, Keating JF.
Knee. 2009 Aug;16(4):245-7. Epub 2009 Jan 31.
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“Patients are likely to be more compliant if they are financially vested in their recovery”

In behavioral economics, the endowment effect (also known as divestiture aversion) is the hypothesis that people ascribe more value to things merely because they own them. This is illustrated by the fact that people will pay more to retain something they own than to obtain something owned by someone else—even when there is no cause for attachment, or even if the item was only obtained minutes ago.

Endowment effect
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Patients' satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists' satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial.

As patient satisfaction is important in maintaining motivation and treatment compliance and the satisfaction of healthcare professionals must be high in order for new treatments to become mainstream in clinics, the results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.

Tousignant M, Boissy P, Moffet H, Corriveau H, Cabana F, Marquis F, Simard J.
Telemed J E Health. 2011 Jun;17(5):376-82. Epub 2011 Apr 14.
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Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults.

Interventions such as supervised or individualised exercise therapy and self-management techniques may enhance exercise adherence. However, high-quality, randomised trials with long-term follow up that explicitly address adherence to exercises and physical activity are needed. A standard validated measure of exercise adherence should be used consistently in future studies.

Jordan JL1, Holden MA, Mason EE, Foster NE.
1Arthritis Research Campaign National Primary Care Centre Primary Care Sciences, Keele University, Keele, Staffordshire, UK, ST5 5BG.
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Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review

Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting.

Corinne L. Coulter, Jennie M. Scarvell, Teresa M. Neeman, Paul N. Smith
Australian Physiotherapy Association
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Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial.

Intensive preoperative training at home is feasible for frail elderly patients waiting for THA and produces relevant changes in functional health. A larger multicenter randomized controlled trial is in progress to investigate the (cost-)effectiveness of preoperative training.

Oosting E, Jans MP, Dronkers JJ, Naber RH, Dronkers-Landman CM, Appelman-de Vries SM, van Meeteren NL.
Arch Phys Med Rehabil. 2012 Apr;93(4):610-6. Epub 2012 Feb 24.
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Physiotherapy home exercise program for haemophiliacs.

Background: Regular physiotherapy can improve the stability and flexibility of joints and decrease the bleeding risk in patients with haemophilia. To reduce the appointments for the patients and to make exercising a part of daily live, an individualized home exercise program (HEP) was designed. Retrospectively the number of bleedings during the HEP was compared to number of bleedings before.

Method: 8 patients aged between 4 and 16 years with haemophilia A were evaluated. At start and after 13 month patients had a motion analysis via topographic ultrasound. According to the results and clinical findings an individualized HEP was created. Standardised scores for clinical evaluation and the patient based evaluation of exercises were designed. At every appointment exercises were individually adjusted.

Results: Patients exercised in median 1.7 times a week. No training related bleeds occurred. 7 of 8 patients showed reduced joint and/or muscle bleeds (p<0.02). Clinical scores raised slightly in every patient. However the second motion analysis of squat and gait showed a worsening in 7 of 8 patients (p>0.05).

Conclusion: A HEP can help to advance in physical fitness and coordination and may reduce bleeding tendency, but needs to be accomplished regularly. Patients are interested but the motivation to exercise at home is low. Disorders measured by motion analysis seem not to be sufficiently influenced by our surrogate training program.

© Georg Thieme Verlag KG Stuttgart · New York.

Pierstorff K, Seuser A, Weinspach S, Laws HJ.
Klin Padiatr. 2011 May;223(3):189-92. Epub 2011 Apr 21.
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Physical therapy instructional video may be as good as an in-person visit for shoulder rehabilitation exercises

Background and Purpose

The accurate performance of physical therapy exercises can be difficult. In this evolving healthcare climate it is important to continually look for better methods to educate patients. The use of handouts, in-person demonstration, and video instruction are all potential avenues used to teach proper exercise form. The purpose of this study was to examine if a corrected error video (CEV) would be as effective as a single visit with a physical therapist (PT) to teach healthy subjects how to properly perform four different shoulder rehabilitation exercises.

Study Design

This was a prospective, single-blinded interventional trial.

Methods

Fifty-eight subjects with no shoulder complaints were recruited from two institutions and randomized into one of two groups: the CEV group (30 subjects) was given a CEV comprised of four shoulder exercises, while the physical therapy group (28 subjects) had one session with a PT as well as a handout of how to complete the exercises. Each subject practiced the exercises for one week and was then videotaped performing them during a return visit. Videos were scored with the shoulder exam assessment tool (SEAT) created by the authors.

Results

There was no difference between the groups on total SEAT score (13.66 ± 0.29 vs 13.46 ± 0.30 for CEV vs PT, p = 0.64, 95% CI [−0.06, 0.037]). Average scores for individual exercises also showed no significant difference.

Conclusion/Clinical Relevance

These results demonstrate that the inexpensive and accessible CEV is as beneficial as direct instruction in teaching subjects to properly perform shoulder rehabilitation exercises.

Level of Evidence

1b

David J. Berkoff, sports medicine physician and associate professor of orthopaedics at the University of North Carolina, Chapel Hill (USA)
American Medical Society for Sports Medicine
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(please also see https://www.tandfonline.com/doi/abs/10.1080/09593980290058454)

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Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.

Based on this evidence, the supplementation of a home-based exercise programme with an 8-week class-based exercise programme can be confidently expected to produce small improvements in locomotor function and clinically important reductions in pain. It is recommended that future research investigates methods of increasing compliance with home exercise programmes and evaluates the impact of these interventions in the primary care setting, where most patients with knee osteoarthritis are managed.

McCarthy CJ, Mills PM, Pullen R, Richardson G, Hawkins N, Roberts CR, Silman AJ, Oldham JA.
Health Technol Assess. 2004 Nov;8(46):iii-iv, 1-61.
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