Tele-Rehabilitation Can Improve Physical Function In Chronic Knee Pain Patients Interview with:
Rachel Nelligan, BPhysio
Physiotherapist & Research Physiotherapist
Department of Physiotherapy | Centre for Health, Exercise and Sports Medicine
The University of Melbourne
Victoria Australia What is the background for this study?

Response: This novel study investigated the efficacy of an internet delivered model of service delivery that combined online education, Skype delivered exercise physiotherapy and an Internet-based interactive pain coping skills training program for people with persistent knee pain.

Osteoarthritis, the leading cause of chronic knee pain and disability globally, has a significant individual, societal and economic burden. On an individual level knee osteoarthritis causes loss of function, reduced quality of life, and psychological distress. Clinical guidelines recommend adoption of a biopsychosocial approach to management which should include nondrug, nonsurgical treatments. Specifically exercise, education and psychological interventions (including pain coping skills training (PCST)) that foster self-management are recommended. Evidence identifies that many knee OA sufferers are not receiving adequate management due in part to challenges of accessing these effective treatments. There is an urgent need for new models of health service delivery to rectify this.

Tele-rehabilitation is growing in acceptance as an effective, time efficient and convenient means for people to access effective health interventions. In knee OA internet delivered interventions specifically remotely delivered physiotherapy exercise using specialised tele-rehabilitation equipment and an Internet-based interactive PCST program (PainCOACH), designed to translate key therapeutic elements of clinician-delivered face-to-face PCST, have shown improved patient outcomes. Prior to this study the combination of these two internet-based treatments has not been investigated. What are the main findings?

Response: Excitingly, our randomised clinical control trial identified that this new model of service delivery, combined remotely delivered internet-based education, exercise and PCST treatments combined is highly effective, managing pain and improving physical function in chronic knee pain sufferers in the short and longer term and is well accepted with high levels of adherence and satisfaction reported. What should readers take away from your report?

Response: The important take away message from our research is that an internet delivered intervention that adopts a biopsychosocial approach to the management of chronic knee pain and knee osteoarthritis, using freely available computer software, can be effective and is well received by its users. Importantly, this model of service delivery has the potential to increase access to these evidence based and effective treatments for knee pain sufferers irrespective of geographical location, without the need for specialised and expensive tele-communication equipment. What recommendations do you have for future research as a result of this study?

Response: Knowing that this model of service delivery can be effective to reduce pain and improve physical function for chronic knee pain sufferers is vital. Before a new model of service delivery can be implemented, however, it is important to explore if it is feasible and accepted by those that use the service. It is also important to gain an understanding of the cost-effectiveness of the treatments.

We have therefore, in conjunction with this RCT, completed qualitative inquiry to help us gain in-depth understand of the experiences of those involved in receiving and delivering the internet delivered treatments (knee OA sufferers and physiotherapists) and have also collected health economic data to evaluate the value of such a service. This data will be analysed and published at a later date.

Further research to tease out the effect of each individual internet-delivered treatment would also be beneficial. Is there anything else you would like to add?

Response: The results of our study are very promising and provide evidence that these internet-delivered treatments are effective to manage chronic knee pain. There is a hurdle, however, to their implementation beyond the research setting. In Australian and other countries insurers only provide reimbursement for face to face delivered treatments not tele-rehabilitation or internet delivered treatments like the ones used in our study. This is a major financial barrier to these effective treatments becoming available to the general public and this needs to be addressed.

We are hopeful that the successful results of our study can facilitate discussions to bring about the policy level change that is needed so that individuals can receive reimbursement for tele-rehabilitation and ultimately enable the general public affordable and equitable access these effective evidence based treatments. Thank you for your contribution to the community.


Bennell KL, Nelligan R, Dobson F, Rini C, Keefe F, Kasza J, et al. Effectiveness of an Internet-Delivered Exercise and Pain-Coping Skills Training Intervention for Persons With Chronic Knee Pain: A Randomized Trial. Ann Intern Med. [Epub ahead of print 21 February 2017] doi: 10.7326/M16-1714

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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