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Does telephone-delivered exercise advice and support by physiotherapists improve pain and/or function in people with knee osteoarthritis? Telecare randomised controlled trial
  1. Rana S Hinman1,
  2. Penny K Campbell1,
  3. Belinda J Lawford1,
  4. Andrew M Briggs2,
  5. Janette Gale3,
  6. Caroline Bills3,
  7. Jessica Kasza4,
  8. Anthony Harris5,
  9. Simon D French1,6,
  10. Stephen J Bunker7,
  11. Andrew Forbes4,
  12. Kim L Bennell1
  1. 1Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  3. 3HealthChange Australia, Melbourne, Victoria, Australia
  4. 4School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
  5. 5Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
  6. 6Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
  7. 7Medibank Private, Melbourne, Victoria, Australia
  1. Correspondence to Professor Rana S Hinman, Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, VIC 3010, Australia; ranash{at}unimelb.edu.au

Abstract

Objective Evaluate a physiotherapist-led telephone-delivered exercise advice and support intervention for people with knee osteoarthritis.

Methods Participant-blinded, assessor-blinded randomised controlled trial. 175 people were randomly allocated to (1) existing telephone service (≥1 nurse consultation for self-management advice) or (2) exercise advice and support (5–10 consultations with a physiotherapist trained in behaviour change for a personalised strengthening and physical activity programme) plus the existing service. Primary outcomes were overall knee pain (Numerical Rating Scale, range 0–10) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, range 0–68) at 6 months. Secondary outcomes, cost-effectiveness and 12-month follow-up were included.

Results 165 (94%) and 158 (90%) participants were retained at 6 and 12 months, respectively. At 6 months, exercise advice and support resulted in greater improvement in function (mean difference 4.7 (95% CI 1.0 to 8.4)), but not overall pain (0.7, 0.0 to 1.4). Eight of 14 secondary outcomes favoured exercise advice and support at 6 months, including pain on daily activities, walking pain, pain self-efficacy, global improvements across multiple domains (overall improvement, improved pain, improved function and improved physical activity) and satisfaction. By 12 months, most outcomes were similar between groups. Exercise advice and support cost $A514/participant and did not save other health service resources.

Conclusion Telephone-delivered physiotherapist-led exercise advice and support modestly improved physical function but not the co-primary outcome of knee pain at 6 months. Functional benefits were not sustained at 12 months. The clinical significance of this effect is uncertain.

Trial registration number Australian New Zealand Clinical Trials Registry (#12616000054415).

  • osteoarthritis
  • physiotherapy
  • knee
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Footnotes

  • Contributors RSH, KLB, SDF, AF, AH, AMB, SJB and JG conceived the study and obtained study funding and in-kind support; RSH, KLB, CB and JG designed the physiotherapy group intervention; JG designed the behavioural change methodology that the physiotherapists were trained in; CB and RSH trained the physiotherapists; PKC recruited participants and coordinated the trial; BJL led the qualitative studies that aided interpretation of trial findings; JK was responsible for statistical analyses; AH was responsible for cost-effective analyses; RSH drafted the manuscript and all authors read and approved the final version for submission.

  • Funding This trial was funded by the National Health and Medical Research Council (Partnership Project #1112133 and Centre of Research Excellence (#1079078)) and the Medibank Better Health Foundation, with in-kind support from Musculoskeletal Australia (formerly Arthritis and Osteoporosis Victoria), HealthChange Australia and the Australian Physiotherapy Association. RSH is supported by National Health and Medical Research Council Fellowship (#1154217). KLB is supported by a National Health and Medical Research Council Fellowship (#1058440).

  • Competing interests JG owns HealthChange Australia, which trained the physiotherapists in behavioural change methodology and employs CB as a training facilitator. AMB was a salaried employee of Arthritis and Osteoporosis Victoria (now known as Musculoskeletal Australia) at the time this trial was designed and grant funding awarded. SJB is employed as Medibank’s Clinical Research Advisor.

  • Patient consent for publication Not required.

  • Ethics approval Obtained from the human research ethics committee of the University of Melbourne (HREC #1544432).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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