Back in November 2019 we announced that Rana Hinman, from the University of Melbourne, won the PEDro prize for the best randomised controlled trial at the TRANSFORM2019 Physiotherapy Conference for her presentation titled “Telephone-delivered exercise advice and behaviour change support by physiotherapists for people with knee osteoarthritis: the TELECARE pragmatic randomised controlled trial”. The prize recognises the achievements of researchers who conduct high quality, clinically important randomised controlled trials.
We are pleased to let you know that the results of Rana’s award winning trial have now been published. The trial is included in PEDro’s Evidence in your inbox feeds for gerontology, musculoskeletal and chronic pain for January 2020.
The trial investigated the benefit of a telephone-delivered exercise advice and support service provided by a physiotherapist, in addition to an existing nurse-led telephone-service, for self-management of knee osteoarthritis. 175 people with chronic knee pain due to osteoarthritis were recruited from across Australia. The main inclusion criteria were the clinical criteria for osteoarthritis (aged 45 years or over, activity-related knee pain, morning knee stiffness for < 30 minutes), knee pain of 4 or higher on a 10-point numerical rating scale in the previous week, and having pain for at least 3 months.
A concealed and random process was used to allocate participants to an existing nurse-led telephone service (n = 88) or additional exercise advice and support from a physiotherapist via telephone (n = 87). The existing service group received one telephone consultation with a nurse for self-management advice. The exercise advice and support group additionally received 5-10 telephone consultations with a physiotherapist trained in behaviour change for a personalised strengthening program and physical activity plan.
Primary outcomes were the change in overall average knee pain (numerical rating scale, range 0-10) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index, range 0-68) from baseline to 6 months (primary time-point) and from baseline to 12 months (secondary time-point). Cost-effectiveness from a societal perspective was also calculated. Outcome assessors were blinded to group allocation and analysis was by intention-to-treat. Follow up was high, with 94% of participants completing the 6-month assessment and 90% at 12 months.
At 6 months, the exercise advice and support group reported greater improvement in function (mean difference 4.7 units (95% confidence interval 1.0 to 8.4)) and overall pain (0.7 units (0.0 to 1.4)) than the existing service group. The between-group difference for function was considered to be clinically worthwhile, while the between-group difference for pain was not. By 12 months, the change in function (3.1 (-0.6 to 6.7)) and pain (0.3 (-0.4 to 1.0)) were similar for both groups.
The additional cost of providing the exercise support and advice from a physiotherapist was $AUD514 per participant. This additional service did not save other health service resources.
The trial concluded that incorporating a physiotherapist-led exercise advice and support into an existing telephone service resulted in modest improvements in physical function at 6 months but not the co-primary outcome of knee pain at 6 months. The results are encouraging for the many Australians with knee osteoarthritis who may be unable to access face to face physiotherapy because they live in rural or remote settings, or have difficulty with accessing a physiotherapist due to mobility limitations.
Hinman RS, et al. Does telephone-delivered exercise advice and support by physiotherapists improve pain and/or function in people with knee osteoarthritis? Telecare randomised controlled trial. Br J Sports Med 2019 Nov 20:Epub ahead of print.
Read more on PEDro.