Comparing in-person physiotherapy with video conferencing for chronic knee pain.
Musculoskeletal pain is a prevalent issue affecting approximately 20% of the global population, leading to disability and diminished quality of life. Among the recommended treatments are structured exercise, physical activity, and patient education, often provided by physiotherapists. However, consistent delivery of evidence-based care for musculoskeletal pain faces challenges due to factors such as patient volume and healthcare access barriers related to geography, transportation, and provider availability. To address these challenges, leveraging technology for remote physiotherapy has been discussed for over two decades, but its implementation was limited before the COVID-19 pandemic, with little research on its effectiveness.
The PEAK trial stands out as the largest and most methodologically rigorous study comparing in-person physiotherapy to telerehabilitation for chronic knee pain, specifically in individuals with osteoarthritis. The trial enrolled 394 adults who were randomly assigned to receive either in-person physiotherapy or telerehabilitation via video conferencing. Both groups underwent five individual treatment sessions over a 3-month period, focusing on strengthening, physical activity, and education. The results of the trial supported the non-inferiority of telerehabilitation compared to in-person physiotherapy for primary outcomes such as knee pain during walking and physical function after 3 months. The study found that telerehabilitation was equally effective in improving these outcomes, with results remaining consistent at the 9-month follow-up and in per-protocol analyses.
The PEAK trial fills a research gap by addressing the question of equivalence between telerehabilitation and in-person physiotherapy, a question that has gained considerable urgency as the future of telerehabilitation is debated post-COVID-19. Before the pandemic, research on telerehabilitation for musculoskeletal pain primarily focused on post-surgical rehabilitation and supplementary roles alongside in-person physiotherapy. The PEAK trial's findings of equivalence between in-person and telerehabilitation not only support the continued availability and reimbursement of telerehabilitation for chronic musculoskeletal pain but also highlight potential cost-effectiveness, particularly when considering factors like patient travel and time.
In addition to clinical outcomes, the PEAK study also addressed concerns about patient satisfaction and therapeutic alliance with telerehabilitation compared to in-person care. Contrary to previous studies, the PEAK trial found that patients were equally satisfied with telerehabilitation, with some even reporting a stronger therapeutic alliance with this approach. The study suggests that patient attitudes towards telerehabilitation may evolve positively, especially with the personalized attention provided through video conferencing. However, it is worth noting that the in-person physiotherapy in the trial did not involve physical touch, which could impact the development of therapeutic alliance. This raises questions about the generalizability of the study's findings to routine clinical care where physical touch is a common component of physiotherapy.
The timing of the PEAK trial, initiated before the COVID-19 pandemic and continuing through its waves, may have influenced participant attitudes towards telerehabilitation. Participants in the in-person group attended fewer sessions, with some citing COVID-19 restrictions or concerns for their reduced attendance. Anxiety around the safety of in-person care during the pandemic could have influenced participant satisfaction and outcomes, potentially favoring telerehabilitation. Despite its prominence during COVID-19, the rationale for continuing telerehabilitation lies in its potential to improve access to care, especially for individuals in rural or underserved communities with limited access to physiotherapists.
While the PEAK trial's findings are promising in demonstrating the non-inferiority of telerehabilitation, further research is needed to assess its effectiveness in delivering high-quality care to diverse populations, including those in underserved or low-income communities. The study's focus on well-educated participants and frequent technology users, along with physiotherapists who received specialized training, raises questions about the generalizability of the results to broader demographics. Overall, the PEAK trial provides valuable insights into the effectiveness of telerehabilitation for chronic knee pain and underscores the importance of evaluating its impact on diverse patient populations.
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02896-9/fulltext
The PEAK trial stands out as the largest and most methodologically rigorous study comparing in-person physiotherapy to telerehabilitation for chronic knee pain, specifically in individuals with osteoarthritis. The trial enrolled 394 adults who were randomly assigned to receive either in-person physiotherapy or telerehabilitation via video conferencing. Both groups underwent five individual treatment sessions over a 3-month period, focusing on strengthening, physical activity, and education. The results of the trial supported the non-inferiority of telerehabilitation compared to in-person physiotherapy for primary outcomes such as knee pain during walking and physical function after 3 months. The study found that telerehabilitation was equally effective in improving these outcomes, with results remaining consistent at the 9-month follow-up and in per-protocol analyses.
The PEAK trial fills a research gap by addressing the question of equivalence between telerehabilitation and in-person physiotherapy, a question that has gained considerable urgency as the future of telerehabilitation is debated post-COVID-19. Before the pandemic, research on telerehabilitation for musculoskeletal pain primarily focused on post-surgical rehabilitation and supplementary roles alongside in-person physiotherapy. The PEAK trial's findings of equivalence between in-person and telerehabilitation not only support the continued availability and reimbursement of telerehabilitation for chronic musculoskeletal pain but also highlight potential cost-effectiveness, particularly when considering factors like patient travel and time.
In addition to clinical outcomes, the PEAK study also addressed concerns about patient satisfaction and therapeutic alliance with telerehabilitation compared to in-person care. Contrary to previous studies, the PEAK trial found that patients were equally satisfied with telerehabilitation, with some even reporting a stronger therapeutic alliance with this approach. The study suggests that patient attitudes towards telerehabilitation may evolve positively, especially with the personalized attention provided through video conferencing. However, it is worth noting that the in-person physiotherapy in the trial did not involve physical touch, which could impact the development of therapeutic alliance. This raises questions about the generalizability of the study's findings to routine clinical care where physical touch is a common component of physiotherapy.
The timing of the PEAK trial, initiated before the COVID-19 pandemic and continuing through its waves, may have influenced participant attitudes towards telerehabilitation. Participants in the in-person group attended fewer sessions, with some citing COVID-19 restrictions or concerns for their reduced attendance. Anxiety around the safety of in-person care during the pandemic could have influenced participant satisfaction and outcomes, potentially favoring telerehabilitation. Despite its prominence during COVID-19, the rationale for continuing telerehabilitation lies in its potential to improve access to care, especially for individuals in rural or underserved communities with limited access to physiotherapists.
While the PEAK trial's findings are promising in demonstrating the non-inferiority of telerehabilitation, further research is needed to assess its effectiveness in delivering high-quality care to diverse populations, including those in underserved or low-income communities. The study's focus on well-educated participants and frequent technology users, along with physiotherapists who received specialized training, raises questions about the generalizability of the results to broader demographics. Overall, the PEAK trial provides valuable insights into the effectiveness of telerehabilitation for chronic knee pain and underscores the importance of evaluating its impact on diverse patient populations.
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02896-9/fulltext
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