Comparing tele-rehabilitation to in-person physiotherapy for chronic knee pain in Australia: The PEAK trial.
The "Telerehabilitation consultations with a physiotherapist for chronic knee pain versus in-person consultations in Australia: the PEAK non-inferiority randomised controlled trial" study, published in The Lancet, aimed to determine if telerehabilitation consultations with a physiotherapist were as effective as in-person consultations for chronic knee pain, particularly related to osteoarthritis. The study recruited primary care physiotherapists from 27 Australian clinics and randomly assigned participants with chronic knee pain to either in-person or telerehabilitation consultations. Both groups underwent five consultations over 3 months focusing on strengthening, physical activity, and education.
The primary outcomes measured were knee pain and physical function at 3 months after randomisation. The study enrolled 394 adults, with 204 allocated to in-person care and 190 to telerehabilitation. At 3 months, both groups reported improved pain and function, with telerehabilitation being non-inferior to in-person care for both outcomes. Adverse events were similar between groups, and none were serious.
The study highlighted the increasing need for rehabilitation due to musculoskeletal conditions globally, with musculoskeletal conditions being a major driver. Telerehabilitation offers increased access to care, particularly for those in geographically isolated areas or with difficulties attending in-person clinics. The preference for video conferencing over telephone calls in delivering telerehabilitation was noted by both patients and physiotherapists due to the ability to monitor patient progress with visual cues.
The PEAK trial is the first non-inferiority trial comparing telerehabilitation with in-person consultations for non-surgical musculoskeletal rehabilitation. The results showed that telerehabilitation is a safe, effective, and potentially more cost-effective option for individuals with chronic knee pain. The trial outcomes were consistent with previous research, which indicated that telerehabilitation is convenient for patients and can lead to better attendance compared to in-person care, particularly during situations like the COVID-19 pandemic where in-person services were restricted.
The study had several strengths, including a large sample size, high rates of follow-up, and the use of generic telecommunications software for telerehabilitation, enhancing the transferability of findings. However, limitations included differential effects of the COVID-19 pandemic on in-person attendance and lack of masking for physiotherapists. The cost-effectiveness analysis indicated that telerehabilitation had lower average costs and produced more quality-adjusted life-years than in-person care.
In conclusion, the PEAK trial demonstrated that telerehabilitation with a physiotherapist is non-inferior to in-person care for chronic knee pain. The study's results have significant implications for the delivery of musculoskeletal rehabilitation services, highlighting the need for routine telerehabilitation training for physiotherapists to ensure the safe and effective provision of care. Telerehabilitation offers a convenient, cost-effective, and clinically effective option for individuals with chronic knee pain, providing a viable alternative to traditional in-person consultations.
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02630-2/fulltext
The primary outcomes measured were knee pain and physical function at 3 months after randomisation. The study enrolled 394 adults, with 204 allocated to in-person care and 190 to telerehabilitation. At 3 months, both groups reported improved pain and function, with telerehabilitation being non-inferior to in-person care for both outcomes. Adverse events were similar between groups, and none were serious.
The study highlighted the increasing need for rehabilitation due to musculoskeletal conditions globally, with musculoskeletal conditions being a major driver. Telerehabilitation offers increased access to care, particularly for those in geographically isolated areas or with difficulties attending in-person clinics. The preference for video conferencing over telephone calls in delivering telerehabilitation was noted by both patients and physiotherapists due to the ability to monitor patient progress with visual cues.
The PEAK trial is the first non-inferiority trial comparing telerehabilitation with in-person consultations for non-surgical musculoskeletal rehabilitation. The results showed that telerehabilitation is a safe, effective, and potentially more cost-effective option for individuals with chronic knee pain. The trial outcomes were consistent with previous research, which indicated that telerehabilitation is convenient for patients and can lead to better attendance compared to in-person care, particularly during situations like the COVID-19 pandemic where in-person services were restricted.
The study had several strengths, including a large sample size, high rates of follow-up, and the use of generic telecommunications software for telerehabilitation, enhancing the transferability of findings. However, limitations included differential effects of the COVID-19 pandemic on in-person attendance and lack of masking for physiotherapists. The cost-effectiveness analysis indicated that telerehabilitation had lower average costs and produced more quality-adjusted life-years than in-person care.
In conclusion, the PEAK trial demonstrated that telerehabilitation with a physiotherapist is non-inferior to in-person care for chronic knee pain. The study's results have significant implications for the delivery of musculoskeletal rehabilitation services, highlighting the need for routine telerehabilitation training for physiotherapists to ensure the safe and effective provision of care. Telerehabilitation offers a convenient, cost-effective, and clinically effective option for individuals with chronic knee pain, providing a viable alternative to traditional in-person consultations.
Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02630-2/fulltext
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