Online and onsite supervised exercise therapy and education for individuals with knee osteoarthritis - A before and after comparison of two different care delivery models

• Published in: Musculoskeletal care Vol. 21; no. 3; pp. 878 - 889
• Main Authors: Holm, Paetur M, Roos, Ewa M, Grønne, Dorte T, Skou, Søren T
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-09-2023
• Subjects: Arthritis; Confidence intervals; Knee; Osteoarthritis; Quality of life; knee; exercise; online; rehabilitation; osteoarthritis
• ISSN: 1478-2189; 1557-0681
• DOI: 10.1002/msc.1765

To compare the 3 and 12-month changes on pain, function and quality of life between online and onsite delivery of Good Life with Osteoarthritis in Denmark (GLA:D
) in individuals with knee osteoarthritis (OA).
Non-inferior comparison of individuals with knee OA receiving physiotherapist-supervised online (TeleGLA:D) or onsite (GLA:D®) (12 exercise and 2 education sessions). The primary outcome was the baseline-to-3-month change on KOOS-12 summary score. Secondary outcomes were changes in KOOS-12 subscales pain, function and quality of life and pain intensity (Visual Analog Scale (VAS 0-100)) at 3 and 12 months; 40 m fast-paced walk and 30 s chair-stand at 3 months. Using mixed linear regressions, comparisons were adjusted for age, sex, BMI, comorbidities and number of knees and hips with OA.
Over a 1-year period (May 2020-May 2021), we included data from 3789 participants (3701 GLA:D®; 88 TeleGLA:D). At 3 months, TeleGLA:D showed non-inferior change-scores to GLA:D® on KOOS-12 summary score; adjusted mean difference (90% Confidence Intervals (CI)) -2.40 (-5.55 to 0.75). For secondary outcomes, there was a statistically significant difference in change-scores, favouring TeleGLA:D in gait speed; adjusted mean difference (90%CI) 0.23 m/s (0.18-0.27). TeleGLA:D remained non-inferior to GLA:D® at 12 months.
Online delivery of physiotherapist-supervised neuromuscular exercise and education for individuals with knee OA may be non-inferior to traditional onsite delivery in reducing pain and improving function and quality of life. The wide confidence intervals, baseline imbalance, loss to follow-up and the non-randomized design highlight the need for a confirmatory randomized controlled trial.