Project Description
2024 Winner Best Overall Paper Award - Professor Rana Hinman
Biography
Rana is a research physiotherapist and National Health & Medical Research Council Investigator Fellow (Leadership Level 2) at the Centre for Health, Exercise & Sports Medicine at the University of Melbourne. Her research focuses on clinical trials of non-drug non-surgical treatment strategies for osteoarthritis, in particular exercise, rehabilitation and biomechanical interventions. Her research aims to develop and evaluate strategies to support positive behaviour change in people with chronic musculoskeletal conditions, particularly adherence to exercise. Rana's research has a focus on implementation science, and she has a strong interest in developing and implementing methods to increase access to care, including telerehabilitation and digital health strategies. Rana has published over 350 peer-reviewed papers and is an Editorial Board member for Journal of Physiotherapy.
The Paper
Prof Rana S Hinman, Penny K Campbell, Alexander J Kimp, Prof Trevor Russell, Prof Nadine E Foster, Jessica Kasza, Prof Anthony Harris, Prof Kim L Bennell.
Telerehabilitation consultations with a physiotherapist for chronic knee pain versus in-person consultations in Australia: the PEAK non-inferiority randomised controlled trial. Lancet. 2024 Mar 30;403(10433):1267-1278. doi: 10.1016/S0140-6736(23)02630-2. Epub 2024 Mar 7.
Abstract
Background: Telerehabilitation is perceived as less effective than in-person care for musculoskeletal problems. We aimed to determine if physiotherapy video conferencing consultations were non-inferior to in-person consultations for chronic knee pain.
Methods: In this non-inferiority randomised controlled trial, we recruited primary care physiotherapists from 27 Australian clinics. Using computer-generated blocks, participants with chronic knee pain consistent with osteoarthritis were randomly assigned (1:1, stratified by physiotherapist and clinic) in-person or telerehabilitation (ie, video conferencing) physiotherapist consultations. Participants and physiotherapists were unmasked to group assignment. Both groups had five consultations over 3 months for strengthening, physical activity, and education. Primary outcomes were knee pain (on a numerical rating scale of 0-10) and physical function (using the Western Ontario and McMaster Universities osteoarthritis index of 0-68) at 3 months after randomisation. Primary analysis was by modified intention-to-treat using all available data. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12619001240134.
Findings: Between Dec 10, 2019, and June 17, 2022, 394 adults were enrolled, with 204 allocated to in-person care and 190 to telerehabilitation. 15 primary care physiotherapists were recruited. At 3 months, 383 (97%) participants provided information for primary outcomes and both groups reported improved pain (mean change 2·98, SD 2·23 for in-person care and 3·14, 1·87 for telerehabilitation) and function (10·20, 11·63 and 10·75, 9·62, respectively). Telerehabilitation was non-inferior for pain (mean difference 0·16, 95% CI -0·26 to 0·57) and function (1·65, -0·23 to 3·53). The number of participants reporting adverse events was similar between groups (40 [21%] for in-person care and 35 [19%] for telerehabilitation) and none were serious.
Interpretation: Telerehabilitation with a physiotherapist is non-inferior to in-person care for chronic knee pain.
Funding: National Health and Medical Research Council.