Is remotely delivered physiotherapy as good or better than face-to-face physiotherapy for the management of some musculoskeletal conditions?

Manuela Ferreira, Joshua Zadro, Lisa Harvey, Hannah Withers, Joanne Glinsky, Jackie Chu, Ian Jordan, Hueiming Liu, Alison Hayes, Barbara Lucas, Deborah Taylor, Tara Lambert, Christopher Maher, Catherine Sherrington, David Wong, Rachel Parmeter, Matthew Jennings, Kitty Duong, Jackson Cruwys, Ian Starkey, Max Boulos, Maggie Duong
Purpose:

The aim of the study was to determine whether a remotely delivered exercise program involving one face-to-face physiotherapy session provided in conjunction with text messages, phone calls and an individualised exercise program delivered through an App was as good or better than usual face-to-face care typically provided in an outpatient hospital setting for some patients with MSK conditions. 

Methods:

This randomised controlled, single blind, non-inferiority trial involved 210 adult participants with a range of MSK conditions. Patients who presented for outpatient physiotherapy at one of the five participating Sydney public hospitals, were randomly allocated to one of the two groups. One group received remotely delivered physiotherapy for 6 weeks. The other group received usual face-to-face physiotherapy care in an outpatient setting. The primary outcome was the Patient Specific Functional Scale (PSFS) measured at 6 weeks with a pre-specified non-inferiority margin of 15/100 points. Secondary outcomes included the PSFS (at 26 weeks), and measures that captured pain, quality of life, impression of therapeutic benefit, satisfaction with service delivery as well as the TAMPA Scale for Kinesiophobia, and the Late Life Function and Disability Index. All secondary outcomes were measured at 6 and 26 weeks (except satisfaction with service delivery). 

Results:

The mean (SD) age of participants was 53 (41-66). Most had chronic conditions including OA of the knee, back pain, and shoulder conditions. The mean between-group difference (95% CI) for the PSFS at 6 weeks was 3/100 points (-4 to 9), where a positive score favours remotely delivered physiotherapy. The lower end of the 95% CI was greater than the pre-specified non-inferiority margin of -15 points. The results for 26 weeks were similar with a mean between-group difference (95% CI) of -2% (-9% to 6%). Whilst non-inferiority margins were not set for the secondary outcomes, there was no indication that one treatment was superior to the other. The mean (95% CI) between group difference for patient satisfaction at 6 weeks was -0.5/10 (-1.4 to 0.3) points.

Conclusion(s):

Remotely delivered physiotherapy is as good as face-to-face physiotherapy for the management of some musculoskeletal conditions. 

Implications:

These findings are important for giving researchers confidence to go on and further test this and similar models for a wider group of patients, and in various clinical settings. New models of care that reduce patients’ dependency on regular face-to-face physiotherapy may reduce waiting times for treatment and increase access to physiotherapy for all patients.

Funding acknowledgements:
State Insurance Regulatory Authority (SIRA) Australia’s Medical Research Future Fund (MRFF) Rapid Applied Research Translation Program grant - Sydney Health Partners.
Keywords:
Physiotherapy
musculoskeletal conditions
telerehabilitation
Primary topic:
Musculoskeletal
Second topic:
Service delivery/emerging roles
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Northern Sydney Local Health District Human Research Ethics committee (trial number: HREC/16HAWKE/431-RESP/16/287) with an amendment for this process evaluation.
Provide the ethics approval number:
2019/ETH08514
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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