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

Abstract

AbstractObjectiveTo 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).DesignNon‐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.ResultsOver 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.ConclusionsOnline 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.