Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
Lancet. 2024 Mar 30;403(10433):1267-1278. doi: 10.1016/S0140-6736(23)02630-2. Epub 2024 Mar 7.
BACKGROUND: Telerehabilitation whether 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.
背景：远程康复是否被认为不如面对面护理对肌肉骨骼问题有效。我们旨在确定物理治疗视频会议咨询是否不如慢性膝关节疼痛的面对面咨询。
方法：在这项非劣效性随机对照试验中，我们从澳大利亚的 27 家诊所招募了初级保健物理治疗师。使用计算机生成的块，符合骨关节炎的慢性膝关节疼痛的参与者被随机分配（1:1，按物理治疗师和诊所分层）进行面对面或远程康复（即视频会议）物理治疗师咨询。参与者和物理治疗师对分组分配不知情。两组在 3 个月内进行了 5 次咨询，内容包括强化锻炼、体育活动和教育。主要结局是随机分组后 3 个月的膝关节疼痛（数字评分 0-10）和身体功能（使用 Western Ontario 和 McMaster 大学骨关节炎指数 0-68）。主要分析是采用所有可用数据进行的修改后的意向治疗。这项试验在澳大利亚和新西兰临床试验注册处注册，ACTRN12619001240134。
结果：2019 年 12 月 10 日至 2022 年 6 月 17 日期间，共有 394 名成年人入组，其中 204 名分配至面对面护理组，190 名分配至远程康复组。招募了 15 名初级保健物理治疗师。在 3 个月时，383 名（97%）参与者提供了主要结局信息，两组均报告疼痛减轻（面对面护理组的平均变化为 2.98，SD 2.23，远程康复组为 3.14，1.87）和功能改善（分别为 10.20、11.63 和 10.75、9.62）。远程康复在疼痛方面不劣于面对面护理（平均差值为 0.16，95%CI-0.26 至 0.57）和功能（1.65，-0.23 至 3.53）。两组报告不良事件的参与者数量相似（面对面护理组 40 名[21%]，远程康复组 35 名[19%]），均无严重不良事件。
结论：远程康复与物理治疗师合作对慢性膝关节疼痛不劣于面对面护理。
经费来源：澳大利亚国家卫生和医学研究委员会。
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