Telemedicine program associated with improvement in chronic knee pain
An accompanying editorial noted limitations in the study but called results encouraging and said they show that “‘telemedicine’ is clearly ready for prime time.”
Patients with chronic knee pain appeared to benefit from an internet-based program involving exercise and training in pain-coping skills, a recent study found.
Researchers in Australia performed a parallel-group randomized controlled trial to evaluate the effectiveness of a multifaceted internet-based intervention for chronic knee pain. Patients in the intervention group were assigned to receive educational material, seven home exercise videoconferences with a physiotherapist, and training in pain-coping skills over a three-month period, while those in the control group were assigned to receive internet-based educational material. The study's primary outcomes were pain while walking on an 11-point numerical rating scale and physical function as measured by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index at three months. Secondary outcomes included knee pain, quality of life, global change overall and in pain and functional status, and arthritis self-efficacy. The study results were published online Feb. 21 by Annals of Internal Medicine.
One hundred forty-eight adults 50 years of age and older who reported having knee pain for more than three months and on most days of the previous month were enrolled in the study. Seventy-four were assigned to the intervention group, and 74 were assigned to the control group. A total of 139 patients (94%) were evaluated for the primary outcome measures at three months, and 133 (90%) were evaluated for the secondary outcome measures at nine months. Significantly more improvement in pain and physical function was seen in the intervention group versus the control group at three months (mean difference in change between groups, 1.6 units [95% CI, 0.8 to 2.3 units] and 9.3 units [95% CI, 5.9 to 12.7 units], respectively). At nine months, mean differences in change between groups for these outcomes were 1.1 units (95% CI, 0.4 to 1.8 units) and 7.0 units (95% CI, 3.4 to 10.5 units), respectively. Most secondary outcomes improved significantly more for intervention participants than for control participants at both three and nine months.
The researchers noted that they could not determine the contribution of the intervention's individual components to the observed benefits or how many sessions would be needed to achieve clinical effectiveness. In addition, they wrote, participants were not blinded to study group and no knee exams were performed, among other limitations. However, they concluded that an internet-based intervention involving education, physiotherapist sessions, and pain-coping training may have short- and longer-term benefits in patients with chronic knee pain and “offers an effective, safe, acceptable, and viable alternative to traditional treatment delivery.”
The author of an accompanying editorial reiterated the study's limitations but called the study results “encouraging” and said they show that “‘telemedicine’ is clearly ready for prime time.” She pointed out that other studies of exercise and behavioral therapy for chronic pain have found that effectiveness may differ by race and ethnicity and called for additional studies to test such protocols in different populations. “Regardless,” she wrote, “this study is an important step forward in validating a pragmatic strategy to help patients with chronic knee pain access effective care.”