Telehealth-delivered group-based exercise therapy and education for knee osteoarthritis: A non-inferiority randomised clinical trial disrupted by COVID-19

Abstract

Objective

Inability to attend in-person care is a common barrier to accessing exercise therapy and education programs for knee osteoarthritis. The primary aim of this randomised clinical trial (RCT) was to determine if telehealth was non-inferior to ‘in-person’ delivery of a group-based exercise therapy and education program (GLA:D^®) for knee-related burden at 3 (primary timepoint), 12 and 24 months in people with knee osteoarthritis.

Design

This pre-registered (ACTRN12619000235101) two-arm (in-person v telehealth) non-inferiority limited-disclosure RCT commenced in April 2019, with a planned sample of 110. Knee-related burden was evaluated at baseline, 3- (primary timepoint), 12- and 24-month following intervention commencement by summating four Knee injury and Osteoarthritis Outcome Score subscales (KOOS₄: pain, symptoms, activities of daily living, quality of life [QoL]). Secondary outcomes included health-related QoL, pain severity, physical activity, functional performance, patient satisfaction and global rating of change.

Results

Recruitment ceased in March 2020 due to COVID-19 restrictions. Forty-four participants enrolled at baseline (22 per group). Forty-three (98%), 40 (91%) and 29 (66%) participants provided 3-, 12- and 24-month follow-up data, respectively. The lower limit of the 95% confidence interval (CI) was above the non-inferiority threshold (i.e. −10 points) for KOOS₄ at 3 (mean difference, 95%CI = 6, −2 to 15) and 12 months (0, −9 to 9). Compared to in-person, mean reduction in worst pain was greater for telehealth delivery at 3 months (16.5, 95%CI 0.8 to 32.2). No other secondary outcomes were different between groups.

Conclusion

Knee-related burden outcomes following telehealth-delivered group-based exercise therapy and education in people with knee osteoarthritis might not be different to in-person delivery.