Internet-delivered physiotherapist-prescribed exercise and pain-coping skills training is beneficial for people with chronic knee pain

Bennell et al found that for persons with chronic knee pain, internet-delivered, physiotherapist-prescribed exercise (via Skype) and pain-coping skills training provided clinically meaningful improvements in pain and function that were sustained for at least 9 months. The authors have completed an innovative approach to address a huge and global health challenge. This study adds an important contribution to the healthcare system, showing that use of welfare technology could be an alternative to provision of traditional physiotherapy services. Welfare technology is a term for personally adapted products and services that can help in daily life.

The promising results are further supported in a follow-up study of both patients and therapists showing positive experiences around central themes of optimal practice.1 

This opens up new possibilities for effective treatment of osteoarthritis in accordance with an individualised patient-centered approach.Despite the interesting results in the study, there are clinical topics that need to be discussed before general recommendations are made. It is unknown whether the positive results in the present study are caused by increased physical activity level or increased lower limb strength, pain-coping skills training, or contextual factors. Furthermore, there is a lack of consensus regarding what kind of conservative regimen provides better long-term clinical outcome and what is the minimum adherence/intervention for clinical satisfactory improvement. These are important considerations, as several reports from the last decade show that about one in five patients that undergo total knee replacements are dissatisfied with post-surgery outcomes, and there is a need for adequate tools for clinical outcome prediction as a part of conservative treatment of patients with knee osteoarthritis.2

The study is an important step forward in the care of this large group of patients where different professions should work together for better-coordinated treatment plans. Although this study challenges the way in which physiotherapy practice has been delivered, we encourage the profession to further investigate the possible benefits of welfare technology. Furthermore, the study might also enhance a necessary debate about how physiotherapy services can be organised and delivered in the future.