Rana S Hinman1, Belinda J Lawford2, Penny K Campbell2, Andrew M Briggs3, Janette Gale4, Caroline Bills5, Simon D French6, Jessica Kasza7, Andrew Forbes8, Anthony Harris9, Stephen J Bunker10, Clare M Delany11, Kim L Bennell2. 1. Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Carlton, Victoria 3010, Australia. 2. Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne. 3. School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia. 4. HealthChange Australia, Sydney, North South Wales, Australia. 5. HealthChange Australia. 6. Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, and School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada. 7. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, and Melbourne EpiCentre, Monash University, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia. 8. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, and Melbourne EpiCentre, Monash University, University of Melbourne and Melbourne Health. 9. Centre for Health Economics, Monash University. 10. Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, and Medibank, Melbourne, Victoria, Australia. 11. Department of Medical Education, The University of Melbourne.
Abstract
BACKGROUND: Exercise and physical activity are a core component of knee osteoarthritis (OA) care, yet access to physical therapists is limited for many people. Telephone service delivery models may increase access. OBJECTIVE: Determine the effectiveness of incorporating exercise advice and behavior change support by physical therapists into an existing Australian nurse-led musculoskeletal telephone service for adults with knee OA. DESIGN: Randomized controlled trial with nested qualitative studies. SETTING: Community, Australia-wide. PARTICIPANTS: One hundred seventy-five people ≥45 years of age with knee symptoms consistent with a clinical diagnosis of knee OA. Eight musculoskeletal physical therapists will provide exercise advice and support. INTERVENTION: Random allocation to receive existing care or exercise advice in addition to existing care. Existing care is a minimum of one phone call from a nurse for advice on OA self-management. Exercise advice involves 5-10 calls over 6 months from a physical therapist trained in behavior change support to prescribe, monitor, and progress a strengthening exercise program and physical activity plan. MEASUREMENTS: Outcomes will be measured at baseline and at 6 and 12 months. Primary outcomes are knee pain and physical function. Secondary outcomes include other measures of knee pain, self-efficacy, physical activity and its mediators, kinesiophobia, health service usage, work productivity, participant-perceived change, and satisfaction. Additional measures include adherence, adverse events, therapeutic alliance, satisfaction with telephone-delivered therapy, and expectation of outcome. Semi-structured interviews with participants with knee OA and therapists will be conducted. LIMITATIONS: Physical therapists cannot be blinded. CONCLUSIONS: This study will determine if incorporating exercise advice and behavior change support by physical therapists into a nurse-led musculoskeletal telephone service improves outcomes for people with knee OA. Findings will inform development and implementation of telerehabilitation services.
BACKGROUND: Exercise and physical activity are a core component of knee osteoarthritis (OA) care, yet access to physical therapists is limited for many people. Telephone service delivery models may increase access. OBJECTIVE: Determine the effectiveness of incorporating exercise advice and behavior change support by physical therapists into an existing Australian nurse-led musculoskeletal telephone service for adults with knee OA. DESIGN: Randomized controlled trial with nested qualitative studies. SETTING: Community, Australia-wide. PARTICIPANTS: One hundred seventy-five people ≥45 years of age with knee symptoms consistent with a clinical diagnosis of knee OA. Eight musculoskeletal physical therapists will provide exercise advice and support. INTERVENTION: Random allocation to receive existing care or exercise advice in addition to existing care. Existing care is a minimum of one phone call from a nurse for advice on OA self-management. Exercise advice involves 5-10 calls over 6 months from a physical therapist trained in behavior change support to prescribe, monitor, and progress a strengthening exercise program and physical activity plan. MEASUREMENTS: Outcomes will be measured at baseline and at 6 and 12 months. Primary outcomes are knee pain and physical function. Secondary outcomes include other measures of knee pain, self-efficacy, physical activity and its mediators, kinesiophobia, health service usage, work productivity, participant-perceived change, and satisfaction. Additional measures include adherence, adverse events, therapeutic alliance, satisfaction with telephone-delivered therapy, and expectation of outcome. Semi-structured interviews with participants with knee OA and therapists will be conducted. LIMITATIONS: Physical therapists cannot be blinded. CONCLUSIONS: This study will determine if incorporating exercise advice and behavior change support by physical therapists into a nurse-led musculoskeletal telephone service improves outcomes for people with knee OA. Findings will inform development and implementation of telerehabilitation services.
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