|
1
|
Withers HG, Glinsky JV, Chu J, Jennings MD, Starkey I, Parmeter R, Boulos M, Cruwys JJ, Duong K, Jordan I, Wong D, Trang S, Duong M, Liu H, Hayes AJ, Lambert TE, Zadro JR, Sherrington C, Maher C, Lucas BR, Taylor D, Ferreira ML, Harvey LA. Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial. J Physiother 2024; 70:124-133. [PMID: 38494405 DOI: 10.1016/j.jphys.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/09/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
QUESTION Is remotely delivered physiotherapy as good or better than face-to-face physiotherapy for the management of musculoskeletal conditions? DESIGN Randomised controlled, non-inferiority trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS A total of 210 adult participants with a musculoskeletal condition who presented for outpatient physiotherapy at five public hospitals in Sydney. INTERVENTION One group received a remotely delivered physiotherapy program for 6 weeks that consisted of one face-to-face physiotherapy session in conjunction with weekly text messages, phone calls at 2 and 4 weeks, and an individualised home exercise program delivered through an app. The other group received usual face-to-face physiotherapy care in an outpatient setting. OUTCOME MEASURES The primary outcome was the Patient Specific Functional Scale at 6 weeks with a pre-specified non-inferiority margin of -15 out of 100 points. Secondary outcomes included: the Patient Specific Functional Scale at 26 weeks; kinesiophobia, pain, function/disability, global impression of change and quality of life at 6 and 26 weeks; and satisfaction with service delivery at 6 weeks. RESULTS The mean between-group difference (95% CI) for the Patient Specific Functional Scale at 6 weeks was 2.7 out of 100 points (-3.5 to 8.8), where a positive score favoured remotely delivered physiotherapy. The lower end of the 95% CI was greater than the non-inferiority margin. Whilst non-inferiority margins were not set for the secondary outcomes, the 95% CI of the mean between-group difference ruled out clinically meaningful differences. CONCLUSION Remotely delivered physiotherapy with support via phone, text and an app is as good as face-to-face physiotherapy for the management of musculoskeletal conditions. TRIAL REGISTRATION ACTRN12619000065190.
Collapse
Affiliation(s)
- Hannah G Withers
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jackie Chu
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Ian Starkey
- Physiotherapy Department, Blacktown and Mt Druitt Hospitals, Sydney, Australia
| | - Rachel Parmeter
- Physiotherapy Department, Blacktown and Mt Druitt Hospitals, Sydney, Australia
| | - Max Boulos
- Musculoskeletal and Cancer Outpatients, Orthopaedics, ED, Fracture Clinic, Women's Health, Camden and Campbelltown Hospital, Sydney, Australia
| | - Jackson J Cruwys
- Physiotherapy Department, Camden and Campbelltown Hospital, Sydney, Australia
| | - Kitty Duong
- Physiotherapy Department, Camden and Campbelltown Hospital, Sydney, Australia
| | - Ian Jordan
- Physiotherapy Department, Hornsby-Ku-Ring-Gai Hospital, Sydney, Australia
| | - David Wong
- Physiotherapy Department, Liverpool Hospital, Sydney, Australia
| | - San Trang
- Physiotherapy Department, Bankstown-Lidcombe Hospital, Sydney, Australia
| | - Maggie Duong
- Physiotherapy Department, Bankstown-Lidcombe Hospital, Sydney, Australia
| | - Hueiming Liu
- The George Institute for Global Health, Sydney, Australia
| | - Alison J Hayes
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tara E Lambert
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Joshua R Zadro
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | | | - Christopher Maher
- Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | - Barbara R Lucas
- Sydney Musculoskeletal Health, School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Deborah Taylor
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Manuela L Ferreira
- Sydney Musculoskeletal Health, School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| |
Collapse
|