• Kim L Bennell, Rachel Nelligan, Fiona Dobson, Christine Rini, Francis Keefe, Jessica Kasza, Simon French, Christina Bryant, Andrew Dalwood, J Haxby Abbott, and Rana S Hinman.
• From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Ca... more rolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. less
• Ann. Intern. Med. 2017 Apr 4; 166 (7): 453-462.

BackgroundEffective, accessible biopsychosocial treatments are needed to manage chronic knee pain on a population level.ObjectiveTo evaluate the effectiveness of Internet-delivered, physiotherapist-prescribed home exercise and pain-coping skills training (PCST).DesignPragmatic parallel-group randomized, controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12614000243617).SettingCommunity (Australia).Patients148 persons aged 50 years or older with chronic knee pain.InterventionThe intervention was delivered via the Internet and included educational material, 7 videoconferencing (Skype [Microsoft]) sessions with a physiotherapist for home exercise, and a PCST program over 3 months. The control was Internet-based educational material.MeasurementsPrimary outcomes were pain during walking (11-point numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index) at 3 months. Secondary outcomes were knee pain, quality of life, global change (overall, pain, and functional status), arthritis self-efficacy, coping, and pain catastrophizing. Outcomes were also measured at 9 months.ResultsOf participants enrolled, 139 (94%) completed primary outcome measures at 3 months and 133 (90%) completed secondary outcome measures at 9 months; multiple imputation was used for missing data. The intervention group reported significantly more improvement in pain (mean difference, 1.6 units [95% CI, 0.9 to 2.3 units]) and physical function (mean difference, 9.3 units [CI, 5.9 to 12.7 units]) than the control group at 3 months, and improvements were sustained at 9 months (mean differences, 1.1 units [CI, 0.4 to 1.8 units] and 7.0 units [CI, 3.4 to 10.5 units], respectively). Intervention participants showed significantly more improvement in most secondary outcomes than control participants. At both time points, significantly more intervention participants reported global improvements.LimitationParticipants were unblinded.ConclusionFor persons with chronic knee pain, Internet-delivered, physiotherapist-prescribed exercise and PCST provide clinically meaningful improvements in pain and function that are sustained for at least 6 months.Primary Funding SourceNational Health and Medical Research Council.

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