Level of participation in physical therapy or an internet-based exercise training program: associations with outcomes for patients with knee osteoarthritis

Megan Pignato, Liubov Arbeeva, Todd A Schwartz, Leigh F Callahan, Jennifer Cooke, Yvonne M Golightly, Adam P Goode, Bryan C Heiderscheit, Carla Hill, Kim M Huffman, Herbert H Severson, Kelli D Allen, Megan Pignato, Liubov Arbeeva, Todd A Schwartz, Leigh F Callahan, Jennifer Cooke, Yvonne M Golightly, Adam P Goode, Bryan C Heiderscheit, Carla Hill, Kim M Huffman, Herbert H Severson, Kelli D Allen

Abstract

Background: To examine whether number of physical therapy (PT) visits or amount of use of an internet-based exercise training (IBET) program is associated with differential improvement in outcomes for participants with knee osteoarthritis (OA).

Methods: A secondary analysis was performed using data from participants in 2 arms of a randomized control trial for individuals with symptomatic knee OA: PT (N = 135) or IBET (N = 124). We examined associations of number of PT visits attended (up to 8) or number of days the IBET website was accessed during the initial 4-month study period with changes in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, pain and function subscales, as well as a 2-min Step Test, at 4-month and 12-month follow-up.

Results: Participants with more PT visits experienced greater improvement in WOMAC total score (estimate per additional visit = - 1.18, CI 95% = - 1.91, 0.46, p < 0.001) and function subscore (estimate = - 0.80, CI 95% = - 1.33, - 0.28, p < 0.001) across follow-up periods. For WOMAC pain subscale, the association with number of PT visits varied significantly between 4- and 12-month follow-up, with a stronger relationship at 4-months. There was a non-significant trend for more PT visits to be associated with greater improvement in 2-min Step Test. More frequent use of the IBET website was not associated with greater improvement for any outcome, at either time point.

Conclusion: Increased number of PT visits was associated with improved outcomes, and some of this benefit persisted 8 months after PT ended. This provides guidance for PT clinical practice and policies.

Trial registration: NCT02312713 , posted 9/25/2015.

Keywords: Exercise; Osteoarthritis; Physical therapy.

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Institutional Review Boards of the University of North Carolna at Chapel Hill and Duke University Medical Center. All study participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

Visual Health Information, Inc. (VHI) owns the website used in the current manuscript. Heiderscheit and Severson have received consulting fees from VHI. A patent related to the website described in this manuscript is currently under review.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Model-Predicted Mean Changes in Outcome by Number of PT Visits Attended
Fig. 2
Fig. 2
Associations between Use of Physical Therapy (PT) or Internet-Based Exercise Training (IBET) and change in Western Ontario and McMasters Universities Osteoarthritis Index Pain and Total Scores at 4- and 12-month Follow-up

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