Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial

Hannah G Withers; Joanne V Glinsky; Jackie Chu; Matthew D Jennings; Ian Starkey; Rachel Parmeter; Max Boulos; Jackson J Cruwys; Kitty Duong; Ian Jordan; David Wong; San Trang; Maggie Duong; Hueiming Liu; Alison J Hayes; Tara E Lambert; Joshua R Zadro; Catherine Sherrington; Christopher Maher; Barbara R Lucas; Deborah Taylor; Manuela L Ferreira; Lisa A Harvey

doi:10.1016/j.jphys.2024.02.016

Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial

J Physiother. 2024 Apr;70(2):124-133. doi: 10.1016/j.jphys.2024.02.016. Epub 2024 Mar 16.

Authors

Hannah G Withers¹, Joanne V Glinsky¹, Jackie Chu¹, Matthew D Jennings², Ian Starkey³, Rachel Parmeter³, Max Boulos⁴, Jackson J Cruwys⁵, Kitty Duong⁵, Ian Jordan⁶, David Wong⁷, San Trang⁸, Maggie Duong⁸, Hueiming Liu⁹, Alison J Hayes¹⁰, Tara E Lambert¹¹, Joshua R Zadro¹², Catherine Sherrington¹², Christopher Maher¹², Barbara R Lucas¹³, Deborah Taylor¹¹, Manuela L Ferreira¹³, Lisa A Harvey¹⁴

Affiliations

¹ John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
² Allied Health, Liverpool Hospital, Sydney, Australia.
³ Physiotherapy Department, Blacktown and Mt Druitt Hospitals, Sydney, Australia.
⁴ Musculoskeletal and Cancer Outpatients, Orthopaedics, ED, Fracture Clinic, Women's Health, Camden and Campbelltown Hospital, Sydney, Australia.
⁵ Physiotherapy Department, Camden and Campbelltown Hospital, Sydney, Australia.
⁶ Physiotherapy Department, Hornsby-Ku-Ring-Gai Hospital, Sydney, Australia.
⁷ Physiotherapy Department, Liverpool Hospital, Sydney, Australia.
⁸ Physiotherapy Department, Bankstown-Lidcombe Hospital, Sydney, Australia.
⁹ The George Institute for Global Health, Sydney, Australia.
¹⁰ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
¹¹ Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
¹² Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia.
¹³ Sydney Musculoskeletal Health, School of Health Sciences, The University of Sydney, Sydney, Australia.
¹⁴ John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: lisa.harvey@sydney.edu.au.

PMID: 38494405
DOI: 10.1016/j.jphys.2024.02.016

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.

Keywords: Musculoskeletal conditions; Physical therapy; Randomised clinical trial; Rehabilitation; Telehealth.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Exercise Therapy
Humans
Musculoskeletal Diseases* / therapy
Patient Satisfaction
Physical Therapy Modalities
Quality of Life*