The Internet may be an effective tool for treating chronic knee pain

1. Significantly greater pain improvement was observed in patients in the intervention group compared to the control.

2. Patients in the pain-control intervention group demonstrated significant improvement in physical function.

Evidence Rating Level: Excellent (1)

Study Rundown: Osteoarthritis (OA) is a major cause of chronic knee pain, leading to global disability among adults. Disease burden of OA is rapidly increasing, due to the high rates of obesity and aging population. Currently, no definitive treatment exists for OA; instead, OA patients are managed through exercise and pain-coping skills training (PCST). This training is based on cognitive behavioural principles. Despite the efficacy of PCST, it remains challenging for many patients to access due to cost, transport issues, and geographic locations. Considering these barriers, the authors of this study aimed to evaluate the role of the Internet in delivering chronic knee pain health interventions. Specifically, they assessed the effectiveness of an innovative Internet-based intervention for persons with chronic knee pain, compared to patient educational materials. This intervention combined physiotherapist-prescribed home exercise delivered via videoconferencing and automated PCST in addition to patient educational materials. One of the main limitations of this study is concerning its methodology. Although participants were blinded to study hypotheses, they were not blinded to treatment. Additionally, the authors could not determine the contribution of each treatment component individually. In general, the results of this study suggest that internet-based interventions may serve as an effective tool for treating chronic knee pain, providing an alternative to in-person PSCT.

Click to read the study, published today in Annals of Internal Medicine

Relevant Reading: Internet-mediated physiotherapy and pain coping skills training for people with persistent knee pain (IMPACT – knee pain): a randomised controlled trial protocol

In-Depth [randomized controlled trial]: In this study, a parallel, 2-group pragmatic randomized, controlled trial was used to assess the efficacy of an internet-based intervention for chronic knee pain. Community-dwelling participants were recruited via various means, and eligibility was confirmed through an online survey followed by a telephone interview. A total of 148 patients were enrolled in the study and assigned randomly to the intervention or control group. Participants were assessed based on primary (improvements in pain and physical function) and secondary outcomes. In terms of primary outcomes, at 3 months the intervention group reported significantly greater improvement in pain (mean difference, 1.6 units [CI, 0.9 to 2.3 units]) and in WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) physical function (mean difference, 9.3 units [CI, 5.9 to 12.7 units]) compared to the control group. These results were sustained at 9 months. The intervention group also demonstrated significantly greater improvement in all secondary outcomes measured (knee pain, quality of life, global change, arthritis self-efficacy, coping, and pain catastrophizing).

Image: PD

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