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

BMC Musculoskelet Disord. 2018 Jul 19;19(1):238. doi: 10.1186/s12891-018-2139-y.


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.

MeSH terms

  • Aged
  • Exercise / physiology*
  • Exercise / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Internet / trends
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / psychology
  • Osteoarthritis, Knee / rehabilitation*
  • Patient Participation / methods
  • Patient Participation / psychology
  • Patient Participation / trends*
  • Physical Therapy Modalities / psychology
  • Physical Therapy Modalities / trends*
  • Self Efficacy
  • Therapy, Computer-Assisted / methods
  • Therapy, Computer-Assisted / trends*
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT02312713