It’s a bit ironic that when injured people are in pain—and their mobility is reduced—they are often expected to travel to a physical therapy clinic. For millions of people, such trips are a burden. In Australia, however, some patients are “letting movement come to them.” Novel research from The University of Melbourne shows that taking physical therapy (PT) and pain-coping skills into the home via Skype and an online program results in pain reduction and increased function in patients with knee problems.1
Kim L. Bennell, BAppSci(Physio), is director of the Centre for Health, Exercise and Sports Medicine (CHESM), professor in physiotherapy at the School of Health Sciences, University of Melbourne, and NHMRC principal research fellow and director of the NHMRC Centre of Research Excellence in Translational Research in Musculoskeletal Pain. Professor Bennell, lead author on the study, says, “Knee pain is a major contributor to global morbidity, and it needs to be addressed with innovative thinking. Our prior studies suggest that adding a psychological component to the physical aspect of treatment might be beneficial. And since it’s fairly unlikely that someone would be referred to a psychologist in dealing with knee pain, we decided to add a cognitive behavioral element to the physical therapy.”
Using print, radio and social media, the researchers recruited 148 patients into the study, a randomized controlled trial. All patients were over 50 years of age and experiencing chronic knee pain.
Training the Trainers
“We worked with Francis Keefe, PhD, from Duke University and Christine Rini from University of North Carolina, who developed an Internet-based pain-coping skills training [PCST] program,” says Professor Bennell. They essentially took elements of face-to-face therapy and put them online. The program addresses such issues as low self-efficacy, poor pain coping and pain catastrophizing.”
The physical therapists received instruction on PCST, and the researchers divided the study participants into two groups. The intervention group received PT, PCST and online educational material; those in the control group had access only to the online educational material.
The Study & Results
Each member of the intervention group received three Internet-delivered treatments. The first was online educational material about exercise, pain management, emotions and the like. The second was an interactive PCST program that involved progressive relaxation, activity-rest cycling, scheduling pleasant activities, changing negative thoughts, pleasant imagery and distraction techniques and problem solving. The third treatment was a series of seven Skype sessions with a physical therapist over 12 weeks (the same therapist on each occasion). Patients were also assigned a home exercise program to do three times per week. They were provided with instructions, video demonstrations and equipment.