“The results were as we had hoped,” says Professor Bennell. “There was a significant improvement in patient pain and functioning, our two core measurements—and these benefits were sustained over nine months. While we did not use X-rays, a diagnosis of chronic knee pain in this age group is consistent with osteoarthritis.”
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Explore This IssueSeptember 2017
“Because the therapist comes into the home [via Skype], our participants felt that it was very patient focused,” says Professor Bennell. “Many patients want nondrug, nonsurgical options. With this program, we can give them what they want. And there is another way we are putting control back into the hands of patients. In a traditional PT model, the therapist says, for example, ‘I am going to prescribe exercise for you, and you need to come here three times a week for six weeks.’ With a patient-centered approach, the therapist will say, ‘What would you like to be able to do that you can’t currently do? There is good evidence to show that exercise is effective for knee pain. Are you interested in learning these exercises? You can do these at home. Are there any issues that might get in the way of you doing these regularly?’ The patient sets goals that are relevant to them, and the therapist helps the patient achieve these goals.”
Bringing This Program to the U.S.
Lindsey A. MacFarlane, MD, MPH, is a member of the Rheumatology Division, Immunology & Allergy at Brigham and Women’s Hospital in Boston. She says, “An increasing number of studies show that cognitive behavioral treatments can be helpful for knee pain and/or osteoarthritis. There are patients for whom traveling to PT appointments is a real hardship, so this is a great alternative.”
As to whether such a program would be practical in the U.S., Dr. MacFarlane says, “The upside is that so many people have Internet access. The problem area is insurance coverage. That may change with time, however, as insurers recognize that patients cite time and cost as barriers to PT. Many of these individuals are just not in a position to take so much time off from work. If patients are able to have the same quality treatment in their homes for less money, then I think insurers will take another look at this option. I would definitely consider it for my patients.”
So what may the future be for Dr. Bennell’s related research? “We are testing models of care and how to make them more accessible. We are also looking at ways to change the culture of physical therapists and their training. [Although] some conditions necessitate a hands-on approach to PT, at times, this is not the case. Our team is digging into which conditions respond best to Internet-based therapy and telemedicine. … There are areas in every nation that have no access to physical therapy. … My message to my colleagues is, ‘We need better ways to support patients in meeting their goals. Weight management, exercise and coping skills should be an integral part of our treatment plans so that patients can adhere to behavioral changes over the long term.’”