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Xiang XN, Wang ZZ, Hu J, Zhang JY, Li K, Chen QX, Xu FS, Zhang YW, He HC, He CQ, Zhu SY. Telehealth-Supported Exercise or Physical Activity Programs for Knee Osteoarthritis: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e54876. [PMID: 39094114 PMCID: PMC11329855 DOI: 10.2196/54876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 05/08/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The integration of telehealth-supported programs in chronic disease management has become increasingly common. However, its effectiveness for individuals with knee osteoarthritis (KOA) remains unclear. OBJECTIVE This study aimed to assess the effectiveness of telehealth-supported exercise or physical activity programs for individuals with KOA. METHODS A comprehensive literature search encompassing Embase, MEDLINE, CENTRAL, Web of Science, PubMed, Scopus, PEDro, GreyNet, and medRxiv from inception to September 2023 was conducted to identify randomized controlled trials comparing telehealth-supported exercise or physical activity programs to a control condition for KOA. Data were extracted and qualitatively synthesized across eligible studies, and a meta-analysis was performed to evaluate the effects. The study was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020. RESULTS In total, 23 studies met eligibility criteria, with 20 included in the meta-analysis. Results showed that telehealth-supported exercise or physical activity programs reduced pain (g=-0.39; 95% CI -0.67 to -0.11; P<.001), improved physical activity (g=0.13; 95% CI 0.03-0.23; P=.01), and enhanced physical function (g=-0.51; 95% CI -0.98 to -0.05; P=.03). Moreover, significant improvements in quality of life (g=0.25; 95% CI 0.14-0.36; P<.001), self-efficacy for pain (g=0.72; 95% CI 0.53-0.91; P<.001), and global improvement (odds ratio 2.69, 95% CI 1.41-5.15; P<.001) were observed. However, self-efficacy for physical function (g=0.14; 95% CI -0.26 to 0.53; P=.50) showed insignificant improvements. Subgroup analyses based on the World Health Organization classification of digital health (pain: χ22=6.5; P=.04 and physical function: χ22=6.4; P=.04), the type of teletechnology in the intervention group (pain: χ24=4.8; P=.31 and function: χ24=13.0; P=.01), and active or inactive controls (pain: χ21=5.3; P=.02 and physical function: χ21=3.4; P=.07) showed significant subgroup differences. CONCLUSIONS Telehealth-supported exercise or physical activity programs might reduce knee pain and improve physical activity, physical function, quality of life, self-efficacy, and global improvement in individuals with KOA. Future research should consider longer implementation durations and assess the feasibility of incorporating wearables and standardized components into large-scale interventions to evaluate the effects. TRIAL REGISTRATION PROSPERO CRD42022359658; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=359658.
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Affiliation(s)
- Xiao-Na Xiang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Ze-Zhang Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Jing Hu
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Jiang-Yin Zhang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Ke Li
- Center of Statistical Research, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
- Joint Lab of Data Science and Business Intelligence, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
| | - Qi-Xu Chen
- Center of Statistical Research, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
- Joint Lab of Data Science and Business Intelligence, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
| | - Fa-Shu Xu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yue-Wen Zhang
- Center of Statistical Research, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
- Joint Lab of Data Science and Business Intelligence, School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
| | - Hong-Chen He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Cheng-Qi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
| | - Si-Yi Zhu
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- School of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, China
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Zhang ZY, Huang L, Tian L, Yi J, Gao M, Wang XQ, Jiang JJ, Liu ZL. Home-based vs center-based exercise on patient-reported and performance-based outcomes for knee osteoarthritis: a systematic review with meta-analysis. Front Public Health 2024; 12:1360824. [PMID: 38550325 PMCID: PMC10973546 DOI: 10.3389/fpubh.2024.1360824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/04/2024] [Indexed: 04/02/2024] Open
Abstract
Background Home-based exercise (HBE) represents an alternative to increase the accessibility of rehabilitation programs and relieve the burden on the health care system for people with knee osteoarthritis. Objectives To summarize for the first time the effectiveness of HBE as compared to center-based exercise (CBE), both with and without HBE, on patient-reported and performance-based outcomes in people with KOA. Methods Searches were conducted on PubMed, Cochrane, Embase, Web of Science, and Scopus until March 10, 2023, without date or language restrictions. Randomized controlled trials investigating HBE versus CBE or HBE combined with CBE for people with KOA were eligible. The primary outcomes were patient-reported: pain, physical disability, and quality of life. The secondary outcomes were performance-based: walking ability, lower limb muscle strength, and balance function. Risk of bias was assessed with the Cochrane Risk of Bias tool and quality of evidence according to the GRADE. Results Eleven trials involving 956 participants were included. There was no difference in short-term pain (SMD, 0.22 [95% CI, -0.04 to 0.47], p = 0.09; I2 = 0%), physical disability (SMD, 0.17 [95% CI, -0.19 to 0.54], p = 0.35; I2 = 0%), walking ability (SMD, -0.21 [95% CI, -0.64 to 0.22], p = 0.33; I2 = 35%) and lower limb muscle strength (SMD, -0.24 [95% CI, -0.88 to 0.41], p = 0.47; I2 = 69%) between HBE and CBE. HBE combined with CBE has better benefits compared with HBE alone in short-term pain (SMD, 0.89 [95% CI, 0.60 to 1.17], p < 0.001; I2 = 11%) and physical disability (SMD, 0.25 [95% CI, 0.00 to 0.50], p = 0.05; I2 = 0%). Conclusion Based on limited evidence, HBE is as effective as CBE on short-term pain, physical disability, walking ability, and lower limb muscle strength in people with knee osteoarthritis. Furthermore, combining HBE with CBE may enhance the overall efficacy of the intervention. Systematic review registration PROSPERO, CRD42023416548.
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Affiliation(s)
- Zhi-Yuan Zhang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Lu Huang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Lv Tian
- School of Nursing, Jilin University, Chang Chun, China
| | - Jiang Yi
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Min Gao
- School of Nursing, Jilin University, Chang Chun, China
| | - Xiao-Qi Wang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Jun-Jie Jiang
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
| | - Zhong-Liang Liu
- Department of Rehabilitation Medicine, The Second Hospital of Jilin University, Chang Chun, China
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Ariie T, Takasaki H, Okoba R, Chiba H, Handa Y, Miki T, Taito S, Tsutsumi Y, Morita M. The effectiveness of exercise with behavior change techniques in people with knee osteoarthritis: A systematic review with meta-analysis. PM R 2023; 15:1012-1025. [PMID: 36152318 DOI: 10.1002/pmrj.12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/17/2022] [Accepted: 08/16/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this systematic review with meta-analysis was to examine the effectiveness of exercise with behavior change techniques (BCTs) on core outcome sets in people with knee osteoarthritis. LITERATURE SURVEY We searched randomized controlled trials (RCTs) in eight databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO, PEDro, ICTRP, and ClinicalTrials.gov) up to November 4, 2021. METHODOLOGY Eligible participants were people with knee osteoarthritis. The intervention was exercise with BCTs. Primary outcomes included physical function, quality of life (QOL) 6 to 12 months after intervention, and adverse events. Secondary outcomes were knee pain, exercise adherence, mobility, and self-efficacy 3 months or more after intervention. The bias risk was assessed using the Risk of Bias 2 tool. The random-effects model was used for the meta-analysis. SYNTHESIS We found 16 individual BCTs, and 37.7% of trials used a single BCT. For meta-analysis, we included 21 RCTs (n = 1623). Most outcomes had a very low certainty of evidence, and the risk of bias was the consistent reason for downgrading evidence levels. The standardized mean difference (SMD) with 95% confidence interval (95% CI) was 0.00 (-0.24, 0.24) in physical function, 0.33 (-0.51, 1.17) in exercise adherence, and 0.04 (-0.39, 0.47) in self-efficacy. The risk ratio (95% CI) of adverse events was 3.6 (0.79, 16.45). QOL was not pooled due to insufficient data (very low certainty of evidence). In contrast, the SMD (95% CI) for knee pain reduction and mobility improvement was -0.33 (-0.53, -0.13) and 0.21 (-0.05, 0.47) with moderate and low certainty of evidence, respectively. CONCLUSION The evidence is inconclusive regarding the effectiveness of BCTs with exercises on core outcome sets. Further research should explore the effectiveness of BCTs with valid design. PROTOCOL REGISTRATION PROSPERO (CRD42020212904).
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Affiliation(s)
- Takashi Ariie
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Saitama, Japan
| | - Ryota Okoba
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka, Japan
| | - Hiroki Chiba
- Graduate school of Rehabilitation Science, Saitama Prefectural University, Saitama, Japan
| | - Yusuke Handa
- Graduate school of Rehabilitation Science, Saitama Prefectural University, Saitama, Japan
| | - Takahiro Miki
- Graduate school of Rehabilitation Science, Saitama Prefectural University, Saitama, Japan
| | - Shunsuke Taito
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Yusuke Tsutsumi
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Masaharu Morita
- Department of Physical Therapy, Health Sciences at Odawara, International University of Health and Welfare, Kanagawa, Japan
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Yang Y, Li S, Cai Y, Zhang Q, Ge P, Shang S, Han H. Effectiveness of telehealth-based exercise interventions on pain, physical function and quality of life in patients with knee osteoarthritis: A meta-analysis. J Clin Nurs 2023; 32:2505-2520. [PMID: 35872635 DOI: 10.1111/jocn.16388] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/04/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the effectiveness of telehealth-based exercise intervention on pain, physical function and quality of life in patients with knee osteoarthritis. DESIGN A systematic review and meta-analysis of randomised controlled trials (RCTs). METHODS Six databases (PubMed, Embase, Cochrane Library, CINAHL, PEDro and Web of Science Core Collection) were searched for relevant randomised controlled trials published from database inception to 3 June 2021. Reviewers independently screened the literature, extracted data and used the Cochrane Collaboration Risk of Bias Tool for quality assessment. A meta-analysis and subgroup analyses, stratified by control condition, intervention duration and delivery type, were conducted by Revman 5.4. The study was reported in compliance with PRISMA statement. RESULTS A total of 9 independent RCTs with 861 participants were included. The meta-analysis showed that the telehealth-based exercise interventions significantly reduced pain in KOA patients (SMD = -0.28, 95% CI [-0.49, -0.08], p < .01) and produced similar effects to controls in terms of physical function and quality of life. Subgroup analysis revealed that telehealth-based exercise interventions were superior to the use of exercise booklet and usual care in terms of pain and physical function and were similar to face-to-face exercise treatment; a long-term (>3 months) intervention and the use of web and smartphone APPs to deliver exercise interventions were associated with better pain relief and physical function. CONCLUSIONS Telehealth-based exercise intervention is an effective strategy for KOA management during the COVID-19 epidemic, and it is significantly better than usual care in reducing knee pain and improving physical function and was able to achieve the effects of traditional face-to-face exercise treatment. Although the duration and type of delivery associated with the effect of the intervention have been identified, patient preference and acceptability need to be considered in practice.
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Affiliation(s)
- Yajie Yang
- School of Nursing, Peking University, Beijing, China
| | - Sitian Li
- Department of Social Medicine, School of Public Health, Shanxi Medical University, Shanxi, China
| | - Ying Cai
- School of Nursing, Peking University, Beijing, China
| | - Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Pu Ge
- Institute of Chinese Medical Sciences, University of Macau, Macau, China
| | - Shaomei Shang
- School of Nursing, Peking University, Beijing, China
| | - Hongbin Han
- Department of Radiology, Peking University Third Hospital, Beijing, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging Technology, Beijing, China
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Hinman RS, Lawford BJ, Nelligan RK, Bennell KL. Virtual Tools to Enable Management of Knee Osteoarthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2023; 9:1-21. [PMID: 37362068 PMCID: PMC10006574 DOI: 10.1007/s40674-023-00202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 06/28/2023]
Abstract
Purpose of review There is increasing recognition that virtual tools, enabled by the internet and telecommunications technology, can increase access to health care. We review evidence about the clinical effectiveness and acceptability of telephone-delivered and videoconferencing clinician consultations, websites and internet-delivered programs, and SMS and mobile applications in enabling the management of people with knee osteoarthritis (OA). We discuss barriers to using virtual tools and suggest strategies to facilitate implementation in clinical settings. Recent findings An increasing number of systematic reviews, meta-analyses, and clinical trials provide evidence showing the effectiveness of virtual tools for improving knee OA management. Qualitative research shows that virtual tools increase patient access to knee OA care, are generally acceptable and convenient for patients, but can be associated with barriers to use from patient and clinician perspectives. Summary Virtual tools offer new opportunities to enable people with knee OA to manage their condition and receive care that may otherwise be difficult or not possible to access. Telephone calls and videoconferencing can be used for real-time synchronous consultations between clinicians and patients, increasing the geographic reach of health services. Websites and internet-based programs can be used to educate patients about their condition, as well as deliver exercise, weight management, and psychological interventions. Mobile apps can monitor and track OA symptoms, exercise, and physical activity, while SMS can facilitate positive behaviour changes for self-management over the long-term when sustained clinician contact may not be possible.
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Affiliation(s)
- Rana S. Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC Australia
| | - Belinda J. Lawford
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC Australia
| | - Rachel K. Nelligan
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC Australia
| | - Kim L. Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC Australia
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Estebanez-Pérez MJ, Martín-Valero R, Moreno-Morales N, Liñán-González A, Fernández-Navarro R, Pastora-Bernal JM. Digital physiotherapy intervention in children in a low resource setting in Anantapur (India): Study protocol for a randomized controlled trial. Front Public Health 2022; 10:1012369. [PMID: 36249182 PMCID: PMC9565479 DOI: 10.3389/fpubh.2022.1012369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/13/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction In rural India the scarcity of physiotherapists and inequalities complicate the recovery of traumatized children. This study protocol will explore a digital physiotherapy intervention in children with ankle fracture in a low-resource setting to improve functional independence and quality of life. Methods and analysis A randomized clinical trial with a mixed quantitative-qualitative design will be carried out. It is a single-blind study, where the evaluator does not know the nature of the intervention. Sixty subjects will be enrolled and randomly divided into two groups: the experimental group (EG) will receive a 4-week digital physiotherapy intervention through an app in a recycled mobile device after hospital discharge; the control group (CG) will receive the physiotherapy standard care recommended for patients discharged from the hospital. Subjects will receive a baseline (T0-pre) assessment of Functional Independence and Quality of Life. At the end of the 4-week intervention (T1-post) a new assessment of the outcome will be performed adding data on adherence, satisfaction (ad hoc questionnaire and TSQ), and barriers of use. Qualitative outcomes will also be explored. The author's hypothesized that the implementation of a digital physiotherapy intervention is feasible and effective to improve functional independence and quality of life. This study protocol is the first to explore the effect of digital physiotherapy intervention in children's patients in a low resource setting (Anantapur). Discussion The successful delivery of the intervention, an optimal adherence records, the absence of significant adverse effects, user satisfaction level and the qualitative analysis of limitations, will demonstrate the effectiveness of these procedure. This study will add more evidence in support the use of digital physiotherapy practice as an effective tool. User particularities, provider's capacity, technological and cultural limitations, and considerations for vulnerable populations will be taken into account. Clinical trial registration NCT04946695 (https://clinicaltrials.gov/).
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Affiliation(s)
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Science, University of Málaga, Málaga, Spain
| | - Noelia Moreno-Morales
- Department of Physiotherapy, Faculty of Health Science, University of Málaga, Málaga, Spain
| | - Antonio Liñán-González
- Department of Nursing, Faculty of Health Science, Melilla Campus, University of Granada, Melilla, Spain
| | - Rocío Fernández-Navarro
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
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Valentijn PP, Tymchenko L, Jacobson T, Kromann J, Biermann CW, AlMoslemany MA, Arends RY. Digital Health Interventions for Musculoskeletal Pain Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e37869. [PMID: 36066943 PMCID: PMC9490534 DOI: 10.2196/37869] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/17/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Digital health solutions can provide populations with musculoskeletal pain with high-reach, low-cost, easily accessible, and scalable patient education and self-management interventions that meet the time and resource restrictions. Objective The main objective of this study was to determine the effectiveness of digital health interventions for people with musculoskeletal pain conditions (ie, low back pain, neck pain, shoulder pain, knee pain, elbow pain, ankle pain, and whiplash). Methods A systematic review and meta-analysis was conducted. We searched PubMed and Cochrane Central Register of Controlled Trials (from 1974 to August 2021) and selected randomized controlled trials of digital health interventions in the target population of patients with musculoskeletal pain with a minimum follow-up of 1 month. A total of 2 researchers independently screened and extracted the data. Results A total of 56 eligible studies were included covering 9359 participants, with a mean follow-up of 25 (SD 15.48) weeks. In moderate-quality evidence, digital health interventions had a small effect on pain (standardized mean difference [SMD] 0.19, 95% CI 0.06-0.32), disability (SMD 0.14, 95% CI 0.03-0.25), quality of life (SMD 0.22, 95% CI 0.07-0.36), emotional functioning (SMD 0.24, 95% CI 0.12-0.35), and self-management (SMD 0.14, 95% CI 0.05-0.24). Conclusions Moderate-quality evidence supports the conclusion that digital health interventions are effective in reducing pain and improving functioning and self-management of musculoskeletal pain conditions. Low-quality evidence indicates that digital health interventions can improve the quality of life and global treatment. Little research has been conducted on the influence of digital health on expenses, knowledge, overall improvement, range of motion, muscle strength, and implementation fidelity. Trial Registration PROSPERO CRD42022307504; https://tinyurl.com/2cd25hus
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Affiliation(s)
- Pim Peter Valentijn
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands.,Department of Health Services Research, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Liza Tymchenko
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands
| | | | | | | | | | - Rosa Ymkje Arends
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands.,University of Applied Sciences Utrecht, Utrecht, Netherlands
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Ghaffari A, Rahbek O, Lauritsen REK, Kappel A, Kold S, Rasmussen J. Criterion Validity of Linear Accelerations Measured with Low-Sampling-Frequency Accelerometers during Overground Walking in Elderly Patients with Knee Osteoarthritis. SENSORS (BASEL, SWITZERLAND) 2022; 22:5289. [PMID: 35890969 PMCID: PMC9322915 DOI: 10.3390/s22145289] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Sensors with a higher sampling rate produce higher-quality data. However, for more extended periods of data acquisition, as in the continuous monitoring of patients, the handling of the generated big data becomes increasingly complicated. This study aimed to determine the validity and reliability of low-sampling-frequency accelerometer (SENS) measurements in patients with knee osteoarthritis. Data were collected simultaneously using SENS and a previously validated sensor (Xsens) during two repetitions of overground walking. The processed acceleration signals were compared with respect to different coordinate axes to determine the test-retest reliability and the agreement between the two systems in the time and frequency domains. In total, 44 participants were included. With respect to different axes, the interclass correlation coefficient for the repeatability of SENS measurements was [0.93-0.96]. The concordance correlation coefficients for the two systems' agreement were [0.81-0.91] in the time domain and [0.43-0.99] in the frequency domain. The absolute biases estimated by the Bland-Altman method were [0.0005-0.008] in the time domain and [0-0.008] in the frequency domain. Low-sampling-frequency accelerometers can provide relatively valid data for measuring the gait accelerations in patients with knee osteoarthritis and can be used in the future for remote patient monitoring.
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Affiliation(s)
- Arash Ghaffari
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark; (O.R.); (R.E.K.L.); (A.K.); (S.K.)
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark; (O.R.); (R.E.K.L.); (A.K.); (S.K.)
| | | | - Andreas Kappel
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark; (O.R.); (R.E.K.L.); (A.K.); (S.K.)
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark; (O.R.); (R.E.K.L.); (A.K.); (S.K.)
| | - John Rasmussen
- Department of Materials and Production, Aalborg University, 9220 Aalborg East, Denmark;
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Alrushud A, Alamam D, Alharthi A, Shaheen A, Alotaibi N, AlSabhan R, Alharbi S, Ali N, Mohammed E, Sweeh J. Physical therapists' perceptions of and satisfaction with delivering telerehabilitation sessions to patients with knee osteoarthritis during the Covid-19 pandemic: Preliminary study. Musculoskeletal Care 2022; 20:926-936. [PMID: 35698900 PMCID: PMC9350341 DOI: 10.1002/msc.1666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This preliminary study was conducted to explore physical therapists' (PT) perceptions of and satisfaction with delivering telerehabilitation sessions to patients with knee osteoarthritis during the Covid-19 pandemic. STUDY DESIGN An exploratory preliminary study using an internet-based survey followed by focus group sessions. METHODS A programme of sessions was administered by 12 PTs from the Physical Therapy Department at Prince Sultan Military Medical City. An internet-based survey containing 17 statements was completed by the PTs. RESULTS With regard to telephone-delivered care, four statements related to patients' privacy, programme convenience, safe patients time and money achieved consensus agreement (≥75% agreed or strongly agreed), there was majority agreement (≥50% of respondents agreed or strongly agreed) with seven of the statements regarding the effectiveness, affordability and safety of the programme, but there was no consensus with regard to the remaining five statements. In addition, most of the participants (84.6%) believed that a telephone consultation should cost 25% or 50% less than a face-to-face session. CONCLUSION Despite the lack of physical contact with patients, the PTs agreed that telerehabilitation would offer patients an easy method of being prescribed a therapeutic programme, save time and money, and maintain patient privacy. Further, the PTs reported barriers and suggested adaptations for this method of service delivery.
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Affiliation(s)
- Asma Alrushud
- Rehabilitation Health Sciences DepartmentCollege of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Dalyah Alamam
- Rehabilitation Health Sciences DepartmentCollege of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Ameerah Alharthi
- Physical Therapy DepartmentPrince Sultan Military Medical CityRiyadhSaudi Arabia
| | - Afaf Shaheen
- Rehabilitation Health Sciences DepartmentCollege of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia,Faculty of Physical Therapy, Basic Science DepartmentCairo UniversityCairoEgypt
| | - Nada Alotaibi
- Rehabilitation Health Sciences DepartmentCollege of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Rand AlSabhan
- Rehabilitation Health Sciences DepartmentCollege of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Shatha Alharbi
- Rehabilitation Health Sciences DepartmentCollege of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Nour Ali
- Rehabilitation Health Sciences DepartmentCollege of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Elaf Mohammed
- Rehabilitation Health Sciences DepartmentCollege of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Joud Sweeh
- Rehabilitation Health Sciences DepartmentCollege of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
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10
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Implementation of Online Behavior Modification Techniques in the Management of Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11071806. [PMID: 35407414 PMCID: PMC8999801 DOI: 10.3390/jcm11071806] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: The main aim of this systematic review and meta-analysis (MA) was to assess the effectiveness of online behavior modification techniques (e-BMT) in the management of chronic musculoskeletal pain. Methods: We conducted a search of Medline (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, APA PsychInfo, and Psychological and Behavioral Collections, from inception to the 30 August 2021. The main outcome measures were pain intensity, pain interference, kinesiophobia, pain catastrophizing and self-efficacy. The statistical analysis was conducted using RStudio software. To compare the outcomes reported by the studies, we calculated the standardized mean difference (SMD) over time and the corresponding 95% confidence interval (CI) for the continuous variables. Results: Regarding pain intensity (vs. usual care/waiting list), we found a statistically significant trivial effect size in favor of e-BMT (n = 5337; SMD = −0.17; 95% CI −0.26, −0.09). With regard to pain intensity (vs. in-person BMT) we found a statistically significant small effect size in favor of in-person BMT (n = 486; SMD = 0.21; 95%CI 0.15, 0.27). With respect to pain interference (vs. usual care/waiting list) a statistically significant small effect size of e-BMT was found (n = 1642; SMD = −0.24; 95%CI −0.44, −0.05). Finally, the same results were found in kinesiophobia, catastrophizing, and self-efficacy (vs. usual care/waiting list) where we found a statistically significant small effect size in favor of e-BMT. Conclusions: e-BMT seems to be an effective option for the management of patients with musculoskeletal conditions although it does not appear superior to in-person BMT in terms of improving pain intensity.
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11
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Young JJ, Važić O, Cregg AC. Management of knee and hip osteoarthritis: an opportunity for the Canadian chiropractic profession. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2021; 65:6-13. [PMID: 34035537 PMCID: PMC8128331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Knee and hip osteoarthritis (OA) place a significant burden on the Canadian health system and are a major public health challenge. This brief commentary discusses the recently published Osteoarthritis Research Society International guideline and the American College of Rheumatology guideline for the management of OA. Special attention has been given to the role of manual therapy, exercise, and patient education for the treatment of knee and hip OA. This article also reviews the Good Life with osteoArthritis in Denmark (GLA:D®) treatment program for knee and hip OA and the implementation of this program in Canada. Lastly, the authors discuss the opportunity for the Canadian chiropractic profession to embrace treatment programs like GLA:D® and take an active role in the strengthening of the Canadian health system from a musculoskeletal perspective.
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Affiliation(s)
- James J. Young
- Center for Muscle and Joint Health, University of Southern Denmark
- Department of Research, Canadian Memorial Chiropractic College
| | - Olja Važić
- Human Health and Nutritional Science, University of Guelph
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12
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Chen T, Or CK, Chen J. Effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain: A systematic review and meta-analysis of randomized controlled trials. J Am Med Inform Assoc 2021; 28:414-423. [PMID: 33236109 PMCID: PMC7883981 DOI: 10.1093/jamia/ocaa282] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The study sought to examine the effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain by a systematic review and meta-analysis of randomized controlled trials. MATERIALS AND METHODS We searched MEDLINE, EMBASE, CINAHL Plus, and the Cochrane Library from database inception to August 2020. A meta-analysis and subgroup analyses, stratified by technology type and program feature, were conducted. RESULTS Twelve randomized controlled trials were reviewed, all of which implemented the programs for 4 weeks to 6 months. Telephone, Web, mobile app, computer, and virtual reality were used to deliver the programs. The meta-analysis showed that these programs were associated with significant improvements in knee pain (standardized mean difference [SMD] = -0.29; 95% confidence interval [CI], -0.48 to -0.10; P = .003) and quality of life (SMD = 0.25; 95% CI, 0.04 to 0.46; P = .02) but not with significant improvement in physical function (SMD = 0.22; 95% CI, 0 to 0.43; P = .053). Subgroup analyses showed that some technology types and program features were suggestive of potential benefits. CONCLUSIONS Using technology to deliver the exercise programs appears to offer benefits. The technology types and program features that were associated with health values have been identified, based on which suggestions are discussed for the further research and development of such programs.
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Affiliation(s)
- Tianrong Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
| | - Jiayin Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China
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13
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Naeemabadi MR, Fazlali H, Najafi S, Dinesen B, Hansen J. Telerehabilitation for Patients With Knee Osteoarthritis: A Focused Review of Technologies and Teleservices. JMIR BIOMEDICAL ENGINEERING 2020. [DOI: 10.2196/16991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background
Telerehabilitation programs are designed with the aim of improving the quality of services as well as overcoming existing limitations in terms of resource management and accessibility of services. This review will collect recent studies investigating telerehabilitation programs for patients with knee osteoarthritis while focusing on the technologies and services provided in the programs.
Objective
The main objective of this review is to identify and discuss the modes of service delivery and technologies in telerehabilitation programs for patients with knee osteoarthritis. The gaps, strengths, and weaknesses of programs will be discussed individually.
Methods
Studies published in English since 2000 were retrieved from the EMBASE, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Physiotherapy Evidence Database (PEDro), and PsycINFO databases. The search words “telerehabilitation,” “telehealth,” “telemedicine,” “teletherapy,” and “ehealth” were combined with “knee” and “rehabilitation” to generate a data set of studies for screening and review. The final group of studies reviewed here includes those that implemented teletreatment for patients for at least 2 weeks of rehabilitation.
Results
In total, 1198 studies were screened, and the full text of 154 studies was reviewed. Of these, 38 studies were included, and data were extracted accordingly. Four modes of telerehabilitation service delivery were identified: phone-based, video-based, sensor-based, and expert system–based telerehabilitation. The intervention services provided in the studies included information, training, communication, monitoring, and tracking. Video-based telerehabilitation programs were frequently used. Among the identified services, information and educational material were introduced in only one-quarter of the studies.
Conclusions
Video-based telerehabilitation programs can be considered the best alternative solution to conventional treatment. This study shows that, in recent years, sensor-based solutions have also become more popular due to rapid developments in sensor technology. Nevertheless, communication and human-generated feedback remain as important as monitoring and intervention services.
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14
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Feasibility and Effectiveness of Telephone-Based Telephysiotherapy for Treatment of Pain in Low-Resource Setting: A Retrospective Pre-Post Design. Pain Res Manag 2020; 2020:2741278. [PMID: 32454919 PMCID: PMC7231093 DOI: 10.1155/2020/2741278] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/25/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022]
Abstract
Introduction Telephysiotherapy (TPT) is a provision of physiotherapy services at a distance, using telecommunication technology when an in-person visit is not a feasible option. The objective of this study was to investigate the effectiveness of TPT in management of pain caused due to various problems among patients living in rural areas of a developing country. Methods This retrospective study conducted in rural areas of Nepal recruited all patients who met the eligibility criteria during a day campaign. Two physiotherapists, one for assessment and another for treatment, were involved. Based on pretraining assessment finding, evidence-based individualized physiotherapy was prescribed. Pamphlets containing pictures of the prescribed exercises and instructions in the Nepali language were distributed. The treating physiotherapist made telephone calls to every patient each week to give necessary information, correction, modification, and progression of the exercise whatever required. At the end of the second and fourth weeks, pain was assessed using the Numeric Pain Rating Scale (NPRS) through telephone calls. The data were analyzed using ANOVA with repeated measures followed by pairwise comparisons. Results Fifteen patients having pain due to various conditions participated in the study. The NPRS demonstrated significantly decreased pain (at rest: F = 3.5, p = 0.04, when worst: F = 26.4, p < 0.001, during activities of daily living: F = 16.6, p < 0.001, and during occupation: F = 15.6, p = 0.001) across time. The result met the minimal clinically important difference of NPRS, which is 2. Conclusions The telephone-based TPT interventions demonstrated significant reduction in pain caused by various musculoskeletal problems. It could be a feasible and effective treatment option for the patients living in rural areas. However, we recommend for large-scale trials to establish effectiveness of the intervention and for its implication into routine clinical practice.
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15
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Schäfer AGM, Zalpour C, von Piekartz H, Hall TM, Paelke V. The Efficacy of Electronic Health-Supported Home Exercise Interventions for Patients With Osteoarthritis of the Knee: Systematic Review. J Med Internet Res 2018; 20:e152. [PMID: 29699963 PMCID: PMC5945993 DOI: 10.2196/jmir.9465] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/07/2018] [Accepted: 02/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far. Objective The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee. Methods MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=−0.31, 95% CI −0.58 to −0.04, low quality; QoL SMD=0.24, 95% CI 0.05-0.43, moderate quality) and long-term effects (pain −0.30, 95% CI −0.07 to −0.53, moderate quality; physical function 0.41, 95% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95% CI 0.06-0.47, high quality). Conclusions eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence.
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Affiliation(s)
- Axel Georg Meender Schäfer
- Course of Study Speech and Language Therapy, Occupational Therapy and Physiotherapy, Faculty of Social Work and Health, University of Applied Sciences and Arts Hildesheim, Hildesheim, Germany
| | - Christoff Zalpour
- Institut für angewandte Physiotherapie und Osteopathie, Fakultät Wirtschafts- und Sozialwissenschaften, University of Applied Sciences Osnabrück, Osnabrück, Germany
| | - Harry von Piekartz
- Institut für angewandte Physiotherapie und Osteopathie, Fakultät Wirtschafts- und Sozialwissenschaften, University of Applied Sciences Osnabrück, Osnabrück, Germany
| | - Toby Maxwell Hall
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Volker Paelke
- International Degree Programme in Media Computer Science, Electrical Engineering and Computer Science, University of Applied Sciences Bremen, Bremen, Germany
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16
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Cottrell MA, Galea OA, O'Leary SP, Hill AJ, Russell TG. Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clin Rehabil 2016; 31:625-638. [PMID: 27141087 DOI: 10.1177/0269215516645148] [Citation(s) in RCA: 322] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of treatment delivered via real-time telerehabilitation for the management of musculoskeletal conditions, and to determine if real-time telerehabilitation is comparable to conventional methods of delivery within this population. DATA SOURCES Six databases (Medline, Embase, Cochrane CENTRAL, PEDro, psycINFO, CINAHL) were searched from inception to November 2015 for literature which reported on the outcomes of real-time telerehabilitation for musculoskeletal conditions. REVIEW METHODS Two reviewers screened 5913 abstracts where 13 studies ( n = 1520) met the eligibility criteria. Methodological quality was assessed using the Downs & Black 'Checklist for Measuring Quality' tool. Results were pooled for meta-analysis based upon primary outcome measures and reported as standardised mean differences and 95% confidence intervals (CI). RESULTS Aggregate results suggest that telerehabilitation is effective in the improvement of physical function (SMD 1.63, 95%CI 0.92-2.33, I2=93%), whilst being slightly more favourable (SMD 0.44, 95%CI 0.19-0.69, I2=58%) than the control cohort following intervention. Sub-group analyses reveals that telerehabilitation in addition to usual care is more favourable (SMD 0.64, 95%CI 0.43-0.85, I2=10%) than usual care alone, whilst treatment delivered solely via telerehabilitation is equivalent to face-to-face intervention (SMD MD 0.14, 95% CI -0.10-0.37, I2 = 0%) for the improvement of physical function. The improvement of pain was also seen to be comparable between cohorts (SMD 0.66, 95%CI -0.27-1.60, I2=96%) following intervention. CONCLUSIONS Real-time telerehabilitation appears to be effective and comparable to conventional methods of healthcare delivery for the improvement of physical function and pain in a variety of musculoskeletal conditions.
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Affiliation(s)
- Michelle A Cottrell
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,2 Centre for Research Excellence in Telehealth, University of Queensland, Australia
| | - Olivia A Galea
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia
| | - Shaun P O'Leary
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,3 Physiotherapy Department, Royal Brisbane and Women's Hospital, Australia
| | - Anne J Hill
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,2 Centre for Research Excellence in Telehealth, University of Queensland, Australia
| | - Trevor G Russell
- 1 School of Health and Rehabilitation Science, University of Queensland, Australia.,2 Centre for Research Excellence in Telehealth, University of Queensland, Australia
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