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Randomized Controlled Trial
. 2024 Apr;70(2):124-133.
doi: 10.1016/j.jphys.2024.02.016. Epub 2024 Mar 16.

Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial

Hannah G Withers  1 , Joanne V Glinsky  1 , Jackie Chu  1 , Matthew D Jennings  2 , Ian Starkey  3 , Rachel Parmeter  3 , Max Boulos  4 , Jackson J Cruwys  5 , Kitty Duong  5 , Ian Jordan  6 , David Wong  7 , San Trang  8 , Maggie Duong  8 , Hueiming Liu  9 , Alison J Hayes  10 , Tara E Lambert  11 , Joshua R Zadro  12 , Catherine Sherrington  12 , Christopher Maher  12 , Barbara R Lucas  13 , Deborah Taylor  11 , Manuela L Ferreira  13 , Lisa A Harvey  14
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Free article
Randomized Controlled Trial

Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial

Hannah G Withers et al. J Physiother. 2024 Apr.
Free article

Abstract

Question: Is remotely delivered physiotherapy as good or better than face-to-face physiotherapy for the management of musculoskeletal conditions?

Design: Randomised controlled, non-inferiority trial with concealed allocation, blinded assessors and intention-to-treat analysis.

Participants: A total of 210 adult participants with a musculoskeletal condition who presented for outpatient physiotherapy at five public hospitals in Sydney.

Intervention: One group received a remotely delivered physiotherapy program for 6 weeks that consisted of one face-to-face physiotherapy session in conjunction with weekly text messages, phone calls at 2 and 4 weeks, and an individualised home exercise program delivered through an app. The other group received usual face-to-face physiotherapy care in an outpatient setting.

Outcome measures: The primary outcome was the Patient Specific Functional Scale at 6 weeks with a pre-specified non-inferiority margin of -15 out of 100 points. Secondary outcomes included: the Patient Specific Functional Scale at 26 weeks; kinesiophobia, pain, function/disability, global impression of change and quality of life at 6 and 26 weeks; and satisfaction with service delivery at 6 weeks.

Results: The mean between-group difference (95% CI) for the Patient Specific Functional Scale at 6 weeks was 2.7 out of 100 points (-3.5 to 8.8), where a positive score favoured remotely delivered physiotherapy. The lower end of the 95% CI was greater than the non-inferiority margin. Whilst non-inferiority margins were not set for the secondary outcomes, the 95% CI of the mean between-group difference ruled out clinically meaningful differences.

Conclusion: Remotely delivered physiotherapy with support via phone, text and an app is as good as face-to-face physiotherapy for the management of musculoskeletal conditions.

Trial registration: ACTRN12619000065190.

Keywords: Musculoskeletal conditions; Physical therapy; Randomised clinical trial; Rehabilitation; Telehealth.

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