Internet-Based Exercise Therapy Using Algorithms for Conservative Treatment of Anterior Knee Pain: A Pragmatic Randomized Controlled Trial.
Tae Won Benjamin Kim, Nic Gay, Arpit Khemka and 1 others
PMID 28582256WHAT IT FOUND
No significant difference between groups in reported pain at 6 weeks.
In 17 people who finished the adaptive video platform, mean reported pain score fell from 4.5 to 3.0, but only finishers were analyzed and the study is small.
Key findings
01At 6 weeks, there was no significant difference between the three arms in reported pain score or in change in pain score by arm allocation.
02In arm 3, 17 users provided initial and 6-week pain data, and mean reported pain score fell from 4.5 to 3.0 (P = .009).
03No adverse events were reported, and 96% (26/27) of arm 3 users said they enjoyed the platform more than in-person physical therapy.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 8% of users who registered completed the 6-week system, and the study used a completion analysis rather than intention-to-treat. The analyzed samples were small: 20 arm 1 users, 33 arm 2 users, and 17 arm 3 users provided initial and 6-week pain data. The study was not sufficiently powered to evaluate efficacy in pain reduction. Patients were not blinded to their intervention, and the software developer was not blinded to allocation. Questionnaires were not validated before the trial and were designed by orthopedic surgeons and physical therapists. Outcomes were self-reported online with no face-to-face clinician interaction. The UCLA activity score was designed for total joint replacement patients, and the starting mean score of 6 suggests many users were already moderately active, so it may not capture small changes in anterior knee pain. Participants had to be computer literate and screened safe for exercise, so results may not apply to less technology-experienced or higher-risk patients.
Declared interests
The trial was funded by SimpleTherapy LLC, the company that created the platform, and the paper states no external funding was used.
The easy way to misread this
Do not conclude that the algorithm platform outperformed the other arms. The between-arm comparison of reported pain scores and change in pain scores at 6 weeks was not significant, and the arm 3 pain reduction came from 17 people who finished rather than the 284 randomized.