A group of Melbourne physiotherapists will trial treating knee osteoarthritis patients across Australia over the telephone.

Under the innovative telehealth trial, a partnership between the University of Melbourne, Arthritis and Osteoporosis Victoria, Medibank and HealthChange Australia, eight physiotherapists will provide exercise education, treatment and ongoing monitoring to 175 patients over 12 months.

Knee osteoarthritis is a common condition and one of the main causes of disability in Australia.

A report from Arthritis and Osteoporosis Victoria, A Problem Worth Solving, shows there were 1.9 million people with osteoarthritis in 2012.

With our nation’s rapidly ageing population and obesity rates, that number is forecast to increase by another 1.1 million people by 2032, affecting 3 million people - a growth of 58 per cent.

University of Melbourne Associate Professor Rana Hinman, a former clinical physiotherapist and member of the Australian Physiotherapy Association who has worked in research and academia for the past 12 years, says the trial aims to reduce surgical and pharmaceutical interventions through ongoing exercise and treatment.

“We don’t have a cure for osteoarthritis so really the only way of managing end-stage disease at the moment is surgical intervention with a joint arthroplasty, and that’s certainly something that most patients really do want to avoid,” she says.

“Surgical intervention is not without its risks and there’s certainly no guarantee that patients’ problems are all resolved with arthroplasty either.

“There are some drug strategies which are typically around analgesics and anti-inflammatories but increasingly research is showing us that they are not as benign as we once thought they were and they are associated with increased side effects.

“There’s also increasing concern about the harms of some of these drugs particularly when we look at the systematic reviews and meta-analyses that have been done that show that the benefits are generally small and not often long-lasting.

“It really does mean that we need to be looking at other options other than drugs and surgery and certainly, at the moment, all of the clinical guidelines for managing knee osteoarthritis advocate exercise self-management and weight control as the core components of managing the condition.

“Drugs are only seen as an additive therapy in addition to those core treatments and exercise is advocated as one of the mainstays of treating knee osteoarthritis.”

There’s ample research evidence that shows structured exercise programs, including muscle strengthening, aerobic exercise and other exercise, for people with knee osteoarthritis reduces knee pain and improves physical function.

But despite the research, Dr Hinman says there’s a large evidence practice gap.

“We know that there’s lots of people with knee osteoarthritis that are either not participating or doing the exercise,” she says.

“This research is really aimed at trying to help close that gap so we’re seeing more of what we know should be done for osteoarthritis implemented.”

Dr Hinman says people with knee osteoarthritis also face barriers to accessing health professionals, often due to financial or geographical constraints or they’re unable to access services because of their chronic knee pain.

The telehealth trial, which recently received $430,000 in National Health and Medical Research Council (NHMRC) funding, will enable physiotherapists to treat people with knee osteoarthritis from a distance, regardless of the patient’s location.

“The beauty of this is there is no geographical boundary,” Dr Hinman says.

“We are so geographically spread out and access to clinicians and to many health professionals is a real issue for people in regional, rural and remote areas.

“It’s even an issue for a lot of people in metropolitan areas when you’re older and somewhat disabled with a painful knee - it’s just not easy to get out and get yourself physically down to your local physio.

“With this, people can have the luxury of being able to have a consultation in their own home or their workplace or wherever suits them.

“The physiotherapists will be prescribing a strengthening exercise program but also working with the patient to help increase their physical activity levels as well.”

Trial participants will receive between five and 10 telephone consultations over a six-month period with follow up consultations spanning another six months.

Participants will also receive video clips of exercises and detailed patient handouts to refer to during the physiotherapy telephone consultations.

As part of the trial, the physiotherapists will be trained in behaviour change in order to support participants troubleshoot any difficulties and to help them adhere to an exercise program.

“This isn’t the sort of thing you can do for a few weeks and then your knee osteoarthritis is better,” Dr Hinman says.

“It’s a long-term commitment that you have to make for a chronic disease to self-manage it…the physios will be operating over the phone to help get their patients exercising and help them to stick with it over the longer term.”

Physiotherapists will undergo their final training for the program in February next year with researchers set to begin recruiting participants in March.

If successful, Dr Hinman says telephone physiotherapy services could provide a real alternative to traditional face to face physiotherapy services for people with knee osteoarthritis, while also improving their access and uptake of exercise.

“What we hope to see is that the patients who get the physiotherapy calls will have greater reduction in knee pain and greater improvements in physical function.

“From a broader perspective, if we get those findings from the trial what I would really hope to see is telephone services for knee osteoarthritis delivered in the community and from health care providers,” she says.

“Ultimately, we could get more people with osteoarthritis exercising and staying active and hopefully therefore reducing the burden of the disease.”