An Australian study has shown that telehealth-delivered diet and physiotherapy programs help people cope with knee osteoarthritis, possibly reducing need for surgery.

Osteoarthritis is a common and painful condition that affects more than 2.2 million Australians – and the knee is one of the most commonly affected joints.

For people who are overweight or obese, the impact of knee osteoarthritis can be more severe – the increased weight on the knee aggravating the pain, making movement more difficult and over time worsening the condition. Eventually, surgery is often needed, which can be risky and is expensive.

That’s why a team at the University of Melbourne started the Better Knee, Better Me randomised controlled trial, which involved 415 people from across Australia who had symptomatic knee osteoarthritis. The study compared the outcomes of participants enrolled in two different telehealth programs over a six month period – one involving exercise and the other combining exercise and a diet program.

People in the exercise only and the diet plus exercise programs both received six consultations with a physiotherapist via Zoom for prescription of an exercise program, as well as a suite of educational resources.

On top of that, those in the diet plus exercise group also received six Zoom consultations with a dietitian guiding them through a very low calorie diet, along with free meal replacements and additional weight loss resources.

The primary outcomes measured by the researchers were changes in knee pain and physical function after 6 months and 12 months. Secondary outcomes were weight, physical activity, quality of life, mental health, global change, satisfaction, willingness to have surgery, orthopedic appointments, and knee surgery.

Compared to the control group who received no intervention, patients in both the exercise only and the diet plus exercise programs reported improvements in their knee pain, physical function and quality of life.

Furthermore, compared to those in the exercise only program, those in the combined diet plus exercise program also reported additional benefits, including greater reductions in knee pain, lower use of pain medications and an average weight loss of 10 kilograms.

Importantly, after both programs, between 55 to 70 per cent of people were now unwilling to undergo knee joint replacement surgery in the future. This suggests that the programs may help reduce surgery rates and, ultimately, reduce the economic burden of osteoarthritis.

The research team also conducted a follow-up study, in which 24 people in the combined program were interviewed. This revealed a trend – that the participants valued the fact that the program was delivered entirely online via telehealth, finding it to be convenient and, contrary to popular expectations, that it didn’t negatively impact the rapport they developed with their physiotherapist or dietitian.

The fact that the program was delivered online also meant that people from remote and rural areas of Australia were able to participate in the program – one third were from regional, rural, or remote areas of Australia.

As it stands, osteoarthritis costs the Australian healthcare system approximately $A3.5 billion each year and joint replacement surgery is one of the key drivers of these costs. In fact, avoiding or delaying knee replacement surgery alone is projected to save over $A233 million in 2030.

Looking forward, the researchers hope the program will be made widely accessible to people in the community who suffer with osteoarthritis.

In 2022, the team will test a similar program in people with hip osteoarthritis with a view to increase access to telehealth-delivered diet and exercise programs for this patient group.