Telemedicine for Knee OA Pain Relief

By Linda Rath | Dec. 14, 2021

If you have knee pain from osteoarthritis (OA), the internet may be your best friend. That’s according to new research in Annals of Internal Medicine and the Journal of Medical Internet Research.  In separate studies, Australian and Chinese researchers concluded that telehealth interventions for knee pain work as well or significantly better than in-person therapies.

Study #1: Diet and Exercise Coaching

Treatment guidelines from the American College of Rheumatology (ACR) and other medical organizations recommend education, exercise and weight loss as first-line treatments for knee OA. Yet many patients get only vague admonitions to exercise more and eat less, with no guidance on how to do it. Australian researchers wanted to change that, so they devised a study providing patients with exercise and nutrition coaching via teleconferencing.

Nearly 400 participants who had OA and were overweight or obese were randomly divided into three groups. All had access to information about OA. One group, called the exercise group, also had six teleconference sessions with a physical therapist as well as behavioral counseling and access to exercise equipment and other resources. The third group, the diet-and-exercise group, received the exercise program along with six consultations with a dietitian and followed a low-calorie ketogenic diet consisting of two meal replacement shakes and one low-carb meal a day.

After six months, the exercise group and the diet-and-exercise group both showed significantly improved pain and function compared to the group that received only information. Diet combined with exercise was also slightly more effective than exercise alone.

Study #2: Analysis of Four OA Pain Studies

Chinese researchers were interested in the effectiveness of a wide variety of web-based treatments for OA, so they analyzed four studies that used different approaches. These included:

• Physical fitness. Developed by researchers at the University of North Carolina at Chapel Hill, this personalized, progressive exercise program emphasizes strength training and stretching three times a week plus daily cardiovascular training.   
• Pain coping skills training (PCST). Coping strategies are among the most effective nondrug treatments for chronic pain, in part because they put patients in charge of their own care. The web-based PainCOACH program teaches people with OA how to use behavioral and cognitive techniques for successfully coping with arthritis pain. Normally, these strategies are delivered in person by a trained therapist over 10 to 12 sessions. In this study, researchers tested an eight-week internet-based version of PCST that used guided instructions, personalized feedback and interactive exercises.
• Cognitive behavioral therapy (CBT). The original aim of this program was to treat major depressive disorder in older adults with OA via the internet. But researchers found that pain, stiffness and mobility also improved significantly with treatment.
• Medical management. This study found that OA could be managed as effectively through telemedicine as in a doctor’s office.

In all four studies, there was significant improvement in knee pain but not always in physical function. Still, the studies demonstrate that arthritis pain can be effectively treated with consistent, personalized, web-based coaching that provides both physical and psychological support. That’s good news for everyone with OA, especially those who have trouble accessing in-person care, including older adults, under- and uninsured people and those living in remote parts of the country or where trained therapists are in short supply.