by John A. Baur, PT, DPT, OCS, CSCS, FAAOMPT
Physical Therapist

Many people are finding information about treatments for health conditions on the internet. A novel approach to physical therapy takes advantage of this propensity to engage online with treatment. This blended approach combines face-to-face visits with an online program or e-Exercise. But is this as effective as traditional physical therapy?

Comparing a Blended Approach with Traditional Physical Therapy

Researchers in a recent study[i] compared the short and long-term effectiveness of a blended approach, which uses an online e-Exercise program to the traditional approach of physical therapy alone. They focused on patients with osteoarthritis of the knee and/or hip. This condition is the most common chronic condition of the joints, causing pain, stiffness and swelling.

Research Participants

The study enrolled 208 patients selected from 143 physical therapy practices. Patients had to meet the following criteria:

· 40 – 80 years of age

· Osteoarthritis of the hip and/or knee

· Not on a waiting list for hip or knee replacement surgery

· No contra-indications for physical activity without supervision

· Moderately physically active

· No current physical therapy program in the last 6 months

· Access to the internet

Blended Approach

This approach combines physical therapy with an online application. It involves 5 face-to-face sessions with a physical therapist and enrollment in an e-Exercise program that has a graded activity module, exercises and information modules. Once the patient is enrolled in the online, e-Exercise program, the physical therapist can adapt the program to the patient’s needs and monitor login frequencies and assignment evaluation. They can then discuss progress during the face-to-face physical therapy session.

Traditional Approach

The traditional approach to treating osteoarthritis over a period of 12 months involves 12 face-to-face sessions with a physical therapist. During those sessions the physical therapist will share information about the disease and treatment and work the patient on a program of physical exercise and strength and stability exercises.

Results

Patients were assessed at 3 and 12 months on quality of life, physical functioning and physical activity. The assessment used an online questionnaire.

At 12 months there was no difference between the groups on health-related quality of life, physical functioning or physical activity. Both approaches achieved the same results.

Recommendations

When choosing between a blended approach that incorporates e-Exercise and traditional physical therapy, the preferences and predisposition of the patient should be considered. The blended approach requires more motivation on the part of the patient and they must take a more active role for the treatment to be successful. If the blended approach is used, it may also be wise to incorporate a personal activity tracker to keep patients motivated and on task.

Physical Therapy First Approach – Treatment for Osteoarthritis

At Physical Therapy First each patient undergoes a complete examination to determine the underlying biomechanical cause of her/his knee/hip osteoarthritis. Physical therapy can help knee/hip osteoarthritis and it all starts with a thorough examine which will include assessing:

– muscle imbalances

– specific muscle weakness

– muscle flexibility

– joint mobility

– shoe wear assessment

– functional movement

– posture

– neurological exam

Based on the finding from the initial physical therapy assessment, a custom treatment plan will be designed to restore movement quality and efficiently, and ultimately decreasing the pain resulting from knee/hip osteoarthritis.

Some of the treatments that may be provided in physical therapy to help address patients with osteoarthritis includes:

– individualized online/e-Exercise program

– adaptive equipment

– bracing

– proper shoe wear

– joint mobilization

– soft tissue mobilization

– specific muscle strengthening

– muscle stretching

– postural correction

– correction of biomechanical faults in functional movement

– physical therapy modalities, such as, moist heat, cold packs, ultrasound, electrical stimulation, phototherapy/laser

[i] Corelien J J Kloek, Daniël Bossen, Peter M Spreeuwenberg, Joost Dekker, Dinny H de Bakker, Cindy Veenhof; Effectiveness of a Blended Physical Therapist Intervention in People With Hip Osteoarthritis, Knee Osteoarthritis, or Both: A Cluster-Randomized Controlled Trial, Physical Therapy, Volume 98, Issue 7, 1 July 2018, Pages 560–570, https://doi.org/10.1093/ptj/pzy045