title: Effectiveness of an Internet-Delivered Exercise and Pain-Coping Skills Training Intervention for Persons With Chronic Knee Pain: A Randomized Trial.
abstract: BACKGROUND
  Effective, accessible biopsychosocial treatments are needed to manage chronic knee pain on a population level.
  
  
  OBJECTIVE
  To evaluate the effectiveness of Internet-delivered, physiotherapist-prescribed home exercise and pain-coping skills training (PCST).
  
  
  METHODS
  Pragmatic parallel-group randomized, controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12614000243617).
  
  
  METHODS
  Community (Australia).
  
  
  METHODS
  148 persons aged 50 years or older with chronic knee pain.
  
  
  METHODS
  The intervention was delivered via the Internet and included educational material, 7 videoconferencing (Skype [Microsoft]) sessions with a physiotherapist for home exercise, and a PCST program over 3 months. The control was Internet-based educational material.
  
  
  METHODS
  Primary outcomes were pain during walking (11-point numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index) at 3 months. Secondary outcomes were knee pain, quality of life, global change (overall, pain, and functional status), arthritis self-efficacy, coping, and pain catastrophizing. Outcomes were also measured at 9 months.
  
  
  RESULTS
  Of participants enrolled, 139 (94%) completed primary outcome measures at 3 months and 133 (90%) completed secondary outcome measures at 9 months; multiple imputation was used for missing data. The intervention group reported significantly more improvement in pain (mean difference, 1.6 units [95% CI, 0.9 to 2.3 units]) and physical function (mean difference, 9.3 units [CI, 5.9 to 12.7 units]) than the control group at 3 months, and improvements were sustained at 9 months (mean differences, 1.1 units [CI, 0.4 to 1.8 units] and 7.0 units [CI, 3.4 to 10.5 units], respectively). Intervention participants showed significantly more improvement in most secondary outcomes than control participants. At both time points, significantly more intervention participants reported global improvements.
  
  
  CONCLUSIONS
  Participants were unblinded.
  
  
  CONCLUSIONS
  For persons with chronic knee pain, Internet-delivered, physiotherapist-prescribed exercise and PCST provide clinically meaningful improvements in pain and function that are sustained for at least 6 months.
  
  
  BACKGROUND
  National Health and Medical Research Council.
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Kim L
authors.initials: KL
authors.lastname: Bennell
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nelligan
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Fiona
authors.initials: F
authors.lastname: Dobson
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Christine
authors.initials: C
authors.lastname: Rini
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Francis
authors.initials: F
authors.lastname: Keefe
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kasza
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Simon
authors.initials: S
authors.lastname: French
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Christina
authors.initials: C
authors.lastname: Bryant
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Andrew
authors.initials: A
authors.lastname: Dalwood
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: J Haxby
authors.initials: JH
authors.lastname: Abbott
authors.affiliation: From the University of Melbourne, Monash University, Royal Women's Hospital, and Physioworks Health Group, Melbourne, Victoria, Australia; UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; Duke University, Durham, North Carolina; Queen's University, Kingston, Ontario, Canada; and Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Rana S
authors.initials: RS
authors.lastname: Hinman
mesh_terms: D000223:Adaptation, Psychological; D000359:Aftercare; D059350:Chronic Pain / Q000209:etiology / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D010353:Patient Education as Topic; D016896:Treatment Outcome