Telephone-Delivered Exercise Advice and Behavior Change Support by Physical Therapists for People with Knee Osteoarthritis: Protocol for the Telecare Randomized Controlled Trial.
BACKGROUND
Exercise and physical activity are a core component of knee osteoarthritis (OA) care, yet access to physical therapists is limited for many people. Telephone service delivery models may increase access.


OBJECTIVE
Determine the effectiveness of incorporating exercise advice and behavior change support by physical therapists into an existing Australian nurse-led musculoskeletal telephone service for adults with knee OA.


METHODS
Randomized controlled trial with nested qualitative studies.


METHODS
Community, Australia-wide.


METHODS
One hundred seventy-five people ≥45 years of age with knee symptoms consistent with a clinical diagnosis of knee OA. Eight musculoskeletal physical therapists will provide exercise advice and support.


METHODS
Random allocation to receive existing care or exercise advice in addition to existing care. Existing care is a minimum of one phone call from a nurse for advice on OA self-management. Exercise advice involves 5-10 calls over 6 months from a physical therapist trained in behavior change support to prescribe, monitor, and progress a strengthening exercise program and physical activity plan.


METHODS
Outcomes will be measured at baseline and at 6 and 12 months. Primary outcomes are knee pain and physical function. Secondary outcomes include other measures of knee pain, self-efficacy, physical activity and its mediators, kinesiophobia, health service usage, work productivity, participant-perceived change, and satisfaction. Additional measures include adherence, adverse events, therapeutic alliance, satisfaction with telephone-delivered therapy, and expectation of outcome. Semi-structured interviews with participants with knee OA and therapists will be conducted.


CONCLUSIONS
Physical therapists cannot be blinded.


CONCLUSIONS
This study will determine if incorporating exercise advice and behavior change support by physical therapists into a nurse-led musculoskeletal telephone service improves outcomes for people with knee OA. Findings will inform development and implementation of telerehabilitation services.
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7, Alan Gilbert Building, Carlton, Victoria 3010, Australia.
Rana S
RS
Hinman
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne.
Belinda J
BJ
Lawford
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne.
Penny K
PK
Campbell
School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia.
Andrew M
AM
Briggs
HealthChange Australia, Sydney, North South Wales, Australia.
Janette
J
Gale
HealthChange Australia.
Caroline
C
Bills
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, and School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
Simon D
SD
French
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, and Melbourne EpiCentre, Monash University, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia.
Jessica
J
Kasza
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, and Melbourne EpiCentre, Monash University, University of Melbourne and Melbourne Health.
Andrew
A
Forbes
Centre for Health Economics, Monash University.
Anthony
A
Harris
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, and Medibank, Melbourne, Victoria, Australia.
Stephen J
SJ
Bunker
Department of Medical Education, The University of Melbourne.
Clare M
CM
Delany
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne.
Kim L
KL
Bennell
D000368:Aged; D001315:Australia; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000534:rehabilitation*; D010043:Outcome and Process Assessment, Health Care; D059408:Pain Management; D059825:Physical Therapists; D036301:Qualitative Research; D011788:Quality of Life; D013689:Telephone