Effectiveness of remote exercise programs in reducing pain for patients with knee osteoarthritis: A systematic review of randomized trials

OBJECTIVE: Remote knee osteoarthritis (OA) management programs are becoming more popular. This systematic review examined the efficacy of remote exercise programs for relieving pain in persons with knee OA. DESIGN: We conducted a search of studies published between January 1st, 2013 to March 31st, 2021 in PubMed, Embase, and MEDLINE. We included randomized trials of patients with knee OA or chronic knee pain, studying interventions with an element of telehealth exercise management, and evaluating knee pain as an outcome. Interventions could include fully remote or both remote and in-person components. We excluded observational cohort studies, pilot studies, and studies with poor Physiotherapy Exercise Database (PEDro) scores. Two reviewers extracted pain data, consisting of mean differences from baseline and between groups, and compared them to minimum clinically important difference (MCID) thresholds. RESULTS: We identified 1867 reports, of which eleven trials with a total of 1861 participants met inclusion criteria. Only one trial demonstrated a clinically meaningful change from baseline between groups. Four interventions were found to result in clinically meaningful improvements in pain from baseline. CONCLUSION: This review was limited by variability in outcome measures, intervention content, and comparators. One trial with an inactive control demonstrated clinically meaningful between group differences in pain. All four interventions demonstrating meaningful improvements from baseline included study-initiated communications to discuss and personalize remotely delivered exercise programs. More studies comparing fully or partially remote exercise programs with both active and inactive controls could help optimize the use of remote programs for management of knee OA pain.