Effects of a periodized circuit training protocol delivered by telerehabilitation compared to face-to-face method for knee osteoarthritis: a protocol for a non-inferiority randomized controlled trial

Abstract

Background Regular exercise is an effective method for reducing pain and disability in patients with knee osteoarthritis (OA), as well as improving body composition. Thus, a combination of both resistance and aerobic training (circuit training) has shown to be promising for this population. However, access to physical therapy is limited by physical distance, social isolation, and/or treatment costs. Remote rehabilitation seems to be an effective way to minimize these barriers, but the benefits are dependent on the participants’ adherence to the interventions provided at a distance. The objectives of this protocol are to compare the effects of a periodized circuit training applied via telerehabilitation with the same protocol applied in the face-to-face model for individuals with knee OA. Methods This study presents a single-blinded protocol for a non-inferiority randomized controlled trial. One hundred participants diagnosed with knee OA (grades II and III Kellgren and Lawrence system), aged 40 years or more, and BMI < 30 kg/m2 will be randomly divided into two groups: telerehabilitation (TR) and face-to-face (FtF) circuit training. The FtF group will perform a 14-week periodized circuit training protocol supervised by a physical therapist, 3 times a week. The TR group will perform the same exercise protocol at home, at least 3 times a week. In addition, the TR group will be able to follow the execution and orientations of the exercises by DVD, a website, and online file sharing tools, and they will receive periodic phone calls in order to motivate, clarify, and inform some aspects of knee OA. The primary outcomes are changes in self-reported pain intensity (visual analog scale (VAS)) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), with a primary end-point of 14 weeks and a secondary end-point of 26 weeks. Secondary outcomes include changes in other clinical outcomes, in morphological characteristics, adherence, acceptability, and treatment perspective. Discussion A circuit training through telerehabilitation may contribute to developing early intervention in the causative and potentiating factors of the knee OA, verifying the effects of a low-cost, non-pharmacological and non-invasive treatment. Trial registration Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-662hn2. Registered on 31 March 2019. Link: http://www.ensaiosclinicos.gov.br; Universal Trial Number (UTN) of World Health Organization: U1111-1230-9517.

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“…The authors are also aware of a number of ongoing studies addressing a range of innovative digital programmes in OA care. Such approaches will likely receive further attention in future updates of these recommendations 78–81…”

“…Such approaches will likely receive further attention in future updates of these recommendations. [78][79][80][81] With regard to outcomes, most of the included studies reported effects primarily on pain and physical function. To follow the recommendations on prioritised outcomes in OA research, 82 more studies investigating the effects of interventions on QoL and patients' global assessment of the target joint may have provided additional relevant information.…”

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“…The success of home-based rehabilitation programmes depends on the feasibility of the interventions and on patient adherence [23]. A previous study in which participants completed a home-based muscle strengthening and joint flexibility programme found high adherence rates (96-100%) [24].…”

Physical therapy as a promising treatment for osteoarthritis: A narrative review

“…Moreover, the selection of appropriate physical therapy content and intensity level also plays an important role in the effectiveness of physical therapy for OA (Aily et al, 2021;Wise, 2022). Therefore, more detailed and unified standards of physical therapy for OA are needed, by which clinicians or rehabilitation therapists can make personalized prescriptions according to the different situations.…”