Osteoarthritis: new study on combining physiotherapist with online exercise programme

The Netherlands Institute for Health Services Research (NIVEL) and Tilburg University have started a study in which patients receive a combination of treatment by a physiotherapist and an online exercise programme, e-Exercise. The aim of the study is to improve treatment for people with hip or knee osteoarthritis and to see whether this is cheaper, more effective, and more efficient than the usual treatment provided by a physiotherapist. The study protocol was published in the scientific journal BMC Musculoskeletal Disorders. Treatment of the first patients began on September 1.

According to estimates, 1.1 million people in the Netherlands have some form of arthritis. This will only increase with the ageing of the population, and a 30% rise is expected by 2030. A physiotherapist sees a patient with arthritis an average of 17 times a year. Depending on the type of supplementary insurance a patient has, a certain number of physiotherapy treatments are covered. Because of this, physiotherapists try to get the best possible results in fewer treatments. Combining face-to-face treatments with an online exercise programme could help to achieve the same or even better results at a lower cost.
 
Arthritis research
NIVEL has been studying the effect of physical activity on arthritis for years. For example, it turned out that surgery can be postponed by continuing to exercise even though it might be painful. And a study using a specially designed online exercise programme showed that those who took part had less pain and exercised more. The new design uses a combination of face-to-face contacts with the physiotherapist and an online exercise programme.
 
e-Exercise
In addition to being cheaper, this is expected to have a number of other advantages. The website will offer instructional videos of exercises patients can watch at home so they can review what the physiotherapist taught them. The online programme also gives them assignments to help them establish a more active lifestyle.
 
Support
The contacts with the physiotherapist also seem to have advantages when compared with exercising without support. For example, a physiotherapist can advise the patient on which exercises to do and adapt the programme so that it fits the needs of the individual patient. And the physiotherapist can see whether a patient has logged in and how often he or she has done the exercises, and talk about this with them later on. In addition, patients receive automatic email reminders when a new exercise assignment is waiting for them.
 
Cost
What are the expectations? “We expect e-Exercise to be cheaper than standard physiotherapy, but we’d really like to know if it also produces similar results – in other words, whether it’s also cost-effective,” says NIVEL researcher Corelien Kloek. “We hope that arthritis patients who have used e-Exercise will have fewer symptoms in their daily lives and will exercise more, for a relatively low cost. When calculating this, we look at all of the costs related to a patient’s arthritis, so also the costs of medication and consultations with other health care professionals.”
 
Around 250 physiotherapists are taking part in the study, which began in September 2014. 
 

Funding
ZonMw
Reumafonds (Dutch)
KNGF
 
Cooperating partner
Tilburg University