Clinical studies.

Home exercise programs, such as the ones you create with Physitrack®, have been shown to increase patient adherence. Below, we reference several studies which confirm this.

Effectiveness of an Internet-Delivered Exercise and Pain-Coping Skills Training Intervention for Persons With Chronic Knee Pain: A Randomized Trial

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).

Design: Pragmatic parallel-group randomized, controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12614000243617)

Setting: Community (Australia).

Patients: 148 persons aged 50 years or older with chronic knee pain.

Intervention: 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.

Measurements: 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.

Limitation: Participants were unblinded.

Conclusion: 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.

Primary Funding Source: National Health and Medical Research Council.

Kim L. Bennell, BAppSci(Physio), PhD; Rachel Nelligan, BPhysio; Fiona Dobson, BAppSci(Physio), PhD; Christine Rini, PhD; Francis Keefe, BA, MS, PhD; Jessica Kasza, BSc(Hons), PhD; Simon French, BAppSc(Chiro), MPH, PhD; Christina Bryant, MA(Clin Psych), PhD; Andrew Dalwood, BAppSci(Physio), GradDipManipTherapy; J. Haxby Abbott, PhD, DPT; Rana S. Hinman, BPhysio(Hons), PhD
Annals of Internal Medicine
Original Article

Tablet-based strength-balance training to motivate and improve adherence to exercise in independently living older people: part 2 of a phase II preclinical exploratory trial.

A tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program. Social or individual motivation strategies were equally effective. The most prominent differences were observed between active and inactive participants. These findings suggest that in older adults a tablet-based intervention enhances training compliance; hence, it is an effective way to improve gait.

van Het Reve E, Silveira P, Daniel F, Casati F, de Bruin ED.
1Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
Original Article

Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults.

Interventions such as supervised or individualised exercise therapy and self-management techniques may enhance exercise adherence. However, high-quality, randomised trials with long-term follow up that explicitly address adherence to exercises and physical activity are needed. A standard validated measure of exercise adherence should be used consistently in future studies.

Jordan JL1, Holden MA, Mason EE, Foster NE.
1Arthritis Research Campaign National Primary Care Centre Primary Care Sciences, Keele University, Keele, Staffordshire, UK, ST5 5BG.
Original Article

Effectiveness of a web-based physical activity intervention in patients with knee and/or hip osteoarthritis: randomized controlled trial.

Join2move (Web-based intervention) resulted in changes in the desired direction for several primary and secondary outcomes. Given the benefits and its self-help format, Join2move could be a component in the effort to enhance PA in sedentary patients with knee and/or hip OA.

Bossen D1, Veenhof C, Van Beek KE, Spreeuwenberg PM, Dekker J, De Bakker DH.
Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
Original Article

“Patients are likely to be more compliant if they are financially vested in their recovery”

In behavioral economics, the endowment effect (also known as divestiture aversion) is the hypothesis that people ascribe more value to things merely because they own them. This is illustrated by the fact that people will pay more to retain something they own than to obtain something owned by someone else—even when there is no cause for attachment, or even if the item was only obtained minutes ago.

Endowment effect
Original Article

Physiotherapy home exercise program for haemophiliacs.

A HEP can help to advance in physical fitness and coordination and may reduce bleeding tendency, but needs to be accomplished regularly. Patients are interested but the motivation to exercise at home is low. Disorders measured by motion analysis seem not to be sufficiently influenced by our surrogate training program.

Pierstorff K, Seuser A, Weinspach S, Laws HJ.
Klin Padiatr. 2011 May;223(3):189-92. Epub 2011 Apr 21.
Original Article

Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial.

Intensive preoperative training at home is feasible for frail elderly patients waiting for THA and produces relevant changes in functional health. A larger multicenter randomized controlled trial is in progress to investigate the (cost-)effectiveness of preoperative training.

Oosting E, Jans MP, Dronkers JJ, Naber RH, Dronkers-Landman CM, Appelman-de Vries SM, van Meeteren NL.
Arch Phys Med Rehabil. 2012 Apr;93(4):610-6. Epub 2012 Feb 24.
Original Article

Evaluation of patient compliance, quality of life impact and cost-effectiveness of a "test in-train out" exercise-based rehabilitation program for patients with intermittent claudication.

A Test-in/Train-out program provided favourable patient compliance, QoL impact and cost-effectiveness in patients with IC.

Malagoni AM, Vagnoni E, Felisatti M, Mandini S, Heidari M, Mascoli F, Basaglia N, Manfredini R, Zamboni P, Manfredini F.
Circ J. 2011;75(9):2128-34. Epub 2011 Jun 28.
Original Article

Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.

Based on this evidence, the supplementation of a home-based exercise programme with an 8-week class-based exercise programme can be confidently expected to produce small improvements in locomotor function and clinically important reductions in pain. It is recommended that future research investigates methods of increasing compliance with home exercise programmes and evaluates the impact of these interventions in the primary care setting, where most patients with knee osteoarthritis are managed.

McCarthy CJ, Mills PM, Pullen R, Richardson G, Hawkins N, Roberts CR, Silman AJ, Oldham JA.
Health Technol Assess. 2004 Nov;8(46):iii-iv, 1-61.
Original Article

Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.

Based on this evidence, the supplementation of a home-based exercise programme with an 8-week class-based exercise programme can be confidently expected to produce small improvements in locomotor function and clinically important reductions in pain. It is recommended that future research investigates methods of increasing compliance with home exercise programmes and evaluates the impact of these interventions in the primary care setting, where most patients with knee osteoarthritis are managed.

McCarthy CJ, Mills PM, Pullen R, Richardson G, Hawkins N, Roberts CR, Silman AJ, Oldham JA.
Health Technol Assess. 2004 Nov;8(46):iii-iv, 1-61.
Original Article

The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review.

From this review, the alliance between therapist and patient appears to have a positive effect on treatment outcome in physical rehabilitation settings; however, more research is needed to determine the strength of this association.

Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML.
Phys Ther. 2010 Aug;90(8):1099-110. Epub 2010 Jun 24.
Original Article

Patients' satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists' satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial.

As patient satisfaction is important in maintaining motivation and treatment compliance and the satisfaction of healthcare professionals must be high in order for new treatments to become mainstream in clinics, the results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.

Tousignant M, Boissy P, Moffet H, Corriveau H, Cabana F, Marquis F, Simard J.
Telemed J E Health. 2011 Jun;17(5):376-82. Epub 2011 Apr 14.
Original Article

A randomized controlled trial of home telerehabilitation for post-knee arthroplasty.

Home telerehabilitation is at least as effective as usual care, and has the potential to increase access to therapy in areas with high speed Internet services.

Tousignant M, Moffet H, Boissy P, Corriveau H, Cabana F, Marquis F.
J Telemed Telecare. 2011;17(4):195-8. Epub 2011 Mar 11.
Original Article

Knee stiffness following anterior cruciate ligament reconstruction: the incidence and associated factors of knee stiffness following anterior cruciate ligament reconstruction.

We reviewed 100 patients retrospectively following primary ACL reconstruction with quadruple hamstring autografts to evaluate the incidence and factors associated with postoperative stiffness. Stiffness was defined as any loss of motion using the contra-lateral leg as a control. The median delay between injury and operation was 15 months. The incidence of stiffness was 12% at 6 months post-reconstruction. Both incomplete attendance at physiotherapy (p<0.005) and previous knee surgery (p<0.005) were the strongest predictors of the stiffness....

Robertson GA, Coleman SG, Keating JF.
Knee. 2009 Aug;16(4):245-7. Epub 2009 Jan 31.
Original Article

Effects of a home program on strength, walking speed, and function after total hip replacement.

The designed home program was effective in improving hip muscle strength, walking speed, and function in patients after THR who practiced the program at least 3 times a week, but adherence to this home program may be a problem.

Jan MH, Hung JY, Lin JC, Wang SF, Liu TK, Tang PF.
J Orthop Surg Res. 2010 Mar 22;5:20.
Original Article

Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial.

A combination of manual physical therapy and supervised exercise yields functional benefits for patients with osteoarthritis of the knee and may delay or prevent the need for surgical intervention.

Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC.
Ann Intern Med. 2000 Feb 1;132(3):173-81.
Original Article

Does commitment to rehabilitation influence clinical outcome of total hip resurfacing arthroplasty?

Patients who were more committed to their therapy after hip resurfacing returned to higher levels of functionality and were more satisfied following their surgery.

Marker DR, Seyler TM, Bhave A, Zywiel MG, Mont MA.
J Orthop Surg Res. 2010 Mar 22;5:20.
Original Article

Videotape instruction versus illustrations for influencing quality of performance, motivation, and confidence to perform simple and complex exercises in healthy subjects.

The findings suggested dynamic modeling via videotape was more effective than static illustrations for promoting correct form for the exercises. In addition, videotape modeling was indicated as more appropriate for encouraging confidence and motivation in an unsupervised exercise environment, such as a home exercise program.

Roddey et. al.
Physiotherapy Theory and Practice, Volume 18, Number 2, 1 June 2002 , pp. 65-73(9).
Original Article

Effects of live, videotaped, or written instruction on learning an upper-extremity exercise program.

Live and videotaped modeling are more effective than a handout alone for achieving performance accuracy of a basic exercise program, as measured by immediate and delayed retention tests.

Reo JA, Mercer VS.
Physical Therapy 2004; 84:622-33.
Original Article

Effect of a Home-Based Exercise Program on Functional Recovery Following Rehabilitation After Hip Fracture.

Among patients who had completed standard rehabilitation after hip fracture, the use of a home exercise program that included exercises such as standing from a chair or climbing a step resulted in improved physical function, according to a study. More than 250,000 people in the United States fracture their hip each year, with many experiencing severe long-term consequences. Many of these patients are no longer able to independently complete basic functional tasks that they could perform prior to the fracture, such as walking 1 block or climbing 5 steps 2 years after a fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. This new study addresses this type of cost-effective program.

Nancy K. Latham, Bette Ann Harris, et al.
JAMA, 2014; 311 (7): 700 DOI: 10.1001/jama.2014.469
Original Article

Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence

Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting.

Corinne L. Coulter, Jennie M. Scarvell, Teresa M. Neeman, Paul N. Smith
Australian Physiotherapy Association
Original Article

Physical therapy instructional video may be as good as an in-person visit for shoulder rehabilitation exercises

A rehab video may get the same results as an in-person visit for shoulder rehabilitation exercises, a new study suggests. "These results are significant for two reasons," said the lead researcher. First, having an additional tool to augment what the patient learns at an initial physical therapy visit may help with exercise accuracy and hopefully therefore improve outcomes. Additionally as access to physical therapy becomes more limited due either to cost or insurance, identifying new tools to better help out patients will be essential.

David J. Berkoff, sports medicine physician and associate professor of orthopaedics at the University of North Carolina, Chapel Hill (USA)
American Medical Society for Sports Medicine
Original Article

Benefits of a home-based physical exercise program in elderly subjects with type 2 diabetes mellitus

A home-based physical exercise program improves quality of life, glycemic control, and weight in type 2 diabetic patients older than 60 years.

Ferrer-García JC1, Sánchez López P, Pablos-Abella C, Albalat-Galera R, Elvira-Macagno L, Sánchez-Juan C, Pablos-Monzó A.
Endocrinol Nutrition
Original Article

Exercise in combination with education is likely to prevent the risk of lower back pain

The results of this systematic review and meta-analysis of RCTs indicate that exercise in combination with education is likely to reduce the risk of LBP and that exercise alone may reduce the risk of an episode of LBP and sick leave due to LBP, at least for the short-term. The available evidence suggests that educa- tion alone, back belts, shoe insoles, and ergonomics do not pre- vent LBP. It is uncertain whether education, training, or ergo- nomic adjustments prevent sick leave due to LBP because the quality of evidence is very low.

Daniel Steffens, PhD; Chris G. Maher, PhD; Leani S. M. Pereira, PhD; Matthew L Stevens, MScMed (Clin Epi); Vinicius C. Oliveira, PhD; Meredith Chapple, BPhty; Luci F. Teixeira-Salmela, PhD; Mark J. Hancock, PhD
Prevention of Low Back Pain. A Systematic Review and Meta-analysis
Original Article