Vol. 2, Issue 2, Part A (2025)

Background: Knee osteoarthritis is a leading cause of chronic pain and disability worldwide. Exercise- and education-based physiotherapy are cornerstones of non-surgical management, but access to in-person services is often limited. Tele-physiotherapy has emerged as a promising alternative, yet robust non-inferiority evidence directly comparing online versus in-person delivery for chronic knee osteoarthritis remains limited.

Objectives: To determine whether an online, synchronous tele-physiotherapy programme is non-inferior to conventional in-person physiotherapy for reducing pain and improving functional outcomes in adults with chronic knee osteoarthritis.

Methods: In this multi-centre, parallel-group, randomized non-inferiority trial, 220 adults (45-80 years) with radiographically confirmed knee osteoarthritis (Kellgren-Lawrence grade II-III) and chronic knee pain were randomly allocated (1:1) to tele-physiotherapy or in-person physiotherapy. Both groups received an identical 8-week, once-weekly supervised protocol of progressive strengthening, neuromuscular and functional exercises, plus structured education and a home-exercise programme. Primary outcomes were knee pain (11-point numerical rating scale, NRS) and physical function (WOMAC function subscale) at 8 weeks. Non-inferiority margins were 1.0 NRS point and 8 WOMAC function points. Secondary outcomes included WOMAC total score, performance-based tests (30-second chair-stand, 40-m fast-paced walk), health-related quality of life, and patient global rating. Analyses were conducted using linear mixed-effects models under an intention-to-treat framework.

Results: Both groups showed clinically and statistically significant improvements at 8 weeks, maintained at 24 weeks. Mean NRS pain decreased by 3.5 points in the tele-physiotherapy group and 3.7 points in the in-person group; mean WOMAC function improved by 18.9 and 20.1 points, respectively. Adjusted between-group differences in change at 8 weeks (tele minus in-person) were 0.10 (95% CI −0.22 to 0.42) for NRS pain and 1.5 (95% CI −1.5 to 4.5) for WOMAC function, with upper confidence bounds below the non-inferiority margins. Secondary outcomes, responder rates, adherence, and satisfaction were similar between groups, and no serious intervention-related adverse events occurred.

Conclusion: Online tele-physiotherapy was non-inferior to conventional in-person physiotherapy for pain and functional outcomes in adults with chronic knee osteoarthritis. These findings support tele-physiotherapy as a safe, effective, and scalable option that can be integrated into routine knee osteoarthritis care pathways.