Telerehabilitation for Knee Osteoarthritis: Study Protocol

Osteoarthritis (OA) of the knee is a chronic degenerative disease that affects the articular cartilage, causing pain, reduced mobility and reduced quality of life. Early detection and appropriate treatment are key to reducing symptoms and slowing disease progression. This study aims to evaluate the effectiveness of therapeutic interventions in patients with knee OA treated at the Artros Medical Centre.

Patients diagnosed with OA of the knee who visit the Artros Medical Centre for a consultation with an orthopaedic specialist will be included in the study. After the visit, they will undergo a radiological examination, based on which the orthopaedic surgeon will assess the severity of the disease. The specialist will then refer suitable patients to a physiotherapist who will further assess them and assign them to a telerehabilitation group (TR) or a control group (TS). The physiotherapist will provide verbal and written explanations of the study procedures to the patients.

Written informed consent will be required from each participant to participate in the study.

After inclusion in the study, the physiotherapist will collect baseline data on the patients, including the following measures:

• Sociodemographic characteristics: age, gender, education, employment status.
• Anthropometric measurements: height (cm), weight (kg), body mass index (BMI) (kg/m²).
• Assessment of knee joint mobility: measurement of range of movement with a goniometer.
• Pain intensity: Use the Numerical Rating Scale (NRS) to measure subjective pain.

Assessment of physical function, stiffness, and pain: The validated Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire is used.

• Physical activity assessment: performed using the International Physical Activity Questionnaire (IPAQ).
• Assessment of health-related quality of life: administered by the 12-item Short Form Health Survey (SF-12).
• Osteoarthritis severity classification: based on knee radiographs (≤ 4 months old) and will be performed according to the Kellgren-Lawrence classification system.

Patients will be randomly assigned to one of two groups:

• telerehabilitation group (TR): They will be enrolled in a tailored physiotherapy programme, including individually tailored exercises to strengthen, stretch, and improve the functionality of the knee joint.
• control group (CG): patients will continue with standard care without additional therapeutic interventions.

Patient measurements and assessments will be carried out at the start of the study and at specific time points (after 12 weeks). All data will be recorded and analysed to identify changes in pain, mobility, functionality, and quality of life.

Statistical analysis Data will be analysed using appropriate statistical methods (e.g., t-test, ANOVA, regression analysis). The main outcome parameters will be changes in WOMAC, NRS, IPAQ, and SF-12, where the statistical significance and clinical relevance of differences between groups will be assessed.

The Declaration of Helsinki will conduct the study, which will be subject to ethics committee approval. Before participation, all participants will be informed in detail about the nature of the study and the potential risks and benefits, and their inclusion will be voluntary.

This study will provide valuable data on the effectiveness of therapeutic interventions in patients with knee OA and will contribute to a better understanding of optimal approaches to treating this disease.

Inclusion criteria

• Patients with symptomatic OA of the knee joint, graded 1-3 on the Kellgren-Lawrence scale
• Patients older than 50 years
• Patients with access to and proficiency in using a computer,
• Patients with the capability to follow the exercises outlined.

Exclusion criteria

• Grade 4 cartilage defect (cartilage defect up to the subchondral bone), for which surgical treatment is professionally indicated,
• Planned arthroplasty of the knee joint within the next 6 months,
• Patients who have had a previous TEP arthroplasty or partial knee arthroplasty (hereafter PEP),
• Patients with a history of trauma or surgical treatment of the knee joint (osteotomy or treatment of cartilage lesions) in the last 6 months,
• Patients who have received an intra-articular injection in the knee joint in the last 3 months,
• Patients who have systemic inflammatory arthritis (e.g. rheumatoid arthritis or gout) or those who have concomitant medical conditions that prevent participation in exercise,
• Patients who have cognitive impairments or are wheelchair users,
• Who has co-morbidities,
• Those who do not have access to a computer have limited language skills that prevent the correct use of tele-rehabilitation or
• Those who are involved in similar study.