Journal Of Physiotherapy[JOURNAL]

Hayes AJ, Withers HG, Glinsky JV … +20 more , Chu J, Jennings MD, Starkey I, Parmeter R, Boulos M, Cruwys JJ, Duong K, Jordan I, Wong D, Trang S, Duong M, Liu H, Lambert TE, Zadro JR, Sherrington C, Maher C, Lucas BR, Taylor D, Ferreira ML, Harvey LA

J Physiother · 2025 Jul · PMID 40579312 · Publisher ↗

QUESTIONS: Is remotely delivered physiotherapy cost saving when compared with usual face-to-face physiotherapy as typically provided in a public hospital outpatient setting? Is remotely delivered physiotherapy cost-effec... QUESTIONS: Is remotely delivered physiotherapy cost saving when compared with usual face-to-face physiotherapy as typically provided in a public hospital outpatient setting? Is remotely delivered physiotherapy cost-effective? DESIGN: Economic evaluation embedded within a randomised controlled, non-inferiority trial using a health system plus patient perspective. PARTICIPANTS: Patients with musculoskeletal conditions presenting to Sydney public hospitals for physiotherapy treatment. INTERVENTION: REFORM was a randomised controlled trial comparing remotely delivered physiotherapy with usual care provided in an outpatient setting. Remotely delivered physiotherapy involved one face-to-face physiotherapy session in conjunction with text messages, phone calls and an individualised exercise program delivered through an 'App'. OUTCOME MEASURES: The economic evaluation included the Patient Specific Functional Scale at 6 weeks in the cost-minimisation and cost-effectiveness analyses, and quality-adjusted life years (QALYs) at 26 weeks in the cost-utility analysis. Health system and patient resource use were derived from patient self-report. RESULTS: Costs per participant over 6 weeks were AUD $742 for remotely delivered physiotherapy and $910 for face-to-face physiotherapy, with a mean cost difference of -$168 (95% CI -$339 to $1). There was a 98% probability of remotely delivered physiotherapy being cost saving within the non-inferiority margin of the Patient Specific Functional Scale, and an 88% probability of being dominant to face-to-face physiotherapy (less costly and more effective). There was a 51% probability of being cost-effective at a nominal $50,000/QALY threshold. CONCLUSION: Moving people with musculoskeletal conditions to a remote model of physiotherapy care is potentially cost saving for health systems and patients, without compromising health outcomes when compared with currently provided public hospital care. TRIAL REGISTRATION: ACTRN12619000065190.

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Non-specific diagnostic labels for musculoskeletal conditions foster positive views about prognosis and non-invasive management but require clear explanation: a systematic review.

Martin S, Smith M, Wilson DA … +3 more , Zadro JR, Ferreira GE, O'Keeffe M

J Physiother · 2025 Jul · PMID 40579311 · Publisher ↗

QUESTIONS: What are patient and public perceptions of diagnostic labels for musculoskeletal pain? How do these labels influence beliefs, emotions and treatment preferences? DESIGN: Systematic review and qualitative meta-... QUESTIONS: What are patient and public perceptions of diagnostic labels for musculoskeletal pain? How do these labels influence beliefs, emotions and treatment preferences? DESIGN: Systematic review and qualitative meta-synthesis. PARTICIPANTS: People with musculoskeletal pain or people presented with hypothetical vignettes of musculoskeletal pain. INTERVENTION: Diagnostic labels for musculoskeletal pain. OUTCOME MEASURES: Patient/public perceptions of diagnostic labels for musculoskeletal pain and the influence of these labels on beliefs, emotions and treatment preferences. RESULTS: Four major themes emerged. First, patients strongly valued diagnoses to validate their pain and guide treatment. Second, poor diagnostic explanations and use of medical jargon led to patient frustration and confusion. Third, specific diagnostic labels were validating but promoted fear and a biomedical view of pain, whereas non-specific labels were associated with less fear but higher confusion. Fourth, non-specific labels led to more positive views towards prognosis and non-invasive management but led some patients to believe that further investigations were needed. CONCLUSION: Patients have a strong desire for a diagnosis and may prefer specific diagnostic labels, but these can lead to patient harm. Non-specific labels, while less threatening, require clear explanations to avoid confusion. REGISTRATION: CRD42024592437.

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Recent highlights and uncertainties in exercise management of knee osteoarthritis.

Haber T, Lawford BJ, Bennell K … +3 more , Holden M, White DK, Hinman RS

J Physiother · 2025 Jul · PMID 40579310 · Publisher ↗

INTRODUCTION: This narrative review outlines recent research highlights and uncertainties in the exercise management of knee osteoarthritis (OA) published between January 2020 and February 2025. METHODS: To identify stud... INTRODUCTION: This narrative review outlines recent research highlights and uncertainties in the exercise management of knee osteoarthritis (OA) published between January 2020 and February 2025. METHODS: To identify studies for inclusion, these electronic databases were searched: Medline, CINAHL Plus, Cochrane Central Trial Register of Controlled Trials and Cochrane Database of Systematic Reviews. Search results were screened and article selection was discussed among the entire research team. Studies that were deemed to be of significant clinical importance, particularly high-quality and/or controversial were selected for inclusion. Study findings were summarised according to overarching themes and future research directions were suggested for each thematic area. FINDINGS: This review highlighted six themes formulated as questions: Is exercise as effective as previously thought? How does exercise work and who might benefit the most? Is there an optimal exercise dose and type? Can patient adherence be improved - and does it matter? Do patients need to be seen in person to deliver exercise? How does communication about osteoarthritis influence patient beliefs about exercise? There were several key findings related to these themes. First, there was reduced certainty in the effectiveness of exercise for knee OA. Additionally, the mechanisms by which exercise improves clinical outcomes are largely unknown and it is unclear which individuals benefit the most from exercise. Research has failed to demonstrate a dose-response relationship between exercise and clinical outcomes and improving patient adherence to exercise may not lead to improved clinical outcomes. Nonetheless, exercise therapy can be effectively delivered remotely via a variety of methods. Communicating about OA using an impairment-based approach has been causally linked to negative beliefs about exercise.

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