A randomised feasibility study to evaluate home-based personalised virtual reality physiotherapy rehabilitation compared to usual care in the treatment of pain for people with knee osteoarthritis

Knee osteoarthritis (OA) is a major public health problem causing chronic pain and impaired physical functioning. As there is no cure, treatments to alleviate symptoms and improve physical function are needed.

Physiotherapy is recommended by clinical guidelines for their ease of application, small number of potential adverse effects, and relatively low-costs. Physiotherapy is often prescribed involving exercise programs and giving advice/information on patients’ self-care. Physiotherapy sessions are limited by NHS staff availability and space in clinics.

Concerns exist how to improve and maintain patient self-efficacy and motivation to undertake physiotherapy beyond the care setting.

New innovative approaches are therefore required to increase motivation whilst coping with rapidly increasing demands for long-term condition management in the home.

This study addresses this urgent need to support self-management in physiotherapy based around an exercise prescription.

The success of self-management depends on adhering to physiotherapy programmes, timely provision of relevant information, feedback, and the ability to telecommunicate with a clinician.

We have therefore been working with a commercial partner on developing an affordable virtual reality (VR)-based home physiotherapy system using body-worn sensors.

This allows for rigorous real-time feedback and monitoring of patients’ home-based physiotherapy while also making it fun to complete the exercises.

While we know this system works in clinical settings, we do not know whether it would work with patients performing their prescribed physiotherapy programmes at home.

Before a large-scale study of VR-based exercise using affordable sensors technology can be conducted, feasibility and acceptability of the intervention within the home environment must first be established.

We therefore wish to undertake a feasibility study to assess if this treatment and research can be carried out and compared to a usual physiotherapy care.

Design of a larger trial to test if VR physiotherapy significantly reduces pain requires information that this feasibility study would provide.

Aspects of feasibility in this study includes the evaluation of recruitment rates and willingness of patients to be randomised and participate in a trial, together with acceptability and safety of the VR-based home physiotherapy system. We will compare the VR-based home physiotherapy intervention to usual physiotherapy care.

We plan to recruit 50 patients with knee OA from individuals referred to physiotherapy clinics in Cardiff and Vale University Health Board.

Equal numbers will be randomised to either use the VR-based home physiotherapy system or to receive usual physiotherapy for 12 weeks. Outcome measures will be obtained at baseline, then 12 and 24 weeks later.

Main outcome measures relating to key feasibility parameters will include numbers of eligible patients; availability for assessment; randomisation and treatment retention; and consent and availability for screening.

Measures of pain and function improvements will be assessed for their ability to distinguish between VR home physiotherapy and usual care.

Participants perspectives on this intervention and their self-efficacy will also be gathered at the end of the study, to help improve this treatment and to gather preliminary evidence of any patient benefit achieved through using this intervention so that its benefits can be tested in future research.