Background/Purpose: Individuals who live in rural areas are more likely to experience knee osteoarthritis-related disability and less likely to be referred to physical therapy for osteoarthritis. Limited access to physical therapy due to lack of licensed professionals in the area and long distances from home to the nearest clinic may exacerbate the underutilization of physical therapy among rural residents with knee osteoarthritis. Increasing uptake of telerehabilitation may mitigate these challenges, but telerehabilitation can be challenging in rural areas due to lower availability of LTE wireless coverage and broadband internet service. In this study, we aimed to evaluate feasibility and future trial design parameters for a novel hybrid in-person + telerehabilitation program (RAPTOR) for rural residents with knee osteoarthritis.

Methods: The study was a single-arm pilot feasibility study with pre-post design. Twenty rural-dwelling adults with knee osteoarthritis were eligible to participate in the RAPTOR program, consisting of up to 10 visits with a physical therapist: two visits delivered in-person and eight visits delivered using a secure, HIPAA-compliant telehealth platform. Feasibility was defined as a combination of acceptability, demand, implementation, integration, and safety. Clinical outcomes entailed a combination of patient-reported (Knee Injury and Osteoarthritis Outcome Score, or KOOS) and performance-based (OARSI-OMERACT core set of performance-based measures) functional measures. Satisfaction with telerehabilitation was assessed using the Telehealth Usability Questionnaire. 

Results: RAPTOR was feasible and safe based on meeting recruitment and attendance targets and having no adverse events during the study, and participants reported high satisfaction with the telerehabilitation component of the program. Eighty-one percent (13/16) of participants who completed the RAPTOR program demonstrated clinically important improvement in patient-reported physical function, and more than half (7-10/14) demonstrated clinically important improvement on the various performance-based physical function tests.

Conclusion: A novel hybrid in-person + telerehabilitation program was safe and feasible. A high proportion demonstrated improvements in function. Participants expressed high degrees of satisfaction with telerehabilitation and minimal barriers to using the platform, supporting the use of telerehabilitation among rural-dwelling older adults. Further testing of this hybrid approach is needed in a comparative trial.

FIGURE 1. Study enrollment and attrition flow chart

TABLE 1. Feasibility outcomes assessed in RAPTOR pilot study

TABLE 2. Participant-reported and performance-based outcomes

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rural-access-to-physical-therapy-for-osteoarthritis-rehabilitation-raptor-a-pilot-feasibility-study/