Winner of the PEDro Prize, Hannah Withers (centre), is flanked by Mark Elkins (Co-director of PEDro) and Geraldine Wallbank (PEDro Project Officer).

The PEDro prize is awarded to the person who presents the best report of a randomised controlled trial at the World Physiotherapy Congress. The award recognises the achievements of researchers who conduct high quality, clinically important randomised controlled trials. To be eligible, the presentation must have been a primary report for a completed randomised controlled trial that evaluates the effects of a physiotherapy intervention.

Judging was carried out by a panel of international trialists. Scoring was based on quality (risk of bias, size, design and analysis of the trial) as well as significance (importance of the findings for clinical practice).

The winning trial is Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial. The lead author, Hannah Withers from Australia, answers some questions about the trial.

What question did you seek to answer with your randomised trial?
Our trial was a non-inferiority trial so the question is couched in terms of ‘as good or better’. The specific question was: “Is remotely delivered physiotherapy as good as or better than usual face-to-face physiotherapy for MSK conditions?”

Was there any existing research that already addressed this question?
There are no studies that have specifically examined this proposed model of care for patients with a variety of musculoskeletal conditions. The most comparable studies have either looked at different components of this model of care in isolation, or looked at a similar model of care in the African context.

What interventions did the trial compare?
One group received a remotely delivered physiotherapy program for 6 weeks that consisted of one face-to-face physiotherapy session in conjunction with weekly text messages, phone calls at 2 and 4 weeks, and an individualised home exercise program delivered through an app. The other group received usual face-to-face physiotherapy care in an outpatient setting.

What outcomes did the trial measure?
The primary outcome was the Patient Specific Functional Scale at 6 weeks with a pre-specified non-inferiority margin of –15 out of 100 points. Secondary outcomes included: the Patient Specific Functional Scale at 26 weeks; kinesiophobia, pain, function/disability, global impression of change and quality of life at 6 and 26 weeks; and satisfaction with service delivery at 6 weeks.

What did the study find?
The mean between-group difference for the Patient Specific Functional Scale at 6 weeks was 2.7 points (95% confidence interval –3.5 to 8.8) favouring remotely delivered physiotherapy. These results indicate that remotely delivered physiotherapy is as good as face-to-face physiotherapy because the lower end of the confidence interval is greater than the non-inferiority margin of –15 points.

The results at 26 weeks were similar with a mean between-group difference (95% CI) of –1.8 points (–9.3 to 5.6).
Whilst non-inferiority margins were not set for any of the secondary outcomes, the confidence intervals around the mean between-group differences ruled out clinically meaningful differences.

What do you think research in this area needs to address next?
Now that we know that remotely delivered physiotherapy is as good as usual care in an outpatient setting, we need to roll it out in a real-world setting. The REFORM intervention was also shown to be cost saving and cost effective so a study to test an implementation strategy which aims to increase access for people with musculoskeletal conditions, improve patients’ functional outcomes and increase physiotherapists’ confidence in delivering physiotherapy remotely will provide the evidence base to widely implement remotely delivered physiotherapy.

The trial results have recently been published and the published report has been indexed on PEDro.

Withers HG, Glinsky JV, Chu J, Jennings MD, Starkey I, Parmeter R, Boulos M, Cruwys JJ, Duong K, Jordan I, Wong D, Trang S, Duong M, Liu H, Hayes AJ, Lambert TE, Zadro JR, Sherrington C, Maher C, Lucas BR, Taylor D, Ferreira ML, Harvey LA (2024) Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial. Journal of Physiotherapy 70:124–133 https://doi.org/10.1016/j.jphys.2024.02.016