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Table 1 Outline of the main components of each of the five consultations with the physiotherapist

From: Technology versus tradition: a non-inferiority trial comparing video to face-to-face consultations with a physiotherapist for people with knee osteoarthritis. Protocol for the PEAK randomised controlled trial

  Initial consultation (45 mins)- WEEK 1 Consultation 2 (30 mins)- WEEK 2 Consultation 3 (30 mins)- WEEK 4 Consultation 4 (30 mins)- WEEK 7 Consultation 5 (30 mins)- WEEK 10
Assessment 15 mins 5 mins 5 mins 5 mins 5 mins
Introduction and setting expectations Checking in … . Checking in … . Checking in … . Checking in … .
Review pre-consultation survey- choose questions for future reassessment. - changes in knee pain - changes in knee pain - changes in knee pain - changes in knee pain
- how they have managed with strengthening exercises - how they have managed with overall program - how they have managed with overall program - how they have managed with overall program
Subjective information as relevant. - adverse events? - adverse events? - adverse events? - adverse events?
Functional observation: walking, squatting, sit to stand, single leg standing balance, anything else as relevant. - comments/questions arising from discussions last time. - comments/questions arising from discussions last time. - comments/questions arising from discussions last time. - comments/question s arising from discussions last time.
Reassess questions from pre-consultation survey. Reassess questions from pre-consultation survey.
Re-assess sit to stand and any other functional tasks as required.
Re-assess sit to stand and any other functional tasks as required.
Check progress with goals.
Education 10 mins     
Understanding OA.
Benefits of exercise/physical activity.
Strengthening exercises 15 mins 10 mins 10–15 min 10–15 min 15 mins
Choose a program of 3 exercises from booklet (1 quadriceps; 1 hip/gluteal; 1 hamstrings/gluteal) Review progress. Review progress. Review progress. Review progress.
Check adherence in Log Book. Check adherence in Log Book. Check adherence in Log Book. Check adherence in Log Book.
- Congratulate adherence. - Congratulate adherence. - Congratulate adherence. - Congratulate adherence.
Prescribe variation (if necessary) and dosage. - Discuss reasons for non-adherence & troubleshoot. - Discuss reasons for non-adherence & troubleshoot. - Discuss reasons for non-adherence & troubleshoot. - Discuss reasons for non-adherence & troubleshoot.
Watch patient perform one set of each exercise & ensure they are working at hard to very hard level.
Review current exercises & modify/progress as required & add 2–3 more to program (max 6 in total; 2 quadriceps; 1 hip/gluteal; 1 hamstrings/gluteal; 1 calf; 1 optional extra). Review current exercises & modify/progress as required. Review current exercises & modify/progress as required. Review current exercises & modify/progress as required.
Discuss exercising with pain/flare-ups. Watch patient perform one set of any new exercises & ensure they are working hard to very hard. Watch patient perform one set of any new exercises & ensure they are working hard to very hard. Watch patient perform one set of any new exercises & ensure they are working hard to very hard.
Instruct use of Log Book.
Check patient knows how to change/progress their program over the next 6 months.
Watch patient perform one set of each new exercise & ensure they are working hard to very hard).
Advise patient to continue exercise program for next 6 months.
Education   5 mins    
Physical activity.
Activity pacing.
Physical activity 5 mins 10 mins 5–10 min 5–10 min 5 mins
Check patient has activity tracker set up and can use it. Review daily step count recorded in Log Book. Review daily step count recorded in Log Book. Review daily step count recorded in Log Book. Review daily step count recorded in Log Book.
Instruct patient to wear activity tracker every day for next week and record daily steps as a baseline for developing a daily step goal at the next visit. Set daily step goal (may be maintain or increase from baseline). Review progress with physical activity plan. Review progress with physical activity plan. Review progress with physical activity plan.
- Congratulate adherence.
Agree on physical activity plan to achieve steps and/or increase/maintain intensity of activity. - Congratulate adherence. - Congratulate adherence. - Discuss reasons for non-adherence & troubleshoot.
- Discuss reasons for non-adherence & troubleshoot. - Discuss reasons for non-adherence & troubleshoot.
Set an ongoing physical activity plan that patient can manage in daily life (may/may not include step goals & use of activity tracker based on patient choice).
Instruct use of Log Book. Ask patient to identify potential barriers & plan strategies for overcoming them. Set daily step goal for coming weeks (may be to maintain or increase from previous weeks).
Agree on physical activity plan to achieve step goal and/or increase/maintain intensity of activity.
Set daily step goal for coming weeks (may be to maintain or increase from previous weeks).
Agree on physical activity plan to achieve step goal and/or increase/maintain intensity of activity.
Check patient knows how to change/progress their program as required.
Advise patient to continue physical activity for next 6 months.
Education    5 mins 5 mins 5 mins
Understanding & managing your pain. Weight loss for OA (relevant for all patients, even those of healthy body weight) Dealing with lapses & set-backs.
Encourage ongoing use of Log Book and activity tracker where possible.
Participant ‘homework’ Pre-reading: Pre-reading: Pre-reading: Pre-reading: Encourage reading of:
Physical activity. Barriers to exercise and physical activity. Weight loss for OA- if appropriate for the individual. Modifying your exercise program. Success stories.
Activity pacing. Understanding & managing pain. Dealing with lapses & set-backs.