Telerehabilitation compared with unsupervised home exercise for knee osteoarthritis: study protocol for a single-centre, parallel-group randomised controlled trial

Abstract

Knee osteoarthritis (OA) is one of the leading causes of disability worldwide, with increasing prevalence and high societal and economic burden. Exercise-based rehabilitation is recommended as first-line management, yet adherence to unsupervised home exercise is often low. Telerehabilitation has the potential to improve access, adherence, and clinical outcomes; however, high-quality randomized controlled trials (RCTs) directly comparing structured telerehabilitation with unsupervised exercise remain scarce. This study is a single-centre, parallel-group randomised controlled trial designed to evaluate the effectiveness of a 3-month telerehabilitation programme compared with unsupervised home-based exercise in patients with knee OA. A total of 120 patients with radiographically confirmed knee OA (Kellgren-Lawrence grade 1–3) will be randomised in a 1:1 ratio to either the telerehabilitation (TR) group or the control (CG) group. Both groups will follow the same standardised exercise protocol, consisting of strengthening, mobility, and balance exercises performed three times per week. The TR group will additionally receive weekly remote supervision via phone or video consultations, supplemented with electronic reminders and motivational support. The primary outcome is improvement in knee function, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes include pain intensity (NRS - Numerical Rating Scale), knee joint mobility (goniometer), physical activity level (International Physical Activity Questionnaire, IPAQ), health-related quality of life (SF-12), exercise adherence, and patient satisfaction. Assessments will be conducted at baseline and after 3 months. Statistical analyses will include independent and paired t -tests as well as multiple linear regression to explore predictors of patient satisfaction. This trial will provide high-quality evidence regarding the effectiveness, feasibility, and patient-centred benefits of telerehabilitation compared with unsupervised exercise in knee OA. The findings will inform clinical decision-making, contribute to the optimisation of rehabilitation protocols, and support the integration of digital health solutions into standard OA care. ClinicalTrials.gov NCT07137897. Registered on 26 August 2025. Unique Protocol IdL7-50184. Protocol version dated 26 August 2025.