Knee osteoarthritis (OA) is a chronic condition that causes knee joint pain and stiffness. Exercise is a key treatment for managing these symptoms, and physical therapy (PT) provides targeted exercises to improve function and reduce pain. 

Attending in-person PT can be challenging for patients because of high out-of-pocket costs, limited insurance coverage, and difficulties with transportation. These barriers can make it difficult for patients to access the consistent and timely care they need for their recovery. 

The good news is that physical therapy exercise routines can be continued effectively at home, allowing patients to maintain and even improve their progress after completing in-person sessions. Using at-home exercises can help reduce pain, manage OA more effectively, and improve your quality of life. 

In-Person vs. Internet-Based Physical Therapy

A notable study compared in-person physical therapy (PT) with an internet-based exercise training program (IBET) for knee OA and found that the IBET program is a similarly effective alternative to in-person PT. 

The study divided participants into three groups: one received PT, another used the IBET program, and a control group was placed on a waiting list. The goal was to see how effective PT and IBET were in managing knee OA compared to no immediate intervention. 

Features of the Internet-Based Program

  • Tailored exercises based on pain, function, and current activity levels 
  • Exercise progression recommendations based on serial measures of pain and function 
  • Videos to demonstrate proper exercise performance 
  • Automated reminders 
  • Progress tracking, including graphs of pain, function, and exercise over time 

Participation and Engagement

  • IBET Group: At the four-month follow-up, 80 percent of participants logged into the website, with an average of about 21 days. By the 12-month mark, 81 percent had logged in, averaging 41 days
  • PT Group: 94 percent attended at least one PT session, and more than half attended between six to eight sessions, averaging nearly six visits.
graphic PT in-person vs internet v2

Key Study Findings

The study compared the benefits of in-person physical therapy and internet-based physical therapy for knee OA.

In-Person Physical Therapy

  • Reported more physical activity instruction 
  • Performed better on physical ability tests 
  • Had higher satisfaction with sleep, fatigue, and overall life satisfaction 
  • Experienced less fatigue 
  • Had a higher overall rating of knee symptom improvement 

Internet-Based Physical Therapy

  • Reported a higher level of weekly stretching 
  • Showed more consistency with exercise 
  • Reported a higher level of symptom improvement in pain 

While the study didn’t find significant differences between the treatment groups and the control group, it highlights the importance of personalized care and consistent engagement with treatment plans. Speak with your health care provider to determine the best approach for managing your knee OA, considering your lifestyle and preferences. 

Using a Hybrid PT Model

Susan Nowell, DPT, finds that physical therapy exercises implemented at home complement in-person PT. As a physical therapist, she thinks of herself as a movement specialist, researcher, coach, and educator. The hybrid model she uses in her practice offers people in-person physical therapy to evaluate their needs and establish a plan of action. Then, with proper guidance on exercises, she can follow up with patients remotely. “We establish a plan of care, get people started, coach them, and guide them through exercises, but alongside that, we’re also doing remote check-ins with our strengthening program,” explains Dr. Nowell. 

After being discharged from in-person physical therapy, Dr. Nowell’s patients still check in remotely at three months, six months, and a year down the road. “We really consider those wellness checks,” she says. “This study reflects what we’re finding in practice that works very well — a wellness, holistic approach utilizing both in-person and web-based care.” 

Using a hybrid model combines the benefits of a professional evaluation and a customized care plan from a physical therapist with the flexibility and ongoing support of telehealth. This approach can enhance recovery outcomes and potentially reduce overall treatment costs. “It depends on the type of patient who’s going to benefit the most from telehealth versus in-person physical therapy,” explains Dr. Nowell. “If the patient really needs hands-on muscle facilitation, or I need to gauge how well they’re activating a muscle, I can’t see what they’re doing functionally through video only, so I would want to see somebody in person. Or if they need some hands-on traction, mobilizations, and manual therapy, then I would prefer to see them in person.”

Tips for Continuing PT at Home

While there is no substitute for in-person PT, Dr. Nowell shares that there is a place for home-based therapy. “Once they get to a place where we’ve set up an exercise program or they’re not in as much pain, then I absolutely think telehealth and video-based or remote-based care is beneficial for guiding somebody forward with exercises,” she explains. Here she shares a few tips to help make it work for you. 

  • Be consistent: Regular engagement with any treatment is crucial. If you opt for an online program, set a routine to follow it consistently. 
  • Use a tailored treatment plan: Working closely with a physical therapist to adjust exercises based on your progress and challenges can enhance the benefits. 
  • Create a routine: Incorporating regular stretching and aerobic activities into your daily routine can help manage OA symptoms. Even small, consistent changes in your physical activity can make a difference. 
  • Remember to stretch: Stretching helps maintain flexibility and reduce muscle tension around the joints, reducing stiffness and increasing your range of motion. 
  • Do low-impact exercises: Walking can help improve cardiovascular health, manage weight, and reduce joint pain. Aim for at least 20-30 minutes of walking at a moderate pace most days of the week. Use supportive shoes and walk on even surfaces to minimize joint strain. 
  • Use strengthening exercises: Strengthening the muscles around your joints helps support and protect them, reducing pain and improving function. Exercises such as leg extensions and squats can be helpful components of your routine. 
  • Ask your doctor about wearing a brace: A knee brace can be worn during physical activity to support your knee by offloading pressure, making it easier to move around. 
  • Listen to your body: If an exercise causes pain (beyond normal discomfort), stop and consult your health care provider. 
  • Stay hydrated: Drink plenty of water before, during, and after exercising. 
  • Seek guidance: If you’re unsure how to perform an exercise, ask your physical therapist for a demonstration or look for reputable online resources. 
  • Stay informed and motivated: Finding motivation and staying informed about your treatment options can help you stay on track. Support from your health care team, family, friends, or OA support groups can be beneficial. 

Remember, managing OA is a journey, and finding what works best for you might take time. Stay proactive, seek support, and keep moving forward towards better joint health. 

Be a More Proactive Patient with PatientSpot

PatientSpot (formerly ArthritisPower) is a patient-led, patient-centered research registry for people living with chronic conditions. You can participate in voluntary research studies about your health conditions and use the app to track your symptoms, disease activity, and medications — and share with your doctor. Learn more and sign up here.

Allen KD, et al. Physical therapy vs internet-based exercise training for patients with knee osteoarthritis: results of a randomized controlled trial. Osteoarthritis Cartilage. March 2018. doi: 

Interview with Susan Nowell, DPT.

  • Was This Helpful?