Most clinics now run a mix of video and in-person appointments, and the question has moved on from "does telehealth work" to "for which patients, which visits, and which tasks". The trial evidence of the last few years answers the first question well and gives useful guidance on the rest.
The PEAK trial
The strongest single study is the PEAK trial, published in The Lancet in 2024. It enrolled 394 adults with chronic knee pain consistent with osteoarthritis across 27 Australian primary care clinics, treated by 15 physiotherapists. Participants were randomised to five consultations over three months, either in person or by video, covering strengthening, physical activity, and education. At three months both groups improved. The between-group difference was 0.16 points on a 0 to 10 pain scale and 1.65 points on the 0 to 68 WOMAC function scale, inside the non-inferiority margin, and the result held at nine months.
The secondary outcomes are the part worth noting. The video group had better attendance, rated the sessions more convenient, reported higher adherence to strengthening exercise at three months, and rated the therapeutic alliance with their physiotherapist higher. Adverse events were similar and none were serious. The limits are real too: nobody was blinded, cost-effectiveness was not assessed, and it is one condition treated with exercise-based care.
The wider meta-analyses
A 2023 systematic review in Physical Therapy Reviews pooled five randomised trials with 402 participants: knee osteoarthritis, hip or knee osteoarthritis before joint replacement, and rehabilitation after total knee replacement. It found no significant difference in WOMAC pain between telehealth and face-to-face care immediately after the intervention or at two months, and comparable function, quality of life, and satisfaction. The authors describe the evidence as low quality and small. The honest summary is that for knee osteoarthritis and post-replacement rehab, video matches in-person care on measured outcomes, with far less certainty for other conditions.
Where in-person still earns its place
- Hands-on assessment: joint play, end-feel, neurological screening, and special tests that need your hands or a plinth.
- First visits for complex or uncertain presentations, where the differential matters and a screen hides too much.
- Manual therapy, where it is a planned part of care.
- Patients without a stable camera setup, a private space, or confidence with the technology.
- Safety: anyone with a falls risk exercising alone at home needs a different plan from someone with a partner in the room.
Where video wins
- Exercise progression check-ins, where the whole visit is watching movement and adjusting dose.
- Seeing the home environment: the actual chair, stairs, and floor space the patient uses.
- Attendance for people with travel, work, or caring barriers. PEAK's attendance advantage is the clearest evidence here.
- Short, frequent touchpoints instead of long, infrequent ones.
- Reviews between visits when monitoring data already exists, so the conversation starts from the record rather than from recall.
Designing a hybrid pathway
- Assess in person, progress by video, and re-assess in person at agreed milestones.
- Set the expectation at booking. Patients who know a visit will be on video prepare the space and the camera.
- Write exercise cues that work on camera. "Turn side-on so I can see the knee" is a different skill from standing beside someone.
- Keep a fallback. If the connection or the setup fails, a phone call plus the exercise log is better than a cancelled visit.
- Let the data decide the cadence. A patient whose log shows steady reps and falling pain can go longer between visits; one whose completion is slipping needs an earlier touchpoint.
How KineTrue fits
In KineTrue, appointments are booked as online or in person, and can recur weekly. Video sessions, patient messaging, and the exercise log live in one record, so a video check-in opens with the last two weeks of reps, holds, range of motion, and pain ratings already in view. For what that review looks like in practice, see what home session data changes about the next appointment.
A non-inferiority result means the approach was not worse on the measured outcomes in the population studied. PEAK studied chronic knee pain treated with exercise and education. It says nothing about acute injury, post-surgical wounds, or neurological rehabilitation, where the delivery decision rests on clinical judgement.