Digital intervention for degenerative meniscal injuries

Group 1 – Digital intervention: - Participants in this group will be provided with a digital exercise and education intervention. Participants will be asked to engage in the intervention 5 days per week for 12 weeks. The exercise and education intervention will be delivered using ‘Physitrack’ patient software. The Physitrack software is accessible for all participants with an internet connection and device (computer/laptop/tablet/smart phone). For the purpose of the study, Physitrack will be the portal used for all exercise, education and outcome measures. Participants will be provided with a login that gives them access to this software. The exercise program is layed out day-by-day and week-by-week with specific instructions, videos of all exercises and key exercise prescription variables included. The participants will be asked to tick off each exercise as they progress to allow the research team to monitor adherence to exercise using the features of the software. The education modules will be uploaded into the software and will be in both short video and written content. These modules are self-guided and can be completed at the particpants own pace. Physitrack has the ability to track completion of these modules for adherence feedback to the research team. Outcome measures when required to be completed are sent to the patient via Physitrack and an alert will be sent to them to be completed. The Physitrack software also has an active messenger service that will link the participant with the research team in the event they have any questions or concerns. Each participant will be provided with a 30-min telehealth introduction session conducted by a physiotherapist/member of the research team prior to commencement that will include an orientation to the Physitrack software and contact instructions for the research team in the event of any issues or concerns. In this session, no individual condition specific information will be provided. The intervention will include a home-based strength training program targeting key lower limb musculature 2 days per week and an aerobic exercise program of their choice on 3 days per week. It is anticipated that this exercise program will take 15-30 minutes per session to complete. Examples of lower limb strength-based exercises included sit-to-stand, seated knee extension, double leg bridges and single leg calf raises. Examples of suggested aerobic exercise include walking, riding a bicycle, exercise bike, rowing machine or swimming. Strength-based exercises are aimed to be of moderate intensity and will be measured using a 0-10 RPE scale. Specific participant instructions regarding this are included in the Physitrack software next to each exercise. In addition, each exercise has cues on how to increase or decrease difficulty to assist in meeting the RPE demands. Aerobic exercise intensity is not measured in this study as we are aiming to encourage any form of movement alongside our training program. In addition, participants will be required to complete patient reported outcome measures at baseline, 12 weeks, and 24 weeks. It is anticipated that the participant commitment at each follow-up point will be approximately 15-20 minutes. Group 2 - Digital intervention + one-off face to face assessment: - These participants will attend a one-hour face to face assessment session involving detailed clinical assessment of the knee with a senior clinician physiotherapist with 11-28 years experience. In the face to face session patients will be provided with a detailed clinical assessment of their knee, discussion regarding any relevant imaging, education regarding their clinical presentation, surgical vs non-surgical options and the role of education/exercise/lifestyle change in the management of degenerative meniscal injuries. This session will be completed within 2-weeks of commencing the digital-based intervention outlined above. The outcome of the face to face session will not have any bearing on the digital intervention and they will continue to complete the standardised intervention. The purpose of this session is to determine if adding a face to face assessment and reassurance adds an effect above and beyond the intervention outlined for group 1. Furthermore, each participant will be provided with a 30-min telehealth introduction session prior to commencement that will include an orientation to the Physitrack software and contact instructions for the research team in the event of any issues or concerns. In this session, no individual condition specific information will be provided. This will be followed by engagement in a digital exercise and education intervention 5 days weekly for 12 weeks delivered using Physitrack patient software per the same protocol as group 1.